2型糖尿病性周围神经病变与听力损伤相关性研究
发布时间：2019-07-10 10:42
【摘要】：目的:本研究应用纯音听阈(Pure Tone Audiometry,PTA)与畸变产物耳声发射(Distortion Product Otoacoustic Emission,DPOAE)检测糖尿病及周围神经病变患者患者的听力及耳蜗外毛细胞功能,从而探讨糖尿病周围神经病变(Diabetic Peripheral Neuropathy,DPN)与听力减退的关系,并行糖尿病及周围神经病变患者听力减退的相关因素分析。为糖尿病及周围神经病变患者听力受损的早期筛查和干预提供依据。方法:1、连续收集2016年2月至2017年1月在南昌大学第二附属医院内分泌与代谢科住院的2型糖尿病(Type 2 Diabetes Mellitus,T2DM)患者70例作为实验组;根据有无周围神经病变,实验组分为DPN组(35例)和非DPN组(35例);另从南昌大学第二附属医院体检科随机入选34例受试者为健康对照组。2、对104例研究对象均行神经传导速度(Nerve Conduction Velocity,NCV)、PTA、DPOAE检查。比较3组的一般资料、临床资料及血清学指标;比较3组间的PTA和DPOAE幅值结果;对PTA正常的研究对象行DPOAE幅值比较;分析DPN严重程度与听力减退程度的相关性;行糖尿病听力减退的危险因素分析。结果:1、DPN组、非DPN组的糖化血红蛋白(HbA1c)、空腹血糖(FBG)、甘油三脂(TG)、胆固醇(TC)、餐后血糖(PBG)、低密度脂蛋白(LDL-C)、尿微量白蛋白(UM-Alb)等指标与健康对照组差异有统计学意义(均P0.05),但DPN组与非DPN组无差异(P0.05)。2、PTA结果比较:DPN组听力正常19例,轻度减退10例,中度减退5例,重度减退1例,极重度减退0例;非DPN组听力正常27例,轻度减退8例,中度减退0例,重度减退0例,极重度减退0例;健康对照组听力均正常。DPN组在0.5KHz、1.0KHz、2.0KHz、4.0KHz所有频率的听阈值均高于非DPN组及健康对照组(均P0.05),非DPN组仅在4.0KHz频率中的听阈值高于健康对照组(P0.05)。3、DPOAE幅值结果比较:DPN组DPOAE幅值在0.5KHz、1.0KHz、2.0KHz、4.0KHz、8.0KHz等频率中均低于非DPN组和健康对照组(均P0.05);非DPN组DPOAE幅值仅在4.0KHz、8.0KHz频率较健康对照组低(p0.05)。4、对三组中PTA结果正常的对象行DPOAE幅值比较,即DPN组19例,非DPN组27例,健康对照组34例。结果显示DPN组DPOAE幅值在0.5KHz、1.0KHz、2.0KHz、4.0KHz、8.0KHz等频率中均低于健康对照组(P0.01),在0.5 KHz、1.0 KHz、2.0 KHz、4.0 KHz频率较非DPN组低(P0.01);非DPN组DPOAE幅值在8.0KHz频率低于健康对照组(P0.01)。5、Spearman相关分析显示DPN严重程度与听力减退程度呈正相关(Spearman相关系数=0.753)。6、多因素逐步Logistic回归分析得出病程(回归系数=0.195,P=0.013)、糖化血红蛋白(回归系数=0.205,P=0.001)是听力减退的独立危险因素。结论:1、2型糖尿病患者听力减退一般表现为轻中度,多为高频听力受损;糖尿病周围神经病变患者常更易合并听力减退,低中高频听力均易受损。2、2型糖尿病患者病程长、高血糖可能更易合并听力损害,糖尿病患者应积极控制血糖,在糖尿病早期就应重视对听力的监测,尤其是合并了周围神经病变的患者。3、畸变产物耳声发射可用于评价听力正常的2型糖尿病及周围神经病变患者的早期耳蜗损害。
[Abstract]:Objective: To study the effects of pure tone audiometry (PTA) and distortion product otoacoustic emission (DPOAE) on the hearing of patients with diabetes and peripheral neuropathy and the function of the outer hair cells of the cochlea. The relationship between DPN and hypohearing, and the related factors of hearing loss in patients with parallel diabetes and peripheral neuropathy. To provide the basis for early screening and intervention of hearing impairment in patients with diabetes and peripheral neuropathy. Methods:1.70 cases of type 2 diabetes (Type 2 Diabetes Mellitus, T2DM) in the second affiliated hospital of Nanchang University from February 2016 to January 2017 were collected as experimental group. According to the presence or absence of peripheral neuropathy, The experimental group was divided into DPN group (35 cases) and non-DPN group (35 cases), and 34 subjects were randomly selected from the second Affiliated Hospital of Nanchang University as the healthy control group, and the nerve conduction velocity (NCV), PTA and DPOAE were examined in 104 subjects. The general data, clinical data and serological markers of the 3 groups were compared; the results of the amplitude of PTA and DPOAE between the three groups were compared; the amplitude of the DPOAE was compared with the normal subjects of PTA; the correlation between the severity of the DPN and the degree of hearing loss was analyzed; and the risk factors of hearing loss in the line of diabetes were analyzed. Results: The glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), triglyceride (TG), cholesterol (TC), postprandial blood glucose (PBG) and low density lipoprotein (LDL-C) in the DPN group, non-DPN group, There was no difference between the indexes of urine microalbumin (UM-Alb) and the healthy control group (P <0.05), but there was no difference between the DPN group and the non-DPN group (P0.05). In the non-DPN group, the hearing was normal in 27, mild in 8, moderate in 0, severe in 0, and severe in 0; and the hearing of the healthy control group was normal. The hearing threshold of DPN group at 0.5KHz, 1.0KHz, 2.0KHz and 4.0KHz was higher than that of the non-DPN group and the healthy control group (P0.05). The hearing threshold of the non-DPN group only in the frequency of 4.0 KHz was higher than that of the healthy control group (P0.05). The amplitude of DPOAE in the non-DPN group was only 4.0 KHz and the frequency of 8.0 KHz was lower than that of the healthy control group (p0.05).4. The amplitude of the DPOAE in the normal subjects in the three groups was compared, that is,19 patients in the DPN group,27 in the non-DPN group and 34 in the healthy control group. The results showed that the amplitude of DPOAE in DPN group was lower than that of healthy control group (P 0.01) at the frequency of 0.5 KHz, 1.0 KHz, 2.0 KHz, 4.0 KHz, and 8.0 KHz (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). Spearman correlation analysis showed that the severity of DPN was positively correlated with the degree of hearing loss (Spearman correlation coefficient = 0.753).6. The multi-factor step-by-step logistic regression analysis results in the course of disease (regression coefficient = 0.195, P = 0.013), and the glycosylated hemoglobin (regression coefficient = 0.205, P = 0.001) is an independent risk factor for hearing loss. Conclusion:1. The hearing loss of type 2 diabetic patients is usually mild and moderate, most of them are high-frequency hearing impairment; the patients with diabetic peripheral neuropathy are often more likely to be combined with hearing loss, and the low-middle-high-frequency hearing is impaired.2. The course of the patients with type 2 diabetes is long, and the hyperglycemia may be more likely to be combined with hearing impairment. The patients with diabetes should actively control the blood sugar, and should pay more attention to the monitoring of the hearing in the early stage of diabetes, especially those with peripheral neuropathy.3. The otoacoustic emission of the distorted product can be used to evaluate the early cochlear damage in patients with type 2 diabetes and peripheral neuropathy.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
本文编号：2512551
[Abstract]:Objective: To study the effects of pure tone audiometry (PTA) and distortion product otoacoustic emission (DPOAE) on the hearing of patients with diabetes and peripheral neuropathy and the function of the outer hair cells of the cochlea. The relationship between DPN and hypohearing, and the related factors of hearing loss in patients with parallel diabetes and peripheral neuropathy. To provide the basis for early screening and intervention of hearing impairment in patients with diabetes and peripheral neuropathy. Methods:1.70 cases of type 2 diabetes (Type 2 Diabetes Mellitus, T2DM) in the second affiliated hospital of Nanchang University from February 2016 to January 2017 were collected as experimental group. According to the presence or absence of peripheral neuropathy, The experimental group was divided into DPN group (35 cases) and non-DPN group (35 cases), and 34 subjects were randomly selected from the second Affiliated Hospital of Nanchang University as the healthy control group, and the nerve conduction velocity (NCV), PTA and DPOAE were examined in 104 subjects. The general data, clinical data and serological markers of the 3 groups were compared; the results of the amplitude of PTA and DPOAE between the three groups were compared; the amplitude of the DPOAE was compared with the normal subjects of PTA; the correlation between the severity of the DPN and the degree of hearing loss was analyzed; and the risk factors of hearing loss in the line of diabetes were analyzed. Results: The glycosylated hemoglobin (HbA1c), fasting blood glucose (FBG), triglyceride (TG), cholesterol (TC), postprandial blood glucose (PBG) and low density lipoprotein (LDL-C) in the DPN group, non-DPN group, There was no difference between the indexes of urine microalbumin (UM-Alb) and the healthy control group (P <0.05), but there was no difference between the DPN group and the non-DPN group (P0.05). In the non-DPN group, the hearing was normal in 27, mild in 8, moderate in 0, severe in 0, and severe in 0; and the hearing of the healthy control group was normal. The hearing threshold of DPN group at 0.5KHz, 1.0KHz, 2.0KHz and 4.0KHz was higher than that of the non-DPN group and the healthy control group (P0.05). The hearing threshold of the non-DPN group only in the frequency of 4.0 KHz was higher than that of the healthy control group (P0.05). The amplitude of DPOAE in the non-DPN group was only 4.0 KHz and the frequency of 8.0 KHz was lower than that of the healthy control group (p0.05).4. The amplitude of the DPOAE in the normal subjects in the three groups was compared, that is,19 patients in the DPN group,27 in the non-DPN group and 34 in the healthy control group. The results showed that the amplitude of DPOAE in DPN group was lower than that of healthy control group (P 0.01) at the frequency of 0.5 KHz, 1.0 KHz, 2.0 KHz, 4.0 KHz, and 8.0 KHz (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). The frequency of DPOAE in the non-DPN group was lower than that of the healthy control group (P0.01). Spearman correlation analysis showed that the severity of DPN was positively correlated with the degree of hearing loss (Spearman correlation coefficient = 0.753).6. The multi-factor step-by-step logistic regression analysis results in the course of disease (regression coefficient = 0.195, P = 0.013), and the glycosylated hemoglobin (regression coefficient = 0.205, P = 0.001) is an independent risk factor for hearing loss. Conclusion:1. The hearing loss of type 2 diabetic patients is usually mild and moderate, most of them are high-frequency hearing impairment; the patients with diabetic peripheral neuropathy are often more likely to be combined with hearing loss, and the low-middle-high-frequency hearing is impaired.2. The course of the patients with type 2 diabetes is long, and the hyperglycemia may be more likely to be combined with hearing impairment. The patients with diabetes should actively control the blood sugar, and should pay more attention to the monitoring of the hearing in the early stage of diabetes, especially those with peripheral neuropathy.3. The otoacoustic emission of the distorted product can be used to evaluate the early cochlear damage in patients with type 2 diabetes and peripheral neuropathy.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R587.2
【参考文献】
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1 白桦;耳鸣、耳聋、眩晕与糖尿病[J];中国临床医生;2005年05期
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