目的 探讨梅尼埃病耳蜗与前庭功能损害程度的相关性及不同程度病变的临床特征.方法 对符合诊断标准的44例梅尼埃病患者进行纯音测听,畸变产物耳声发射、Metz重振试验、听性脑干反应(ABR)、耳蜗电图(ECochG)、甘油试验等听力学检查及双温试验、Fukuda踏步试验等前庭功能检查.将测试结果用耳蜗与前庭功能损害的综合评价函数进行评价,同时根据0.5、1、2 kHz平均听阈,将病例分成Ⅰ组6例(平均听阈<25 dB HL)、Ⅱ组13例(平均听阈25～40 dB HL)、Ⅲ组25例(平均听阈41～70 dB HL).结果 Ⅰ、Ⅱ、Ⅲ组-SP/AP阳性率和CP异常率呈上升趋势,各组间差异有统计学意义(P＜0.05).半规管功能异常者(25例)中纯音听阈值、-SP/AP值和耳蜗电图阳性率明显高于半规管功能正常者(19例)(P＜0.05).ECochG阳性者(28例)Metz重振试验,甘油试验阳性率显著高于ECochG阴性者(16例)(P＜0.05).耳蜗功能损害的综合评价函数为f1=0.212 X11+0.259X12+0.429 X13+0.367 X14前庭功能损害的综合评价函数为f2=0.275 X21+0.375 X22+0.398 X23+0.119X24,综合评价函数f1与f2呈正相关性(r=0.395,P＜0.05).结论 梅尼埃病耳蜗功能与前庭功能损害程度呈较弱正相关性,运用主成分分析法构建的综合评价模型可以较全面综合原始变量信息,合理反映耳蜗和前庭功能损伤程度,为疾病诊断、治疗选择和疗效评价提供依据.%Objective To investigate the correlations between the cochlear and vestibular dysfunctions and to study the clinical features of different pathological changes in Meniere’s disease.Methods 44 patients diagnosed as Meniere's disease according to the 2006 Guiyang Diagnosis Standard received audiologic and vestibular assessments,including pure tone audiometry, distortion product otoacoustic emission(DPOAE), auditory brainstem response (ABR), electrocochleography(EcochG), Metz s recruitment test, the glycerol test, vestibular caloric test , and fukuda stepping test.The comprehensive evaluation functions of cochlear and vestibular dysfunctions were administered.According to hearing impairment, Meniere cases were divided into three groups: Group 1(＜25 dB HL)with 6 cases, Group 2(25～40 dB HL)with 13 cases and Group 3 (41～70 dB HL)with 25 cases.Results The positive rate of -sp/ap ratio and the abnormal percentage of semicircular canals function increased with Group 1, 2 and 3 (P ＜0.05).The auditory thresholds, -SP/AP ratios and the positive rates of electrocochleography in the abnormal group of semicircular canals function were significantly higher than the normal group with statistically significant differences (P＜0.05).The positive rates of Metz’s recruitment test and glycerol test in group EcochG(+) were significantly higher than that of group EcochG(- )(P＜0.05).The comprehensive evaluation functions of cochlear and vestibular dysfunctions were as follows: f1=0.212X11 +0.259 X12 +0.429 X13 +0.367 X14, f2= 0.275 X21 +0.375X22 + 0.398X23 + 0.119X24.There was a positive correlation between f1 and f2 (r= 0.395, P＜0.05 ).Conclusion There is a positive correlation between cochlear and vestibular dysfunctions in Meniere's disease.The comprehensive evaluation functions obtained from the principal component analysis could completely synthesize the original variables, and reasonably reflect the degree of injury at cochlear and vestibular function.It will provide me evidences for disease diagnosis, treatment selection and curative effect.
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