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不同程度OSAHS患者颞横回的氢质子波谱研究

发布时间:2018-08-02 11:07
【摘要】:目的:阻塞性睡眠呼吸暂停低通气综合征(obstructive sleepapnea-hypopnea syndrome,OSAHS)与感音神经性聋是耳鼻咽喉科常见疾病。近年来,研究表明OSAHS患者感音神经性聋的发病率较正常人群高,但机制尚未明确,目前临床上对于听力的检测虽然可以对患者听力状况作出评价,但其不能提早发现听皮层区神经细胞代谢障碍。现在研究表明,感音神经性聋患者的听皮层区神经代谢产物的变化可能提示其早期的听力下降,但是目前听皮层早期代谢变化尚缺乏有效的检测手段。磁共振波谱分析(proton magnetic resonace spectroscopy,MRS)1973年首次在医学领域应用,MRS可以选择性地、无创地定对活体组织内的代谢物浓度进行准确测定,而且他的检测灵敏度较高,坐标中的不同共频率波峰被其用来分析并且判断特定化学物质的含量,从而为临床上测定脑内神经性病变及脑部良恶性肿瘤等提供参考信息。目前有些原子核,例如:31P、1H、23NA、13C、19F等被用在医学领域进行波谱学研究,在原子核中,氢质子在有机物机构中具有高自然丰度和核磁感性,所以在磁共振波谱研究中氢质子是应用最多的原子核。体内的多种微量代谢物,如N-乙酰门冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)、乳酸(Lac)、肌醇(mI)、谷氨酸(Glu)和谷氨酰胺(Gln)等可以被氢质子磁共振波谱(1H-proton magnetic resonacespectroscopy,1H-MRS)检测到。本实验利用磁共振氢质子波谱(1H-MRS)检测不同程度OSAHS患者颞横回听皮层区的早期神经代谢产物变化情况,进而有效判断OSAHS患者感音神经性聋听皮层神经细胞早期病变,为寻找可靠早期预警指标提供临床实验依据。 方法:随机抽取经PSG监测确诊的OSAHS患者112例以及健康志愿者15例,并对所有患者及健康志愿者进行纯音测听及听性脑干反应分析(ABR),纯音听阈筛查将其分为轻中度OSAHS双侧耳聋组,重度OSAHS双侧耳聋组,轻中度OSAHS单侧耳聋组,重度OSAHS单侧耳聋组,轻中度OSAHS组,重度OSAHS组以及正常对照组,对各组行双侧颞横回听皮层行1H-MRS检测,根据神经代谢产物其峰下面积计算NAA/Cr、Cho/Cr、mI/Cr、NAA/Cho,比较上述各组间差异;测定OSAHS患者呼吸紊乱指数(Apnea Hyponea Index, AHI)与各神经代谢产物NAA/Cr、Cho/Cr、NAA/Cho之间的相关性,最后ROC曲线用于测定上述各组指标诊断早期感音神经性聋的灵敏度及特异度,以确定OSAHS患者并发感音神经性聋的神经代谢产物的判定阈值。 结果: 1OSAHS患者中耳聋的发生率显著高于正常健康人群,根据纯音测听结果分析OSAHS患者组的感音神经性聋发病率为47.4%,OSAHS组的发病率明显高于普通人群。 2OSAHS患者AHI指数与NAA/Cr、Cho/Cr、mI/Cr、NAA/Cho做线性相关分析,发现AHI与NAA/Cr、NAA/Cho呈负相关性,而与Cho/Cr呈正相关性。 3正常组左右耳与单纯轻中度OSAHS组及重度OSAHS组之间左右耳对应听皮层区神经代谢产物NAA/Cho,三者依次递减,差异具有统计学意义(P0.05)。mI/Cr、Cho/Cr三组依次递增,轻中度组与重度组分别与正常对照组有统计学意义,但两者差异无统计学意义(P0.05)。 4OSAHS伴耳聋组与OSAHS无耳聋组,正常对照组脑内神经代谢产物之间的比较NAA/Cr、NAA/Cho依次升高,而Cho/Cr、mI/Cr依次降低;OSAHS无耳聋组、轻中度OSAHS伴耳聋组及重度OSAHS伴耳聋组比较,NAA/Cr、NAA/Cho依次递减,而Cho/Cr、mI/Cr依次递增,NAA/Cho比较具有差异性(P0.05)。 5单侧神经性耳聋组患侧,健侧与正常对照组比较,NAA/Cr、NAA/Cho依次升高,Cho/Cr、mI/Cr依次降低,并具有统计学差异(P0.05)。 6采用ROC曲线测定单纯OSAHS与OSAHS合并感音神经性聋的神经代谢产物的判定值(预警值)。 本研究发现在NAA与Cho两者比值在1.93处时,ROC曲线下面积为73%,其诊断的灵敏度为92%,特异度为78%,灵敏度与特异度均很高,表明当NAA/Cho低于1.93时OSAHS患者可能会并发神经性耳聋,,其可以作为筛查OSHAS耳聋发生的一个特异性指标,Cho/Cr及NAA/Cr其曲线下面积为50%,诊断准确性不高,所以不予考虑。 结论: 1OSAHS人群中感音神经性聋较正常人群中有较高的发生率。 2本研究发现OSAHS不伴感音神经性聋患者颞横回神经细胞出现了早期听皮层神经细胞代谢功能减退征象,与之相比伴有神经性耳聋的患者其减退更为明显。 3结合神经代谢产物变化及ROC测定,初步研究结果显示NAA/Cho有可能作为判定该人群感音神经性聋发生的早期判定指标。
[Abstract]:Objective: obstructive sleep apnea hypopnea syndrome (obstructive sleepapnea-hypopnea syndrome, OSAHS) and sensorineural hearing loss are common diseases in otolaryngology. In recent years, studies have shown that the incidence of sensorineural deafness in OSAHS patients is higher than that of normal people, but the mechanism is not yet clear, and it is now clinically detected for hearing. It is possible to evaluate the hearing status of the patients, but it is not possible to detect the metabolic disorders in the auditory cortex early. The present study shows that the changes in the nerve metabolites in the auditory cortex area of the patients with sensorineural hearing loss may indicate the early hearing loss, but the early metabolic changes in the auditory cortex are still lacking effective detection methods. Proton magnetic resonace spectroscopy (MRS) was first used in the medical field for the first time in 1973. MRS can selectively and accurately determine the concentration of metabolites in living tissues, and his detection sensitivity is high, and the different common frequency peaks in the coordinates are used to analyze and judge specific chemicals. There are some nuclei, such as 31P, 1H, 23NA, 13C, 19F, etc., which are used in the field of spectroscopy in the field of medicine. In the nucleus, hydrogen protons have high natural abundance and nuclear magnetic susceptibility in organic bodies. Hydrogen protons are the most used nuclei in the spectroscopic study. A variety of trace metabolites in the body, such as N- acetyl aspartic acid (NAA), choline (Cho), creatine (Cr), lactic acid (Lac), inositol (mI), glutamic acid (Glu) and glutamine (Gln), can be detected by the hydrogen proton magnetic resonance spectroscopy (1H-proton magnetic resonacespectroscopy, 1H-MRS). Magnetic resonance hydrogen proton spectroscopy (1H-MRS) was used to detect the changes of early nerve metabolites in the auditory cortex of different levels of OSAHS patients, and then the early pathological changes of the auditory cortex of the sensorineural hearing cortex in OSAHS patients were effectively judged, and the clinical experimental basis was provided for finding reliable early warning indicators.
