血栓弹力图对突发性聋预后判断的意义

Correlation between Thrombelastography and Prognosis of Patients with Sudden Hearing Loss

张雨菲;刘淑云;王立宇;肖其珍;殷泽登;

1:西南医科大学附属医院耳鼻咽喉头颈外科

2:简阳市人民医院耳鼻咽喉科

摘要
目的探讨血栓弹力图(thromboelastography, TEG)在突发性聋(sudden hearing loss, SHL)预后判断中的意义。方法以2018年2月到2019年1月住院治疗的115例SHL患者为研究对象,其中男51例,女64例;年龄14~81岁,平均46.37±14.32岁;低频下降型35例(38耳)、高频下降型17例(23耳)、平坦型38例(41耳)、全聋型25例(26耳);根据SHL的预后,分为痊愈(44例)、显效(4例)、有效(19例)、无效(48例)4组。分别检测各组TEG中凝血反应时间(R)、凝固时间(K)、凝固角(α角)、血栓最大振幅(MA)、血栓最大幅度后30 min血凝块减少速率(LY30%)及血栓最大幅度后30 min时估计溶解百分数(EPL);采用症状自评量表-90(SCL-90)对受试对象进行问卷调查,评估分析TEG各指标与SHL患者不良精神心理状态的相关性。结果低频下降型、高频下降型、平坦型和全聋型组K时间分别为2.45±0.61、2.39±0.58、2.31±0.77和1.85±0.89 min,全聋组与低频下降组(P<0.001)、高频(P=0.02)及平坦型组(P=0.01)比较,K时间缩短;R时间分别为6.19±1.15、5.71±0.78、5.83±1.02和4.85±1.04 min;全聋组与低频下降组(P<0.01)、高频下降组(P<0.01)和平坦型组(P<0.001)比较,R时间缩短。不同听阈曲线组的MA(F=0.38,P=0.76)、α角(F=0.99,P=0.40)、EPL(F=1.84,P=0.14)和LY30%(F=2.44,P=0.06)等差异无统计学意义。不同预后组中K(F=1.36,P=0.25)、R(F=2.23,P=0.08)、MA(F=2.25,P=0.08)、α角(F=1.09,P=0.35)、EPL(U=0.50,P=0.91)和LY30%(U=2.01,P=0.56)差异无统计学意义。TEG与精神心理状态相关性分析显示,α角与恐怖因子(r=0.21,P=0.02)之间存在正相关性。结论 TEG中K和R时间在全聋型SHL的诊断及治疗决策中可能有一定意义;TEG对SHL的预后的判断无意义;α角与恐怖因子呈正相关,表明血液高凝状态可能与SHL患者产生不良精神心理状态如恐怖情绪存在相关性。
关键词
突发性聋;血栓弹力图;精神心理;预后
基金项目(Foundation):
作者
张雨菲;刘淑云;王立宇;肖其珍;殷泽登;
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