2型糖尿病早期肾脏损害与前庭及听力功能相关性研究

发布时间：2018-03-26 05:12

本文选题：2型糖尿病　切入点：听力损伤　出处：《山东大学》2017年硕士论文

【摘要】：研究背景及目的:糖尿病是常见的慢性内分泌代谢性疾病,可以合并心脑大血管及视网膜、肾脏、周围神经等微血管病变,而这些并发症会大大影响患者的生活质量。近年来,关于糖尿病和内耳的研究越来越多,已经有研究证明糖尿病病人比非糖尿病患者听力损害发生率明显增高。目前的研究发现,糖尿病造成的听力损伤典型表现为双耳渐进性的感音神经性听力减退,首先累及高频。但糖尿病性听力损伤的发病机制尚未完全明确,可能的机制为:外毛细胞的丧失,微血管壁增厚,螺旋神经节神经元萎缩和电解质紊乱等。一些证据表明,内耳和肾脏有相似性,尤其是在解剖结构及生理学上。通过电子显微镜下的观察,内耳的血管纹与肾脏的肾小球都是与微血管密切相关的上皮结构。糖尿病重要的微血管并发症有很多,而本研究旨在评估合并或不合并糖尿病肾病的糖尿病患者的前庭-听力功能损伤,探讨糖尿病患者临床指标与前庭-听力功能损伤的关系。方法:第1组即NC组(15男,15女,60只耳)为正常健康人,作为对照组。2型糖尿病患者60人,并根据尿白蛋白/肌酐比值(ACR)分为两组。第2组即DM组(15男,15女,60只耳)为糖尿病患者未合并糖尿病肾病,第3组即DN组(14男,16女,60只耳)为糖尿病患者合并糖尿病肾病。分别统计每个人的糖尿病病程、血压、BMI、腰围、C肽、胰岛素、肌酐、尿素氮、肾小球滤过率、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿酸、糖化血红蛋白、眼底照相、神经传导及颈动脉超声检查等。并分别检测三组受试者的纯音测听、耳声发射、视频眼震电图描记、冷热水试验及前庭诱发的肌源性电位。分别对三组受试者听力及前庭功能结果进行统计,并观察临床指标与内耳损伤的相关关系。所有数据均应用SPSS21.0统计软件进行分析。结果:1.临床指标观察结果由表1可知,两组糖尿病患者糖化血红蛋白、空腹血糖、收缩压、腰臀比、甘油三酯、总胆固醇、低密度脂蛋白、高密度脂蛋白、尿酸水平明显高于健康组(p0.05)。此外,DM组BMI、腰围及同型半胧氨酸水平上与NC组有明显统计学差异(p0.05)。DM组与DN组病程、同型半胱氨酸及胱抑素C水平有统计学差异(p0.05),肌酐、尿素氮、肾小球滤过率等无统计学差异(p0.05)。DM组中7名(23.33%)患者有眼底病变,8名(26.67%)患者有周围神经病变,12名(40%)病人有颈动脉超声异常。DN组中27名(90%)患者有眼底病变,23名(76.67%)患者有周围神经病变,27名(90%)患者有颈动脉超声异常。两组糖尿病患者有统计学差异(p0.05)2.纯音测听结果由图1可知,两组糖尿病患者左耳(500、1000、2000、4000、8000Hz)和右耳(500、1000、2000、4000、8000Hz)与 NC 组有统计学差异(p0.05),且DN组比DM组左耳250、8000Hz及右耳8000Hz处的听力损伤更严重(p0.05)。两耳无统计学差异(p0.05)。糖化血红蛋白、腰围、尿白蛋白/肌酐比值及肾小球滤过率与听力损伤有相关关系。3.耳声发射由图2可知,DN组患者在左耳(4kHz)和右耳(0.75、2、4kHz)处与NC组比较有统计学差异(p0.05)。DM组在右耳0.75kHz、4kHz处与NC组有统计学差异(p0.05)。两耳比较无差异(p0.05)。4.视频眼震电图描记和冷热水试验由表2可知,视频眼震电图描记结果三组均为正常。冷热水试验结果中,DM组中5人表现为前庭功能受损,DN组中9人表现为前庭功能受损。但两组无统计学差异(p0.05)。糖化血红蛋白及尿白蛋白/肌酐比值与前庭功能损伤有相关关系。5.前庭诱发的肌源性电位NC组2人(6.67%)右耳未引出振幅,1人(3.33%)左耳未引出振幅;DM组3人(10%)右耳未引出振幅,1人(3.33%)左耳未引出振幅,2人(6.67%)双耳均未引出振幅;DN组5人(16.67%)右耳未引出振幅,2人(6.67%)左耳未引出振幅,3人(10%)双耳均未引出振幅。由表3可知,两组糖尿病组左耳及右耳振幅与健康人比有统计学差异(p0.05),但DM组与DN组两耳振幅均无统计学差异(p0.05))。由表5、表6可知VEMPs振幅降低与糖尿病病程、糖化血红蛋白、低密度脂蛋白及糖尿病视网膜病变与前庭功能损伤有相关关系。结论:1.糖尿病患者比非糖尿病患者听力损伤发生率高,表现为双侧渐进性的感音神经性听力损伤,且以高频为主。合并糖尿病肾病患者与未合并糖尿病肾病患者相比,发生率高。2.听力损伤出现的较早,前庭损伤出现较晚。表明内耳损伤是一个逐渐进展的过程,有听力损害的患者容易出现前庭功能的损伤。3.糖化血红蛋白、腰围、尿微量白蛋白/肌酐比值及肾小球滤过率与听力损伤有相关关系,可以增加2型糖尿病患者听力损伤的风险。尿微量白蛋白/肌酐比值、糖尿病病程、糖化血红蛋白、低密度脂蛋白及糖尿病视网膜病变与前庭功能损伤有相关关系,可以增加2型糖尿病前庭功能损伤的风险。4.现在社会对糖尿病肾病警惕性高并能进行早期筛查,而对糖尿病听力损害及前庭功能损害警惕性低,出现微量蛋白尿时,提示糖尿病肾病病人可能已经有早期耳蜗-前庭功能损伤,为早期诊断提供可能,为进一步预防治疗提供依据,可以明显提高患者生活质量。
[Abstract]:Background and objective: diabetes mellitus is a common endocrine metabolic chronic disease, can be complicated with cardio vascular and retina, kidney, peripheral nerve microangiopathy, and these complications will greatly affect the quality of life of patients. In recent years, more and more research on diabetes and inner ear, has been demonstrated in diabetic patients than in nondiabetic patients the incidence of hearing impairment was obviously increased. The current study found that diabetes caused hearing loss showed bilateral progressive sensorineural hearing loss in high frequency. But first, the pathogenesis of diabetic hearing impairment has not been entirely clear, the possible mechanism for loss of outer hair cells, vascular wall thickening, spiral ganglion neurons atrophy and electrolyte disorder. Some evidence suggests that the inner ear and kidney are similar, especially in anatomy and physiology. Observed