1型糖尿病患者的耳蜗功能障碍和微血管并发症
Cochlear dysfunction and microvascular complications in patients with type 1 diabetes mellitus.
作者信息
Felício João Soares, de Souza d'Albuquerque Silva Lilian, Martins Carlliane Lima E Lins Pinto, Neto João Felício Abrahão, de Lemos Manuela Nascimento, de Souza Resende Fabrício, da Silva Wanderson Maia, de Alcântara Angélica Leite, de Oliveira Maria Clara Neres Iunes, de Souza Neto Norberto Jorge Kzan, de Franco Isabela Imbelloni Farias, Zahalan Nathalie Abdallah, Janaú Luísa Correa, de Souza Ana Carolina Contente Braga, Santos Flavia Marques, de Queiroz Natércia Neves Marques, Mourão Neyla Arroyo Lara, Dos Santos Márcia Costa, Felício Karem Miléo, de Melo Franciane Trindade Cunha
机构信息
Endocrinology Division - Programa de Pós-Graduação em Oncologia e Ciências Médicas, University Hospital João de Barros Barreto, Federal University of Pará, Mundurucus Street, 4487, Guamá, Belém, PA Postal Code: 66073-000 Brazil.
出版信息
Diabetol Metab Syndr. 2018 Nov 9;10:81. doi: 10.1186/s13098-018-0380-z. eCollection 2018.
Sensorineural hearing impairment has been associated with DM, and it is probably linked to the same pathophysiological mechanisms as well-established in microvascular diabetes complications. The study of otoacoustic emissions (OAEs) is useful to identify subclinical cochlear dysfunction. Therefore, the aim of this study was to evaluate the association between abnormal OAEs responses, diabetic kidney disease (DKD) and diabetic cardiac autonomic neuropathy (CAN). We performed a cross-sectional study with 37 type 1 DM patients without auditory symptoms, submitted to the study of Distortion Product Otoacoustic Emissions (DPOAEs) and screened for DKD and CAN. The otoacoustic emissions responses were considered abnormal in 27/37 (73%) patients. A correlation was found between abnormal OAEs responses and presence of DKD (r = 0.36, p < 0.05), and 14/16 (88%) patients with a lower amplitude of OAEs in 8 kHz frequency band presented DKD. Abnormal OAEs responses in the 6 kHz frequency band were correlated with the presence (r = 0.41, p = 0.01) and severity of CAN (r = 0.44, p < 0.001). Additionally, 7/9 (78%) patients with abnormal OAE responses in this frequency also presented abnormal CAN scores. Our results suggest that abnormal otoacoustic emissions responses in high frequency bands are associated with diabetes microvascular complications and could be a risk marker for DKD and CAN, presenting low sensitivity and high specificity. Therefore, assuming that hearing impairment is a pre-clinical stage of hearing loss, performing distortion product otoacoustic emissions in T1DM patients with microvascular complications could be useful to identify those who would be benefit with regular audiologic follow up and tighter diabetes control.
感音神经性听力障碍与糖尿病相关，可能与已明确的微血管糖尿病并发症具有相同的病理生理机制。耳声发射（OAE）研究有助于识别亚临床耳蜗功能障碍。因此，本研究旨在评估异常耳声发射反应、糖尿病肾病（DKD）和糖尿病心脏自主神经病变（CAN）之间的关联。我们对37例无听觉症状的1型糖尿病患者进行了横断面研究，对其进行畸变产物耳声发射（DPOAE）研究，并筛查DKD和CAN。在37例患者中，有27例（73%）的耳声发射反应被认为异常。发现异常耳声发射反应与DKD的存在之间存在相关性（r = 0.36，p < 0.05），在8kHz频段耳声发射幅度较低的16例患者中有14例（88%）患有DKD。6kHz频段的异常耳声发射反应与CAN的存在（r = 0.41，p = 0.01）和严重程度（r = 0.44，p < 0.001）相关。此外，该频率耳声发射反应异常的9例患者中有7例（78%）CAN评分也异常。我们的结果表明，高频段异常耳声发射反应与糖尿病微血管并发症相关，可能是DKD和CAN的风险标志物，敏感性低但特异性高。因此，假设听力障碍是听力损失的临床前期，对患有微血管并发症的1型糖尿病患者进行畸变产物耳声发射检查，可能有助于识别那些将从定期听力随访和更严格的糖尿病控制中获益的患者。
Zotero 插件