摘要
目的探究突发性耳聋(sudden deafness,SD)患者血小板参数水平对患者听力损伤严重程度的评估价值。方法选择2019年3月至2022年3月于天水市中西医结合医院(天水市第二人民医院)耳鼻咽喉科就诊的SD患者288例。根据听力损伤程度分为轻中度组163例,重度组125例。分析SD患者一般资料、血清指标。Logistic回归分析血小板参数与患者听力损伤程度的关系。广义相加模型分析患者听力损伤模型与血小板参数的关系。多因素Logistic分析SD患者重度听力损伤的独立影响因素。建立回归方程y=1-1/(1+e-z)预测模型并进行验证。结果轻中度组合并高血压例数、合并睡眠障碍例数、合并情绪不稳定例数、血小板分布宽度(platelet distribution width,PDW)、平均血小板体积(mean platelet volume,MPV)、血小板计数(platelet count,PLT)均低于重度组,差异均有统计学意义(P<0.05)。轻中度组病程短于重度组,差异有统计学意义(P<0.05)。轻中度组血红蛋白(hemoglobin,Hb)、血小板计数高于重度组,差异有统计学意义(P<0.05)。轻中度组合并冠心病例数、合并糖尿病例数、呼吸频率、心率、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、血肌酐(serum creatinine,Scr)、尿酸(uric acid,UA)、空腹血糖(fasting plasma glucose,FPG)与重度组比较,差异均无统计学意义(P>0.05)。血小板参数与SD患者听力损伤严重程度显著相关。血小板参数与SD耳聋严重程度存在一定线性关系。PDW、PCT、MPV对听力损伤严重程度具有正向作用,差异有统计学意义(P<0.05)。PLT对听力损伤严重程度具有反向作用,差异有统计学意义(P<0.05)。血小板参数对重度听力损伤的预测效能良好。PDW、PVT、MPV、PLT联合预测听力损伤严重程度,预测效能更高。合并高血压、合并睡眠障碍、合并情绪不稳定、血小板参数等均是重度听力损伤发生的重要因素。经Bootstrap自抽样,预测模型区分度、准确度较好。结论血小板参数与SD患者听力损伤程度密切相关,PDW、PVT、MPV、PLT联合预测对听力损伤程度预测有较高价值。临床应做好对SD患者的血小板参数水平监测,以提高预后。
Objective To investigate potential value of platelet parameters in assessing the severity of hearing loss in patients with sudden deafness(SD).Methods A total of 288 patients with SD treated at the Department of Otorhinolaryngology,Tianshui Hospital of Integrated Traditional Chinese and Western Medicine(Tianshui Second People's Hospital)from March 2019 to March 2022 were divided into two groups based on the degree of hearing loss,i.e.mild to moderate(163 cases)and severe(125 cases).General data and serum indexes were analyzed.Logistic regression was used to analyze the relationship between platelet parameters and the degree of hearing impairment.The generalized additive model was used to analyze the relationship between hearing impairment models and platelet parameters.Multivariate Logistic analysis was used to determine independent influencing factors for severe hearing loss.The prediction model of regression equation y=1-1/(1+e-z)was established and verified.Results The case number of comorbid hypertension,sleep disorders and emotional instability,as well as platelet distribution width(PDW),plateletcrit(PCT),mean platelet volume(MPV)in the mild-to-moderate hearing loss group were all lower than in the severe loss group(P<0.05),with shorter disease course(P<0.05)and higher hemoglobin(Hb)and platelet count(PLT)level(P<0.05).There was no significant difference in respiratory rate,heart rate,systolic blood pressure(SBP),diastolic blood pressure(DBP),serum creatinine(Scr),uric acid(UA),fasting plasma glucose(FPG)comorbid coronary heart disease or diabetes,and between the two groups(P>0.05).Platelet parameters are correlated with hearing loss severity with certain linear relationship.PDW,PCT and MPV showed a positive effect on hearing loss severity(P<0.05),while PLT showed a reversed effect(P<0.05).Platelet parameters demonstrated predictive power for severe hearing loss,with higher predictive efficiency when PDW,PVT,MPV and PLT were combined.Co-existing hypertension,sleep disorders,emotional instability,unfavorable platelet parameters,among others,were important factors for severe hearing loss.Through bootstrap self-sampling,the prediction model showed satisfying discrimination and accuracy.Conclusion Platelet parameters are closely related to the degree of hearing loss in SD,and combined PDW,PVT,MPV and PLT have high predictive values.Clinically,monitoring platelet parameters in SD patients should be considered to improve prognosis.
作者
张晓辉
吴文武
王雪萍
侯小娟
邵文慧
刘百溪
ZHANG Xiaohui;WU Wenwu;WANG Xueping;HOU Xiaojuan;SHAO Wenhui;LIU Baixi(Department of Otolaryngology,Tianshui Hospital of Integrated Traditional Chinese and Western Medicine,Tianshui Second People's Hospital,Tianshui 741020,China)
出处
《中华耳科学杂志》
北大核心
2025年第1期8-15,共8页
Chinese Journal of Otology
关键词
血小板参数
突发性耳聋
听力损伤程度
联合预测
评估价值
platelet parameter
sudden deafness
degree of hearing impairment
joint forecasting
appraised value
作者简介
通信作者:张晓辉,本科,副主任医师,研究方向:耳鼻咽喉科,Email:zhangXIAOhui23230@126net.com.cn。
