突发性聋患者血常规、血脂、血液流变学的水平及其与预后的相关性

目的检测突发性聋(Sudden deafness,SD)患者外周血血常规、血脂、血液流变学的水平,并与健康正常人相比,同时探讨这些指标与其疗效的关系。方法回顾性分析2018年1月至2019年6月148例突发性聋(简称突聋)患者的临床资料,与同期的160例健康对照者相比较,分析不同听阈曲线类型(低频下降型、平坦下降型、高频下降型及全聋型)的突聋患者血常规相关指标白细胞、中性粒细胞、淋巴细胞、平均血小板体积(mean platelet volume,MPV)、血小板/淋巴细胞比值(platelet lymphocyte ratio,PLR)及中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte,NLR),血脂相关指标(总胆固醇、甘油三酯),血液流变学(血浆粘度、全血粘度高切、全血粘度中切、全血粘度低切)的水平及其与突发性聋疗效的相关性。结果①突聋组血常规、血脂、血液流变学与对照组的比较:突聋组白细胞、中性粒细胞、淋巴细胞、MPV、NLR、PLR、总胆固醇、甘油三酯、全血粘度中切与对照组相比差异有统计学意义(P<0.05),其中突聋组患者白细胞、中性粒细胞、MPV、NLR、PLR、总胆固醇、全血粘度中切均较对照组升高,淋巴细胞、甘油三酯较对照组降低。突聋组血浆粘度、全血粘度高切、全血粘度低切较对照组升高,差异无统计学意义(P>0.05)。②不同类型听阈曲线突聋患者血常规、血脂、血液流变学的比较:低频下降型、平坦下降型、高频下降型及全聋型患者的白细胞、中性粒细胞、MPV、NLR、PLR与对照组相比明显升高;其淋巴细胞与对照组相比明显降低;低频下降型总胆固醇、全血粘度高切、中切、低切较对照组升高;平坦下降型总胆固醇、全血粘度高切、中切较对照组升高;全聋型总胆固醇、全血粘度高切较对照组升高,以上差异均有统计学意义(P<0.05)。高频下降型总胆固醇、全血粘度高切、中切、低切较对照组升高,各类型突聋患者与对照组的甘油三酯、血浆粘度差异,均无明显统计学意义(P>0.05)。③不同类型听阈曲线突聋患者不同疗效的血常规、血脂、血液流变学的比较:突聋组治疗无效组白细胞、中性粒细胞、NLR、血浆粘度、全血粘度高切、低切较治疗有效组升高;低频下降型治疗无效组的白细胞、中性粒细胞、NLR、全血粘度低切较治疗有效组升高;高频下降型治疗无效组的白细胞、中性粒细胞、全血粘度高切、中切、低切较治疗有效组升高;平坦下降型治疗无效组的白细胞、中性粒细胞、淋巴细胞、血浆粘度较治疗有效组升高;全聋型治疗无效组的白细胞、中性粒细胞、NLR、PLR较治疗有效组升高,以上差异均有统计学意义(P<0.05)。④突聋组患者血常规指标中白细胞、中性粒细胞、NLR与预后呈负相关性,血液流变学指标中的血浆粘度、全血粘度低切与预后呈负相关性。结论突聋患者可能存在炎症感染、脂代谢异常以及血流变学异常,同时发现突聋患者的白细胞、中性粒细胞、NLR、血浆粘度、全血粘度低切对其预后能起到一定的预测作用。临床工作中,我们应该关注突聋患者的血常规、血液流变学指标,可给予抗感染、降低血粘度等治疗,可能有助于其预后。

Levels of blood routine,blood lipids and hemorheology in patients with sudden deafness and their correlation with prognosis

Objective To explore the levels of blood routine,blood lipids and hemorheology in peripheral blood of patients with sudden deafness(SD),and compare with healthy people,and to explore the relationship between these indexes and their therapeutic effects.Methood The clinical data of 148 patients with SD from January 2018 to June 2019 were retrospective analyzed and compared with 160 healthy controls in the same period,to analyze the levels of blood routine(white blood cell,WBC),(neutrophils,lymphocytes,MPV,PLR,and NLR),blood lipid related indicators(Total cholesterol,TC),(Triglyceride,TG),hemorheology(plasma viscosity,PV),(High shear viscosity,HSV),(Middle shear viscosity,MSV),(low shear viscosity,LSV)and their correlation with curative effect in patients with different hearing threshold curves(Low-frequency hearing loss,flat hearing loss,high-frequency hearing loss,and total deafness).Result①1.Blood routine,blood lipids,and blood rheology in the SD group were compared with the normal group:There were significant differences in the WBC,neutrophils,lymphocytes,MPV,NLR,PLR,TC,TG and MSV between the SD group and the control group(P<0.05).Among them,WBC,neutrophils,MPV,NLR,PLR,TC and MSV were significantly higher in the SD group than in the control group,and lymphocytes and TG were lower than the control group.The PV,HSV and LSV of the SD group were higher than those of the control group,and the difference was not statistically significant(P>0.05).②Comparison of blood routine,blood lipids and hemorheology in different types of SD patients:WBC,neutrophils,MPV,NLR,PLR in patients with low-frequency hearing loss,flat hearing loss,high-frequency hearing loss and total deafness were significantly higher than those in the control group,The lymphocytes were significantly lower than the control group;The TC,HSV,MSV,and LSV of the low-frequency hearing loss patients were higher than those of the control group;The TC,HSV,and MSV of patients with flat hearing loss were higher than those of the control group;The TC and HSV of patients with total deafness were higher than those of the control group,and the above differences were statistically significant(P<0.05).The TC,HSV,MSV and LSV of patients with high-frequency hearing loss were higher than those of the control group.There was no significant difference in TG and PV between the patients with different types of SD and the control group(P>0.05).③Comparison of blood routine,blood lipids,and blood rheology for different types of SD patients:WBC,neutrophils,NLR,PV,HSV,LSV in the ineffective group of the SD group were higher than those in the treatment effective group;WBC,neutrophils,NLR,and LSV in the low-frequency hearing loss ineffective group were higher than those in the effective group;WBC,neutrophils,HSV,MSV,and LSV of the high-frequency hearing loss in ineffective group were higher than those in the treatment-effective group;WBC,neutrophils,lymphocytes,and PV of the flat hearing loss in ineffective group were higher than those in the treatment-effective group;WBC,neutrophils,NLR,and PLR of the total deafness in ineffective group were higher than those in the treatment-effective group.The difference was statistically significant(P<0.05).④There was a negative correlation between WBC,neutrophils and NLR in the blood routine indicators of the patients in the SD group,and the PV and LSV in the hemorheology index were negatively correlated with the prognosis.Conclusion Patients with SD may have infection,abnormal lipid metabolism and abnormal blood rheology.At the same time,it is found that WBC,neutrophils,NLR,PV and LSV of patients with sudden deafness can predict their prognosis to some extent.In clinical work,we should pay attention to the blood routine and blood rheology indicators of patients with sudden deafness,and doctors can give anti-infection,lower blood viscosity and other treatments,which may help its prognosis.