杨明 伏飞达 朱晓燕

[摘要] 目的 探討突发性耳聋患者血清可溶性血管细胞黏附分子-1（sVCAM-1）的表达水平及临床意义。 方法 选择2016年1月～2017年6月南京市中西医结合医院收治的97例突发性耳聋患者作为病例组，并于同期随机选取60名健康体检者为对照组，采用酶联免疫吸附法测定两组血清sVCAM-1水平，并分析其与患者人口学资料的关系以及其对突发性耳聋的诊断价值。 结果 病例组患者血清sVCAM-1水平高于对照组，差异有统计学意义（P < 0.05）。≥45岁患者血清sVCAM-1水平高于<45岁者，听力损失严重患者血清sVCAM-1水平更高，全聋型患者血清sVCAM-1水平高于其他分型，有上呼吸道感染和心脑血管合并症患者血清sVCAM-1水平更高，差异均有统计学意义（P < 0.05）。sVCAM-1诊断突发性耳聋的ROC曲线下面积为0.904（95%CI：0.841～0.967），灵敏度为76.5%，特异度为91.8%，此时sVCAM-1的最佳截断值为579.23 ng/mL。 结论 突发性耳聋患者血清sVCAM-1水平明显升高，其与年龄、听力下降程度、听力曲线、上呼吸道感染、心脑血管合并症密切相关，早期检测可有效预测突发性耳聋的发生。

[关键词] 突发性耳聋；可溶性血管细胞黏附分子-1；临床意义

[中图分类号] R764.43 [文献标识码] A [文章编号] 1673-7210（2018）05（c）-0119-04

Changes and significance of serum sVCAM-1 level in patients with sudden deafness

YANG Ming FU Feida ZHU Xiaoyan

Department of ENT， Nanjing Integrated Traditional Chinese and Western Medicine Hospital， Jiangsu Province， Nanjing 210000， China

[Abstract] Objective To explore the expression of serum soluble vascular cell adhesion molecule-1 （sVCAM-1） and its clinical significance. Methods A total of 97 patients with sudden deafness admitted to Nanjing Integrated Traditional Chinese and Western Medicine Hospital from January 2016 to June 2017 were selected as the case group， 60 healthy subjects were randomly selected as the control group at the same period. The serum sVCAM-1 level in the two groups was measured by the enzyme-linked immunosorbent assay， in addition， the relationship between sVCAM-1 with patients' demographic data and the diagnostic value of sVCAM-1 for sudden deafness were analyzed. Results The serum sVCAM-1 level in the case group was higher than that of control group， with statistically significant difference （P < 0.05）. The sVCAM-1 level of patients at the age≥45 was higher than the age<45， and sVCAM-1 level in patients with severe hearing loss was more higher， and sVCAM-1 level in patients with total deafness type was more higher than those in other types， sVCAM-1 level of patients with upper respiratory tract infection and cardiovascular complications were more higher， with statistically significant differences （P < 0.05）. The ROC area of sVCAM-1 in the diagnosis of sudden deafness was 0.904 （95%CI：0.841-0.967）， the sensitivity was 76.5% and the specificity was 91.8%， the best truncation value of sVCAM-1 at this time was 579.23 ng/mL. Conclusion The serum sVCAM-1 in patients with sudden deafness is significantly elevated， which is closely related to age， hearing loss， hearing curve， upper respiratory tract infection and cerebrovascular complications. Early detection can effectively predict the occurrence of sudden deafness.

[Key words] Sudden deafness； Soluble vascular cell adhesion molecule-1； Clinical significance

耳聋是临床耳鼻喉科常见的急症，是指突然发生，短时间内（几分钟、几小时或者3 d以内）出现原因不明的感音神经性听力损失，并且至少两个相连的频率听力下降超过20 dB，常伴有不同程度的耳鸣、眩晕等临床症状[1-2]。流行病学调查显示[3]，突发性耳聋人群发病率在5万～20/10万之间，随着人们生活节奏的加快以及工作生活压力的增大，其发病率逐渐升高。研究发现[4]，约有30%～60%的突发性耳聋患者因治疗不及时而损伤前庭，进一步加重听力损伤，影响患者预后。早发现、早诊断、早治疗是有效缓解突发性听力耳聋症状，改善患者预后的重要措施。研究证实[5]，免疫异常、病毒感染、内耳循环障碍等是导致突发性耳聋的重要因素，而内耳循环障碍是主要的发病机制之一。可溶性血管细胞黏附分子-1（solube vascular cell adhesion molecule-1，sVCAM-1）是由血管内皮细胞表面的黏附分子脱落后进入血液所形成的跨膜糖蛋白分子，研究显示[6-7]，sVCAM-1参与了细胞的信号转导、活化过程，在糖尿病性血管病变、动脉粥样硬化、创伤等疾病的发生和发展过程中发挥重要作用。……