under the electron microscope, the inner ear vasculature and the kidney glomeruli are closely related with the micro vascular epithelial structure. There are a lot of important diabetic microvascular complications, and the purpose of this study was to evaluate with or without diabetes nephropathy in diabetic patients to vestibular dysfunction, and explore the relationship between clinical indexes and vestibular patients with diabetes hearing impairment. Methods: first groups: NC group (15 male, 15 female, 60 ears) for healthy people, patients with type.2 diabetes as a control group of 60 people, and according to urinary albumin / creatinine ratio (ACR) were divided into two groups. Second groups: DM group (15 male, 15 female, 60 ears) for diabetic patients without diabetes nephropathy, third group: DN group (14 male, 16 female, 60 ears) for diabetic patients with diabetic nephropathy. The duration of diabetes, the statistics of each were blood pressure, BMI, waist circumference, C peptide, insulin, serum creatinine, urea nitrogen, glomerular Filtration rate, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, glycosylated hemoglobin, uric acid, fundus photography, nerve conduction and carotid artery ultrasonography. And to detect three groups of subjects pure tone audiometry, acoustic emission, video electronystagmography, myogenic potential of cold and hot water test and vestibular evoked respectively. For the three groups of subjects of hearing and vestibular function results in statistics, and to observe the correlation between clinical indexes and inner ear damage. All data were analyzed using SPSS21.0. Results: 1.. Clinical observation index results table 1 shows, two groups of patients with diabetes mellitus HbA1c, fasting blood glucose, systolic blood pressure, waist hip ratio, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein and uric acid levels were significantly higher than the healthy group (P0.05). In addition, DM group, BMI, waist circumference and homocysteine level and NC group in Ming Dynasty Significant statistical difference (P0.05) of.DM group and DN group, the level of homocysteine and cystatin C had significant difference (P0.05), creatinine, urea nitrogen, there was no significant difference in glomerular filtration rate (P0.05) in the.DM group 7 (23.33%) patients with fundus lesions, 8 (26.67%) patients had peripheral nerve lesions, 12 (40%) patients with carotid artery ultrasound abnormalities in the.DN group 27 (90%) patients with fundus lesions, 23 (76.67%) patients with peripheral neuropathy, 27 (90%) patients with carotid artery ultrasound abnormalities. Two groups of diabetic patients had statistically significant difference (P0.05 2.) the results of pure tone audiometry we can see from Figure 1, the two groups of left ear in patients with diabetes mellitus (5001000200040008000Hz) and right (5001000200040008000Hz) had significant difference with NC group (P0.05), and DN group than in DM group the left ear hearing loss of 2508000Hz and 8000Hz at the right ear is more serious (P0.05). No significant difference between the two ears (P0.05) blood glycosylated. Red protein, waist circumference, urinary albumin / creatinine ratio and glomerular