突发性聋伴眩晕患者的临床特征、预后影响因素及预测模型构建OA

Objective To investigate the clinical characteristics of patients with sudden sensorineural hearing loss(SSNHL)accompanied by vertigo,to analyze key factors influencing therapeutic outcomes,and to construct and validate a logistic regression model for prognostic prediction,thereby providing a basis for individualized treatment decision-making.Methods A retrospective cohort study was conducted including 156 patients with SSNHL.Univariate analysis was performed using t-tests and chi-square tests.Based on clinical variables such as time from onset,age,degree of hearing loss and tinnitus,two stepwise logistic regression models(a basic model and an adjusted model)were constructed for multivariate analysis.Model 1 adopted the backward:LR method for variable selection.Model 2,on the basis of Model 1,additionally incorporated vestibular function-related variables and was analyzed using the enter method.Results Among the 156 patients,40-59 years old accounted for the highest proportion(43.6%),53.8%(84/156)were male,52.6%(82/156)had left-sided onset,62.2%(97/156)had onset time≤7 days,and profound hearing loss on admission accounted for the highest proportion(39.7%,62/156).Chi-square analysis showed that onset time was significantly correlated with discharge efficacy(P=0.038),and the effective rate of patients treated≤7 d(46.4%)was significantly higher than that of patients treated≥15 d(21.2%).Tinnitus was marginally correlated with efficacy(P=0.053),and the effective rate was higher in patients without tinnitus.Logistic regression showed that onset time≥15 d(OR=0.201,95%CI=0.073-0.552)and tinnitus(OR=0.193,95%CI=0.043-0.865)were the main adverse prognostic factors.Total cholesterol(CHOL,OR=0.353,95%CI=0.133-0.940),low-density lipoprotein(LDL,OR=3.763,95%CI=1.281-11.048),prothrombin time(PT,OR=0.825,95%CI=0.685-0.993)and activated partial thromboplastin time(APTT,OR=1.093,95%CI=1.000-1.195)were also independent influencing factors.The model sensitivity and specificity were 50.8%and 82.8%,respectively.After including vestibular function indicators,total cholesterol(OR=0.363),LDL(OR=3.454),onset time≥15 d(OR=0.187),tinnitus(OR=0.160)and side(OR=0.454)were still independent influencing factors,and the model sensitivity and specificity increased to 58.7%and 84.9%,respectively.Conclusion Onset time,initial hearing loss degree and tinnitus are the main factors affecting the discharge efficacy of SSNHL patients with vertigo.Time from onset to treatment≥15 d indicates a significantly worse prognosis.Blood lipid metabolism indicators'such as total cholesterol and LDL,as well as coagulation function parameters,are also related to efficacy,suggesting that inner ear microcirculation disturbance and hypercoagulable state play an important role in the disease process.The inclusion of vestibular function indicators'such as spontaneous nystagmus and video head impulse test(vHIT)can further improve the efficacy of the prognostic evaluation model,help to identify high-risk people with poor prognosis early,and guide the formulation of individualized treatment plans.