听觉神经系统检查在糖尿病神经病变中的诊断价值及影响糖尿病患者听力损伤因素分析

摘要

目的：探讨听觉神经系统检查在糖尿病神经病变（DPN）中的诊断价值及影响患者听力损伤的相关危险因素。方法选择70例入住廊坊市人民医院耳鼻喉科的糖尿病患者作为研究对象，对比分析听觉脑干反应（ABR）、DPOAE、5．07／10 g 尼龙丝、128 Hz 音叉及神经传导速度（NCV）检查的结果。基于 Pearson 与多元 Logistic 回归分析的方法对影响患者听力损伤的相关危险因素进行分析。结果（1）ABR、DPOAE、128 Hz 音叉及5．07／10 g 尼龙丝检查与 NCV 检查的一致性κ值分别为0．562、0．513、0．429及0．352；（2）听力正常组（n ＝38）与听力损伤组（n ＝32）在糖化血红蛋白（HbA1 C）、甘油三酯（TG）、高胆固醇（CHO）水平及病程方面的差异均具有统计学意义（P ＜0．05）；（3）经多元 Logistic 回归分析，HbA1 C（β＝0．419，S．E ＝0．192，Wald ＝8．293，P ＜0．05，OR ＝1．827，95％CI 1．362～2．209）及病程（β＝0．753，S．E ＝0．368，Wald ＝9．091，P ＜0．05，OR＝2．238，95％CI 1．827～3．114）为影响糖尿病患者听力损伤的因素。结论ABR 及 DPOAE 与 NCV 检查的一致性较好，其在DPN 的临床诊断中具有较高的价值；影响糖尿病患者听力损伤的因素为 HbAlc 及病程，应注意对其进行仔细观察，以采取强有效的措施对患者进行干预治疗。%Objective To investigate the value of auditory nervous system examination in the diagnosis of diabetic neuropathy(DNP)in diabetic patients and to explore the relevant factors influencing hearing damage.Methods A retrospective analysis was made of the clinical data of 70 cases of diabetic patients admitted to Department of ENT in Langfang People’s Hospital from December 2011 to De-cember 2013.Auditory brainstem responses to the ABR,distortion product otoacoustic emissions(DPOAE),nylon wire with fork and nerve conduction velocity of 5.07 /10g,128Hz(NCV)examination were compared and analyzed.And then univariate Pearson and multi-variate Logistic regression analysis was made to analyze the influential factors of hearing loss in patients with diabetes mellitus.Results The agreement of ABR,DPOAE,128Hz tuning fork and 5.07 /10g monofilament with NCV values were 0.562,0.513,0.429 and 0.352,respectively.There were statistically significant differences between the normal hearing group(n =38)and hearing injury group (n =32)in glycosylated hemoglobin(HbA1 C),triglyceride(TG),cholesterol(CHO)and the course of disease(P <0.05).The multiva-riate Logistic regression analysis showed that HbA1 C(β=0.419,S.E =0.192,Wald =8.293,P <0.05,OR =1.827,95%CI 1.362 ~2.209)and the course of disease(β=0.753,S.E =0.368,Wald =9.091,P <0.05,OR =2.238,95%CI 1.827 ~3.114)were influ-ence factors of hearing damage in patients with diabetes mellitus.Conclusions The consistency of ABR,DPOAE and NCV examination is good,which is of high value in the clinical diagnosis of DPN.The influence factors of hearing loss in patients with diabetes are HbAlc and the course of disease,which should be closely observed so that effective measures of intervention can be adopted among the pa-tients.