filtration rate and hearing loss are related to.3. otoacoustic emission is shown by Figure 2, patients in group DN (4kHz) in the left ear and the right ear (0.75,2,4kHz) and the NC group were significantly different (P0.05).DM group in the right ear 0.75kHz, there were significant differences in 4kHz with the NC group (P0.05). There were no difference between the two ears (P0.05).4. video electronystagmography and hot and cold water test table 2 shows, video electronystagmography results in three groups were normal. Hot and cold water test results, 5 people in the DM group showed vestibular dysfunction, 9 group DN is in the form of vestibular dysfunction. But no significant difference between two groups (P0.05). Glycated hemoglobin and urine albumin / creatinine ratio and vestibular function injury myogenic potential NC correlation between.5. vestibular evoked group 2 (6.67%) did not elicit ear amplitude, 1 (3.33%) did not elicit left ear amplitude; DM group 3 (1 0%) did not elicit ear amplitude, 1 (3.33%) did not elicit left ear amplitude, 2 (6.67%) ears were not drawn amplitude; DN group of 5 people (16.67%) did not elicit ear amplitude, 2 (6.67%) did not elicit left ear amplitude, 3 (10%) ears were not drawn by the amplitude. Table 3 shows that two groups of diabetic group left ear and the right ear amplitude and the health of people than there were statistically significant differences (P0.05), but there were no significant differences between DM group and DN group, two ears). Amplitude (P0.05) from table 5, table 6 shows that the VEMPs amplitude decreased with the duration of diabetes, HbA1c, correlation between lipoprotein and the diabetic retinopathy and the vestibular function of low density injury. Conclusion: 1. diabetic patients than in nondiabetic patients the incidence of hearing loss was high, showed bilateral progressive sensorineural hearing loss, and with a high frequency. In patients with diabetic nephropathy compared with patients with diabetic renal disease with high incidence,.2. hearing injury Now earlier, vestibular damage appeared later. That inner ear damage is a gradual process, with hearing impairment patients prone to vestibular function damage.3. HbA1c, waist circumference, urinary albumin / creatinine and glomerular filtration rate and the relationship with hearing impairment, can increase the risk of type 2 diabetes mellitus patients with hearing damage the urine albumin / creatinine ratio, duration of diabetes, HbA1c, correlation between lipoprotein and diabetic retinopathy and vestibular function of low density damage, can increase the vestibular function injury of type 2 diabetes risk.4. now society on diabetic nephropathy high vigilance and early screening for diabetes, hearing impairment and vestibular function the damage of low vigilance, microalbuminuria, have early cochlear and vestibular functions may indicate injury in patients with diabetic nephropathy, as early The diagnosis provides the possibility, provides the basis for further prevention and treatment, and can obviously improve the quality of life of the patients.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2;R692.9;R764

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