突發性耳聾之預後分析

目的：不明原因之突發性耳聾的病因及致病機轉目前仍不清楚，目前已有一些特定且明確的預後因子，然而對於特定病原體抗體及免疫生化檢查的研究卻仍稀少。本研究的目的主要探討不明原因之突發性耳聾的各種預後因子和聽力恢復機率之相關性。方法：經回溯性檢閱病歷，收集2000年01月至2012年12月間，於成大醫院診斷為不明原因之突發性耳聾並接受住院類固醇治療之病患，共計190名病患。收集病患基本特性，包括年齡、性別、受損耳、眩暈、耳鳴、季節、延遲治療時間、聽力檢查結果、血液、生化、特定病毒抗體及免疫生化檢查等項目。本研究以順序邏輯斯迴歸分析（ordered logistic regression analysis），探討各項因子與預後之相關性。結果：190名病患中，聽力完全改善有56名（29.5%），部分改善有91名（47.9%），未改善有43名（22.6%）。由單變數分析顯示，性別、有無耳鳴、近1個月之上呼吸道感染史、初診聽力損失程度、白血球數目、紅血球沉降速率、C-反應蛋白、血清補體C4、病原體抗體、抗核抗體及類風濕因子與病患之聽力改善無顯著相關（p＞0.05）。而由多變數分析發現，年齡、有無眩暈、發病季節、延遲治療時間及血清補體C3與病患之聽力改善有顯著相關（p＜0.05）。當危險預後因子同時出現時，其聽力完全改善的機率可能小於13.4%。結論：本研究結果顯示白血球數目、紅血球沉降速率、C-反應蛋白、血清補體C4、抗核抗體、類風濕因子、梅毒血清檢查、病原體抗體等實驗室檢查，與預後並無顯著相關。而年齡、有無眩暈、季節、延遲治療時間及血清補體C3，與預後有顯著相關，可當作是預測病情變化的臨床指標。

關鍵字

不明原因性之突發感音神經性聽覺損失；病因；預後因子

並列摘要

BACKGROUND: The etiologies, pathogenesis and prognostic factors of idiopathic sudden sensorineural hearing loss (ISSHL) are unclear. The purpose of this study was to evaluate the clinical prognostic factors and the probability of hearing recovery of ISSHL. METHODS: The medical records of 190 patients who had been treated with steroid for ISSHL between 2000 and 2012 were evaluated retrospectively. Clinical and laboratory data including age, sex, tinnitus, URI history, vertigo, season, treatment delay period, WBC, ESR, CRP, C3, C4, ANA, RF, VDRL and viral IgM antibody were recorded. Statistical analyses were performed to determine the prognostic significance of clinical and laboratory variables to predict hearing recovery.RESULTS: Among the 190 patients, 97(51%) were male, 93(49%) were female. Fortythree (22.6%) of the 190 patients had no hearing recovery, 91(47.9%) had partial hearing recovery, and 56(29.5%) had complete hearing recovery. In the univariate analysis, tinnitus, URI history, WBC, ESR, CRP, C4, ANA, RF, VDRL and viral IgM antibody had no significant correlation with hearing recovery of ISSHL. In the multivariate analysis, age, vertigo, season, treatment delay period and C3 level showed significant correlation with the hearing recovery of ISSHL (p ＜ 0.05). The probability of complete hearing recovery was less than 13.4% when all unfavorable variables were present. CONCLUSIONS: Based on our retrospective analysis, laboratory tests, such as WBC, ESR, CRP, C4, ANA, RF, VDRL and viral IgM antibody are not recommended routinely for ISSHL patients. Prognostic indicators for hearing recovery in ISSHL include age, vertigo, season, treatment delay period and serum C3 level. Further investigation is needed to confirm our findings.

並列關鍵字

idiopathic sudden sensorineural hearing loss ； etiology ； prognostic factors

國際替代計量

突發性耳聾之預後分析

全文下載

主題瀏覽