强直性脊柱炎患者的听力学及抗膜迷路蛋白抗体的检测

目的　对强直性脊柱炎 (ankylosingspondylitis ,AS)患者进行听力学检测并分析听力减退的特点。方法　采用问卷调查、临床耳鼻咽喉科检查、听力学测试、抗膜迷路抗体检查、血清免疫学检测方法 ,对确诊为AS的 34例 (6 8耳 )患者的临床资料加以分析。结果　 34例中主诉听力减退 11例 ,纯音测听发现听力减退 2 4例 (41耳 ) ,占 6 0 3% (41/ 6 8) ,2耳见鼓膜穿孔为混合性聋 ,39耳为感音神经性聋 ,其中高频听力减退 2 6耳 (2 6 / 39,6 6 7% )。听性脑干反应 (auditorybrainstemresponse ,ABR)除 1例 (2耳 )因重度聋无反应外 ,余 2 6例均正常。抗原抗体反应检测法检查 32例抗膜迷路抗体 ,9例阳性 (2 8 1% )。实验室检查 34例 ,HLA B2 7全部阳性 ,抗核抗体 (antinclearantibody,ANA)、类风湿因子(rheumatoidfactor,RF)均阴性 ,C 反应蛋白 (C reactiveprotein ,CRP)增高占 81 8% (2 7/ 33)。其余免疫学指标也有不同改变。结论　半数以上的AS伴有感音神经性听力减退 ,以高频听力减退居多 ,为耳蜗性聋伴免疫学异常 ,是全身性自身免疫病的内耳表现。对AS患者应定期进行听力学监测。

Relationships between ankylosing spondylitis and ear disease

Objective To explore whether patients with ankylosing spondylitis (AS) have hearing loss and the pattern of hearing loss Methods Questionnaire,physical examination of the ear, nose and throat, hearing test and sero immunity examinations were conducted in 34 patients (68 ears) with AS Results Among 34 patients,11 cases reported decrease in the sound perception, and 24 cases (41 ears, 60 3%) had hearing loss as evidenced by the pure tone audiometry In those patients with hearing loss, 2 ears with perforation of tympanic membrane showed conductive hearing loss and the remainder 39 ears showed sensorineural hearing loss in which 26 ears(66 7%) experienced high frequency hearing loss Auditory brainstem responses were normally presented in 26 case, whereas abolished in 1 case (2 ears) with severe hearing loss Examinations of sero immunity showed a positive response in HLA B27, but negative responses in the antinuclear antibody and rheumatoid factor The percentage of the C reactive protein increase was 81 8% Autoantibodies anaginst the inner ear were positive in 9 cases (28 1%) In addition, all other immunological examinations revealed certain changes Conclusion More than half of the patients with AS had sensorineural hearing loss, particularly in the high frequency range This hearing loss is paralleled by abnormal immunology and is a local expression of systemic autoimmune disease Therefore, periodical hearing tests are necessary for these patients