本文選題：內(nèi)耳內(nèi)淋巴顯像 + 梅尼埃病　； 參考：《山東大學(xué)》2010年碩士論文

【摘要】： 研究背景：梅尼埃病(Meniere's disease)是一種特發(fā)性內(nèi)耳病,表現(xiàn)為反復(fù)發(fā)作的旋轉(zhuǎn)性眩暈,波動性感音性聽力損失,耳鳴和耳脹滿感。梅尼埃病的基本病理改變?yōu)閮?nèi)耳膜迷路積水。由于無法對梅尼埃病患者進行活體病理檢查,現(xiàn)階段也無法通過檢查手段證實內(nèi)耳內(nèi)淋巴積水,所以目前梅尼埃病的臨床診斷主要依賴于典型癥狀,以及耳蝸電圖(electrocochleography, EcochG)、前庭誘發(fā)肌源性電位(vestibular evoked myogenic potential, VEMP)、甘油試驗和前庭功能檢查等輔助推測內(nèi)耳內(nèi)淋巴積水的存在,缺乏影像學(xué)的客觀診斷依據(jù)。特別是梅尼埃病的早期癥狀多不典型,難以與其他疾病進行鑒別,對梅尼埃病的早期診斷和治療造成困難。因此內(nèi)耳內(nèi)淋巴顯像對內(nèi)淋巴積水的診斷具有重要意義。目前國際上對內(nèi)耳內(nèi)淋巴顯像關(guān)注很多。近年來核磁增強造影劑的應(yīng)用,使得人體的內(nèi)耳內(nèi)淋巴間隙得以顯影。造影劑的給藥方法也實現(xiàn)了由全身給藥到局部給藥,由有創(chuàng)給藥方法到無創(chuàng)給藥方法的發(fā)展,但是目前尚缺乏關(guān)于正常內(nèi)耳內(nèi)淋巴顯像的研究。 目的：本研究旨在通過無創(chuàng)性給藥技術(shù),即經(jīng)咽鼓管中耳腔導(dǎo)入造影劑釓、行內(nèi)耳MRI掃描,以健康正常受試者為研究對象證明內(nèi)耳內(nèi)淋巴顯像的可行性及這種給藥方法的安全性。 方法：將28例正常受試者隨機分成A組14人、B組14人,采用經(jīng)咽鼓管置管中耳腔給藥的方法,在耳內(nèi)窺鏡監(jiān)視下A組給入稀釋的釓噴酸葡胺,B組給地塞米松、釓噴酸葡胺混合稀釋溶液,給藥24小時后行內(nèi)耳3D-FLAIR和2D-FLAIR MRI(3T核磁共振機)掃描。對A9志愿者分別在給藥8小時和24小時后行內(nèi)耳MRI掃描。給藥前對受試者進行純音測聽、聲阻抗測試、耳蝸電圖、VEMP檢查和耳部、鼻部檢查,給藥后1-2周、1個月時進行純音測聽和聲阻抗測試。 結(jié)果：1.給藥時,A組9例正常受試者、B組8例正常受試者耳內(nèi)窺鏡下可見鼓室內(nèi)液平面隨給藥進行而上升。 2.上述A組9例正常受試者、B組8例正常受試者內(nèi)耳3D-FLAIR和2D-FLAIR MRI掃描圖像可見耳蝸及前庭部外淋巴間隙增強顯影,中階和橢圓囊球囊呈暗性區(qū)域。編號A9的正常志愿者左耳給藥8小時和24小時后分別掃描,可見給藥24小時后較給藥8小時后造影劑彌散范圍更廣。全組正常受試者中,經(jīng)咽鼓管置管中耳腔造影劑導(dǎo)入行內(nèi)耳MRI掃描成功率(內(nèi)耳得到較強增強顯影)為61%,其中研究初期的18例受試者成功率為44%,后期10例受試者成功率為90%。 3.28例正常受試者咽鼓管內(nèi)置管時出現(xiàn)一過性刺痛,6例正常受試者給藥過程中出現(xiàn)一過性旋轉(zhuǎn)性眩暈,19例正常受試者出現(xiàn)耳脹悶感,6例正常受試者出現(xiàn)聽力下降,20例正常受試者給藥時出現(xiàn)流水樣耳鳴,1例正常受試者出現(xiàn)咳嗽。上述癥狀均在給藥結(jié)束后5分鐘內(nèi)消失。 4.給藥后1-2周,共隨訪到25例正常受試者,其中24例復(fù)查純音測聽和聲阻抗測試都在正常范圍,與受試前純音測聽結(jié)果相較未見明顯差異。B5正常受試者復(fù)查純音測聽聽力圖示氣、骨導(dǎo)差,但聲阻抗測試結(jié)果正常。給藥1月后,共隨訪到24例正常受試者,24例受試者復(fù)查純音測聽和聲阻抗測試都在正常范圍,與受試前純音測聽和聲阻抗測試結(jié)果相較未見明顯差異。其中包括B5受試者。 結(jié)論：經(jīng)咽鼓管置管中耳腔造影劑導(dǎo)入是一種安全、有效、可行、痛苦和副反應(yīng)較小的無創(chuàng)操作。經(jīng)咽鼓管置管中耳腔造影劑導(dǎo)入行內(nèi)耳MRI掃描能夠得到內(nèi)耳外淋巴間隙的增強顯影,通過對比可顯像內(nèi)耳內(nèi)淋巴間隙。造影劑隨時間由耳蝸起始部和前庭向耳蝸頂轉(zhuǎn)和半規(guī)管擴散。地塞米松對內(nèi)耳的顯影程度無明顯影響。本研究為進一步以內(nèi)淋巴積水為主要病理特征的一系列內(nèi)耳病的內(nèi)淋巴積水客觀診斷的研究奠定了必要的基礎(chǔ)。
[Abstract]:Background: Meniere's disease is a type of idiopathic internal ear disease, characterized by recurrent vertigo, recurrent hearing loss, tinnitus, and fullness of the ear. The basic pathological changes of Meniere's disease are intravastric labyrinthine hydrops. There is no current stage of biopsy for patients with Meniere's disease. The method of examination confirmed the inner ear lymphatic hydrops, so the clinical diagnosis of Meniere's disease mainly depends on the typical symptoms, electrocochleography (EcochG), the vestibular evoked myogenic potential (vestibular evoked myogenic potential, VEMP), the glycerol test and the vestibular function examination to conjecture the internal ear drenching. The existence of hydrocephalus is lack of an objective diagnostic basis for imaging. Especially, the early symptoms of Meniere's disease are mostly untypical. It is difficult to identify with other diseases and make it difficult for the early diagnosis and treatment of Meniere's disease. Therefore, internal ear lympho imaging is of great significance for the diagnosis of endolymphatic hydrops. The application of NMR contrast media in recent years has made the internal auditory space of the inner ear of the human body developed. The method of administration of the contrast agent has also realized the development of the local administration from the whole body to the local drug, from the invasive method to the noninvasive method, but there is still a lack of research on the normal inner ear lympho imaging.
Objective: the purpose of this study was to demonstrate the feasibility of internal auditory lympho imaging and the safety of this method by introducing the contrast agent gadolinium through the middle ear cavity of the eustachian tube through the noninvasive technique, that is, the MRI scan of the inner ear.
