Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss
Cardiovascular and thrombophilic risk factors for idiopathic sudden sensorineural hearing loss
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DOI：
10.1111/j.1538-7836.2005.01310.x
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发表时间：
2005-05-01
影响因子：
10.4
通讯作者：
Prisco, D
中科院分区：
文献类型：
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作者：
Marcucci, R;Liotta, AA;Prisco, D
背景：近年来，突发性感音神经性耳聋(SSHL)在西方国家的发病率呈显著上升趋势，每年发病率为20/10万。到目前为止，还没有发现这种疾病的明确原因，但在排除了感染性发作或听神经瘤的患者中，假设有耳蜗性缺血。目的：本病例对照研究的目的是探讨除心血管危险因素外，获得性和遗传性危险因素[抗凝血酶、蛋白C和S；凝血因子V(FV)Leiden、FII基因多态性；狼疮抗凝剂(LA)；抗心磷脂抗体；空腹同型半胱氨酸(HY)；脂蛋白(A)(Lp(A))；纤溶酶原激活物抑制物-1(PAI-1)]。患者和方法：我们调查了155例患者(男性67例，女性88例；年龄55例，年龄19-79岁)，以及155例对照组(男性67例，女性88例；年龄54岁，年龄19-78岁)。空腹HY水平显著高于对照组[11.6(6.7-60)mU/L vs.8.7(5.0-24)mU/L]和PAI-1水平[19(2-95)mg/dL vs.14.5(4.0-87)mg/dL]。狼疮抗凝剂阳性13例(8.4%)，ACL阳性20例(12.9%)，其中4例为IgM阳性，16例为免疫球蛋白阳性。S发现，无一例患者存在生理性凝血抑制物抗凝血酶、蛋白C和蛋白缺乏。Lp(A)水平[111(1-1146)mg/L比103(11-695)mg/L]、FV Leiden(4.5%比4.5%)和FII变异体G20210A(3.8%比3.2%)在患者组和对照组之间无显著差异。结果与结论：在多因素分析中(调整年龄、性别和传统心血管危险因素)ISSHL的独立危险因素为：ACL阳性：OR 5.6(95%CI 2.0~15.3)，第二、三分位数(相对于第一个三分位数)：T2=OR 4.8(95%CI 1.9~12.6)/T3=OR 19(95%CI 7~50.1)；第三个三分位数内的PAI-1和HY水平(相对于第一个三分位数)：OR 20(95%可信区间7.8-78)和OR 4.0(95%可信区间2.0-8)。1)。这些初步数据表明，高胆固醇血症、高同型半胱氨酸血症、PAI-1水平升高和抗心磷脂抗体与ISSHL有关，从而间接支持了血管闭塞在疾病发病机制中的假说。
Background: In recent years there has been a significant increase in the diagnosis of Sudden sensorineural hearing loss (SSHL) in western, countries with an incidence of 20 of 100 000 people affected every year. No clear causes for this disease have been found thus far, but cochlear ischemia has been hypothesized in patients in whom an infectious episode or acoustic neurinoma have been excluded. Objectives: The aim of this case-control study was to investigate a number of acquired and inherited thrombophilic risk factors [antithrombin, protein C and S; factor V (FV) Leiden, FII polymorphism; lupus anticoagulant (LA); anticardiolipin (aCL) antibodies; fasting homocysteine (Hey); lipoprotein(a) (Lp(a)); plasminogen activator inhibitor-1 (PAI-1)] in addition to cardiovascular risk factors in patients with idiopathic SSHL (ISSHL). Patients and methods: We investigated 155 patients (67 male/88 female; age: 55 (range 19-79 years) with a diagnosis of ISSHL within 30 days from the onset of symptoms, and 155 controls (67 male/88 female; age 54 (range 19-78 years). Fasting Hey levels were significantly higher in patients than in controls [11.6 (6.7-60) mu mol/L vs. 8.7 (5.0-24) mu mol/L] as well as PAI-1 levels [19 (2-95) mg/dL vs. 14.5 (4.0-87) mg/dL]. Lupus anticoagulant was present in 13 of 155 (8.4%) patients; 20 patients (12.9%) had positivity of aCL (four IgM and 16 IgG). In no patient was a deficiency of physiological clotting inhibitors antithrombin, protein C and protein S found. No significant differences between patients and controls were observed for Lp(a) plasma levels [111 (1-1146) mg/L vs. 103 (11-695) mg/L] and for the presence of FV Leiden (4.5% vs. 4.5%) and FII variant G20210A (3.8% vs. 3.2%). Results and conclusions: Independent risk factors for ISSHL at the multivariate analysis (adjusted for age, sex and the traditional cardiovascular risk factors) were the positivity of aCL: OR 5.6 (95% CI 2.0-15.3); cholesterollevels within the second and third tertiles (with respect to the first tertile): T2 = OR 4.8 (95% CI 1.9-12.6)/T3 = OR 19 (95% CI 7-50.1); PAI-1 and Hey levels within the third tertile (with respect to the first tertile): OR 20 (95% CI 7.8-78) and OR 4.0 (95% CI 2.0-8. 1), respectively. These preliminary data Suggest that hypercholesterolemia, hyperhomocysteinemia, elevated PAI-1 levels and anticardiolipin antibodies are associated with ISSHL, so indirectly supporting the hypothesis of a vascular Occlusion in the pathogenesis of the disease.