Methods: 112 OSAHS patients and 15 healthy volunteers were randomly selected by PSG monitoring, and all the patients and healthy volunteers were treated with pure tone audiometry and auditory brainstem response analysis (ABR). The pure tone hearing threshold screening was divided into mild and moderate OSAHS bilateral deafness group, severe OSAHS bilateral deafness group, mild to moderate OSAHS unilateral deafness group and severe OSA. HS unilateral deafness group, mild and moderate OSAHS group, severe OSAHS group and normal control group, 1H-MRS detection was performed on bilateral temporal lateral auditory cortex in each group. According to the area under the peak of nerve metabolism, NAA/Cr, Cho/Cr, mI/Cr, NAA/Cho were calculated and the differences between the groups were compared, and the respiratory disorder index of OSAHS patients (Apnea Hyponea Index,) and the various gods were measured. The correlation between the metabolites NAA/Cr, Cho/Cr, and NAA/Cho, and the final ROC curve was used to determine the sensitivity and specificity of the early diagnosis of sensorineural deafness to determine the threshold of the nerve metabolites in OSAHS patients with sensorineural deafness.
Result:
The incidence of deafness in 1OSAHS patients was significantly higher than that in normal healthy people. According to the results of pure tone audiometry, the incidence of sensorineural hearing loss in OSAHS patients was 47.4%, and the incidence of group OSAHS was significantly higher than that of the general population.
AHI index of patients with 2OSAHS was negatively correlated with NAA/Cr, Cho/Cr, mI/Cr, NAA/Cho, but positively correlated with Cho/Cr.
3 the left and right ears of the normal group and the mild and moderate OSAHS group and the severe OSAHS group corresponded to the nerve metabolites NAA/Cho in the auditory cortex area, and the three decreased in turn. The difference was statistically significant (P0.05).MI/Cr, the Cho/Cr three groups were increasing in turn. The difference between the mild and moderate group and the severe group was statistically significant, but there was no statistical difference between the two groups. Learning meaning (P0.05).
4OSAHS with the deafness group and the OSAHS non deafness group, the comparison of the brain nerve metabolites in the normal control group was NAA/Cr, the NAA/Cho increased in turn, while Cho/Cr and mI/Cr decreased in turn, and the OSAHS without deafness group, the mild and moderate OSAHS accompanied by the deafness group and the severe OSAHS accompanied deafness group, NAA/Cr, NAA/Cho descended in turn. There is a difference (P0.05).
5 Compared with the normal control group, the NAA/Cr and NAA/Cho of the unilateral nervous deafness group increased in turn, Cho/Cr and mI/Cr decreased in turn, and the difference was statistically significant (P 0.05).
6 the ROC curve was used to determine the diagnostic value of the neurometabolites of OSAHS and OSAHS combined with sensorineural hearing loss (early warning value).
This study found that when the ratio of NAA to Cho was 1.93, the area under the ROC curve was 73%, the sensitivity of the diagnosis was 92%, the specificity was 78%, and the sensitivity and specificity were high. It showed that when NAA/Cho was lower than 1.93, OSAHS patients may be accompanied by neurogenic deafness, which could be used as a specific index for screening OSHAS deafness, Cho/Cr and NAA. /Cr the area under the curve is 50%, and the diagnostic accuracy is not high, so it is not considered.
Conclusion:
The incidence of sensorineural hearing loss in the 1OSAHS population was higher than that in the normal population.
2 we found that the temporal transverse gyrus of OSAHS without sensorineural hearing loss appeared in the early auditory cortex of the auditory cortex, and the hypogonadism of the patients with neurogenic deafness was more obvious than that in the patients with neurogenic deafness.
3 combined with the changes of nerve metabolites and the determination of ROC, preliminary findings suggest that NAA/Cho may be an early determinant of the occurrence of sensorineural deafness in this population.
【学位授予单位】:河北医科大学
【学位级别】:硕士
【学位授予年份】:2014
【分类号】:R766

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