Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Muhammadiyah Sumatera Utara, Medan, Sumatera Utara, Indonesia.
Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universitas Sumatera Utara, Medan, Sumatera Utara, Indonesia.
J Chin Med Assoc. 2019 Apr;82(4):272-276. doi: 10.1097/JCMA.0000000000000036.
Rheumatoid arthritis (RA) is an autoimmune disease. Sensorineural and conductive hearing loss have been reported in RA, but the results of most studies are not in agreement. The pathogenesis of the hearing loss is not clearly understood. The presence of sensorineural hearing loss was related to matrix metalloproteinase-3 (MMP-3). The aim of this study was to assess hearing loss in RA patients and to examine the correlation between plasma MMP-3 levels and hearing loss in such patients.
This is a cross-sectional and analytic research. Subjects consisted of 21 RA patients with hearing loss as a study group and 21 RA patients without hearing loss as controls. All patients were evaluated by pure tone audiometry and tympanometry. The amounts of plasma MMP-3 were determined using enzyme-linked immunosorbent assay. Pearson Chi-square test was used to determine the correlation of gender, age, disease duration, erythrocyte sedimentation rate, and platelet count of both groups. Independent t-test was used to assess equality of mean values at 250 to 8000 Hz hearing thresholds, pure tone mean values, air-bone gaps, and MMP-3 plasma levels of both groups.
This study found sensorineural (76.2%), conductive (14.3%), and mixed (9.5%) hearing loss. The most common degree of hearing loss was mild (66.7%). There was an increased incidence of As-type tympanogram in the study group (28.6%) and control group (47.6%). There were significant differences between both groups in mean hearing thresholds (p < 0.001), mean of air conduction thresholds at 1000 to 8000 Hz (p < 0.05), and mean of bone conduction thresholds in all frequencies (p < 0.05). The significant difference of mean MMP-3 levels was also found between the groups (p < 0.001).
Hearing loss is a common finding in RA. MMP-3 plasma contributed to degrade the incudomalleolar and incudostapedial joints and could damage the inner ear hair cells due to oxidative process in RA.
类风湿关节炎（RA）是一种自身免疫性疾病。已有报道称 RA 患者存在感音神经性和传导性听力损失，但大多数研究的结果并不一致。听力损失的发病机制尚不清楚。感音神经性听力损失的存在与基质金属蛋白酶-3（MMP-3）有关。本研究旨在评估 RA 患者的听力损失，并检查此类患者血浆 MMP-3 水平与听力损失之间的相关性。
这是一项横断面分析研究。研究对象包括 21 例听力损失的 RA 患者（观察组）和 21 例听力正常的 RA 患者（对照组）。所有患者均进行纯音听阈测试和鼓室导抗测试。采用酶联免疫吸附试验测定血浆 MMP-3 含量。采用 Pearson Chi-square 检验比较两组患者的性别、年龄、病程、红细胞沉降率和血小板计数。采用独立样本 t 检验比较两组患者 250-8000Hz 听阈均值、纯音听阈均值、气骨导差值及 MMP-3 血浆水平的差异。
本研究发现感音神经性（76.2%）、传导性（14.3%）和混合性（9.5%）听力损失。最常见的听力损失程度为轻度（66.7%）。观察组（28.6%）和对照组（47.6%）A型鼓室图的发生率较高。两组患者的平均听阈（p<0.001）、1000-8000Hz 气导听阈均值（p<0.05）和各频率骨导听阈均值（p<0.05）差异均有统计学意义。两组 MMP-3 水平的差异也有统计学意义（p<0.001）。
听力损失是 RA 的常见表现。MMP-3 可能通过氧化过程降解砧镫关节，导致 RA 患者内耳毛细胞损伤，从而导致听力损失。
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