陈远泉 潘志明 梁丽丽 何建鸿 赵欣 郭绣琴

【摘要】 目的：應用内耳钆造影MRI对梅尼埃病（MD）患者内淋巴积水进行检测，探讨MD患者内淋巴积水程度与听力的关系。方法：选取2018年9月-2020年12月在佛山市禅城区中心医院耳鼻喉科就诊的110例MD患者为研究对象，所有入组患者均行纯音听阈测试、前庭诱发肌源性电位（VEMP）测试以及内耳钆造影MRI检测。根据内耳钆造影MRI检查结果，评估患者内淋巴积水程度，比较不同内淋巴积水程度患者的性别、年龄、发病年龄、病程、纯音听阈以及VEMP异常率，采用Spearman检验分析内淋巴积水程度与纯音听阈、VEMP的相关性。结果：不同内淋巴积水程度患者性别、发病年龄、病程比较，差异均无统计学意义（P>0.05）;但重度积水患者年龄明显高于无积水和轻度积水患者，差异有统计学意义（P<0.05）。重度积水患者听阈、VEMP异常率均高于无积水和轻度积水患者，差异均有统计学意义（P<0.05）。Spearman相关性分析显示，MD患者内淋巴积水程度与纯音听阈、VEMP呈正相关（rs=0.557、0.461，P<0.05）。结论：内耳钆造影MRI所见内淋巴积水程度与MD患者年龄、纯音听阈、VEMP均显著相关，是临床诊断MD患者内淋巴积水的有效方法。

【关键词】 梅尼埃病 内淋巴积水 内耳钆造影 MRI 纯音听阈

Correlation between Gadolinium Contrast MRI in Evaluating Endolymphatic Hydrops and Hearing in Patients with Menieres Disease/CHEN Yuanquan， PAN Zhiming， LIANG Lili， HE Jianhong， ZHAO Xin， GUO Xiuqin. //Medical Innovation of China， 2021， 18（12）： 0-048

[Abstract] Objective： To detect endolymphatic hydrops in patients with Menieres disease （MD） by gadolinium contrast MRI， and to explore the relationship between the degree of endolymphatic hydrops and hearing. Method： From September 2018 to December 2020， 110 MD patients in the Department of Otorhinolaryngology， Chancheng District Central Hospital of Foshan City were selected as the research objects. All patients were tested with pure tone hearing threshold test， vestibular evoked myogenic potential （VEMP） test and gadolinium contrast MRI. According to the results of gadolinium contrast MRI examination of inner ear， the degree of endolymphatic hydrops was evaluated. The gender， age， onset age， course of disease， pure tone hearing threshold and VEMP abnormal rate of patients with different degrees of endolymphatic hydrops were compared. The correlation between the degree of endolymphatic hydrops and pure tone hearing threshold and VEMP was analyzed by Spearman test. Result： There were no significant differences in gender， age of onset and course of disease among patients with different degrees of endolymphatic hydrops （P>0.05）， but the age of patients with severe endolymphatic hydrops was significantly higher than that of patients with no endolymphatic hydrops and mild endolymphatic hydrops （P<0.05）. The hearing threshold and abnormal rate of VEMP in patients with severe endolymphatic hydrops were higher than those in patients with no endolymphatic hydrops and mild endolymphatic hydrops， and the differences were statistically significant （P<0.05）. Spearman correlation analysis showed that the degree of endolymphatic hydrops in MD patients were positively correlated with pure tone hearing threshold and VEMP （rs=0.557， 0.461， P<0.05）. Conclusion： The degree of endolymphatic hydrops on gadolinium contrast MRI is significantly correlated with the age， pure tone hearing threshold and VEMP of MD patients， which is an effective method for clinical diagnosis of endolymphatic hydrops in MD patients.

[Key words] Menieres disease Endolymphatic hydrops Gadolinium angiography of inner ear MRI Pure tone hearing threshold

First-authors address： Central Hospital of Chancheng District in Foshan City， Foshan 528031， China

doi：10.3969/j.issn.1674-4985.2021.12.010

近年来，随着国内外对梅尼埃病（Menieres disease，MD）的研究越來越深入，有学者发现MD患者会出现膜迷路（内淋巴）积水这一重要病理特征改变，该病理特征改变在内耳钆造影增强磁共振造影技术下可清晰地显示，给临床诊治MD带来的新契机[1-3]。2015年杨凤等[4]学者对43例MD患者经鼓室注射钆喷酸葡胺造影剂后行内耳MRI检查，发现在T1加权三维自旋回波序列下得到的图像可明确内淋巴积水情况，同时也证实了该检查手段安全、可行。但是，目前有关MD患者内淋巴积水情况与临床症状的相关性研究较少，此次课题以本院耳鼻喉科就诊的110例MD患者为研究对象，借助内耳钆造影MRI技术分析了MD患者内淋巴积水与听力的关系。现报……