Methods: 28 normal subjects were randomly divided into group A 14 people, group B 14 people, using eustachian tube in the middle ear cavity administration method, under the ear endoscopy under the monitoring of A group to dilute gadolinium gadolinium acid meglumine, B group dexamethasone, gadolinium dexamethasone mixed dilution solution, after 24 hours, the internal ear 3D-FLAIR and 2D-FLAIR MRI (3T MRI) scan. The A9 volunteers were treated with MRI scan for 8 hours and 24 hours after administration. Before administration, the subjects were given pure tone audiometry, acoustic impedance test, cochlear electrogram, VEMP examination and ear, nasal examination, 1-2 weeks after administration and 1 months of pure tone audiometry and acoustic impedance test.
Results: 1. of the 9 normal subjects in group A and 8 normal subjects in group B, the fluid level in the tympanic cavity increased with drug administration.
2. of the 9 normal subjects in group A, 8 cases of normal subjects in group B showed enhanced imaging of the cochlea and the vestibule lymph space in the inner ear of the normal subjects. The middle and the oval sacs showed a dark area. The normal volunteers in the B group were given the left ear of the normal volunteers for 8 hours and 24 hours after 24 hours, and the drug was given 8 hours after the administration of the drug for 24 hours. In the whole group of normal subjects, the successful rate of MRI scan in the inner ear of the middle ear cavity through the eustachian tube catheterization was 61%. The success rate of the 18 subjects in the early study was 44%, and the success rate of the later 10 subjects was 90%..
3.28 cases of normal subjects had an excessive stabbing pain in the tube of eustachian tube, 6 normal subjects were given a sexual rotatory vertigo in the course of the administration, 19 normal subjects had ear distention, 6 normal subjects had hearing loss, 20 normal subjects were given the flow of water like tinnitus and 1 normal subjects had coughing. The symptoms disappeared within 5 minutes after the end of the administration.
4. after 1-2 weeks, a total of 25 normal subjects were followed up to 25 normal subjects, of which 24 cases of pure tone audiometry and acoustic impedance test were in normal range. There was no significant difference compared with the results of pure tone audiometry before the test..B5 normal subjects reviewed pure tone audiometry, bone conductance, but the results of acoustic impedance test were normal. After January, a total of 24 cases were followed up to 24 cases. In the subjects, 24 subjects were examined in the normal range of pure tone audiometry and acoustic impedance test. There was no significant difference compared with the results of pure tone audiometry and acoustic impedance test before the test, including B5 subjects.
Conclusion: the introduction of the middle ear cavity contrast agent through the eustachian tube is a safe, effective, feasible, noninvasive operation with less pain and side effects. The enhanced development of the inner ear lymphatic space can be obtained by MRI scan through the eustachian tube catheterization, and the internal auricular lymph space can be scintid by contrast. The contrast agent can be followed by the ear with the ear. The initial part of the cochlea and the vestibule to the cochlear apex and the semicircular canal diffused. Dexamethasone has no significant influence on the development of the inner ear. This study lays a necessary foundation for the objective diagnosis of endolymphatic hydrops in a series of internal ear diseases which are the main pathological features of the lymphatic water.

【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2010
【分類號】：R764.04

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