儿童先天性感音神经性聋传导通路DTI参数与预后的关系分析
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喀什地区第二人民医院

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新疆维吾尔自治区自然科学基金(2017D01C086)


Analysis of relationship between DTI parameters of conduction pathway and prognosis in children with congenital sensorineural hearing-loss
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    摘要:

    摘要 目的:探讨儿童先天性感音神经性聋传导通路磁共振弥散张量成像(DTI)参数与预后的关系。方法:选取2017年1月~2020年3月本院收治的136例先天性感音神经性耳聋儿童归为观察组,另选取同期118例体检正常听力儿童归为对照组,均行头部DTI检查,包括双侧斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、窝背侧核、下丘、窝腹侧核、听神经区域的表现弥散系数(ADC)值与各向异性分数(FA)值。对比观察组、对照组以上各部位的ADC值、FA值。另治疗后随访1年,根据听觉行为分级标准评分(CAP)将观察组患儿分为预后良好组与预后不良组,对比预后良好组与预后不良组各部位的ADC值、FA值,并分析各部位的ADC值、FA值与CAP评分的相关性。结果:观察组与对照组的斜方体、内侧膝状体、窝背侧核、下丘、窝腹侧核、听神经区域ADC值比较差异均无统计学意义(P>0.05),窝背侧核、窝腹侧核、听神经区域FA值比较差异均无统计学意义(P>0.05);观察组颞横回、颞上回、听辐射、上橄榄核区的ADC值均高于对照组(P<0.05),斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、下丘区的FA值均低于对照组(P<0.05);术后1年,观察组患儿预后良好率、预后不良率分别为65.44%(89/136)、34.56%(47/136);预后不良组与预后不良组的斜方体、内侧膝状体、窝背侧核、下丘、窝腹侧核、听神经区域ADC值以及窝背侧核、窝腹侧核、听神经区域FA值比较差异均无统计学意义(P>0.05),预后不良组颞横回、颞上回、听辐射、上橄榄核区的ADC值均高于预后良好组(P<0.05),斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、下丘区的FA值均低于预后良好组(P<0.05);经Pearson相关性分析,先天性神经感音性聋患儿斜方体、内侧膝状体、窝背侧核、下丘、窝腹侧核、听神经区域的ADC值与CAP评分无相关性(P>0.05),窝背侧核、窝腹侧核、听神经区域的FA值与CAP评分无相关性(P>0.05),颞横回、颞上回、听辐射、上橄榄核的ADC值与CAP评分均呈负相关性(P<0.05),斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、下丘的FA值与CAP评分均呈正相关性(P<0.05)。结论:先天性感音神经性耳聋患儿存在听觉传导通路上某些特定位置的DTI参数异常情况,且该DTI参数变化与预后关系密切,其中颞横回、颞上回、听辐射、上橄榄核区的ADC值均与患儿术后听力恢复效果负相关,而斜方体、颞横回、颞上回、内侧膝状体、听辐射、上橄榄核、下丘区的FA值均与术后听力恢复效果正相关,此对临床诊治具有重要指导作用。

    Abstract:

    [Abstract] Objective: To investigate the relationship between diffusion tensor imaging (DTI) parameters of magnetic resonance of conduction pathway and prognosis in children with congenital sensorineural hearing-loss. Methods: 136 children with congenital sensorineural hearing-loss treated in our hospital from January 2017 to March 2020 were selected as observation group, and 118 children with normal hearing at the same period were selected as control group, and all of them were examined by DTI, including apparent dispersion coefficient (ADC) value and fractional anisotropy (FA) value of bilateral trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus, dorsal fossa nucleus, inferior colliculus, ventral fossa nucleus and auditory nerve area. The ADC and FA values of the above parts of the observation group and control group were compared. In addition, followed up for 1 year after treatment, and the observation group was divided into good prognosis group and poor prognosis group according to the categories of auditory performance (CAP), and the ADC value and FA value of each part between the good prognosis group and the poor prognosis group were compared, and the correlation between ADC value, FA value and CAP score were analyzed. Results: There was no significant difference in the ADC values of trapezoid, medial geniculate body, fossa dorsal nucleus, inferior colliculus, fossa ventral nucleus and auditory nerve between the observation group and the control group (P > 0.05), and there was no significant difference in the FA values of dorsal fossa nucleus, ventral fossa nucleus and auditory nerve between the two groups (P > 0.05). The ADC values of transverse temporal gyrus, superior temporal gyrus, auditory radiation and superior olivary nucleus in the observation group were higher than those in the control group (P < 0.05), and the FA values of trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus and inferior colliculus were lower than those in the control group (P < 0.05). One year after operation, the good prognosis rate and poor prognosis rate of the observation group were 65.44% (89/136) and 34.56% (47/136) respectively, and there was no significant difference in ADC values of trapezium, medial geniculate body, dorsal fossa nucleus, inferior colliculus, ventral fossa nucleus and auditory nerve area and FA values of dorsal fossa nucleus, ventral fossa nucleus and auditory nerve area between the two groups (P > 0.05), but the ADC values of transverse temporal gyrus, superior temporal gyrus, auditory radiation and superior olivary nucleus in poor prognosis group were higher than those in good prognosis group (P < 0.05), while the FA values of trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus and inferior colliculus were lower than those in good prognosis group (P < 0.05). Pearson correlation analysis showed that there was no correlation between the ADC values of the trapezoid body, medial geniculate body, dorsal fossa nucleus, inferior colliculus, ventral fossa nucleus and auditory nerve area and CAP score (P > 0.05), and there was no correlation between FA of the dorsal fossa nucleus, ventral fossa nucleus and auditory nerve area and CAP score (P > 0.05), but the ADC values of transverse temporal gyrus, superior temporal gyrus, auditory radiation and superior olivary nucleus were negatively correlated with CAP score (P < 0.05), while FA values of trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus and inferior colliculus were positively correlated with CAP score (P < 0.05). Conclusion: There are abnormal DTI parameters at some specific positions in the auditory conduction pathway in children with congenital sensorineural hearing-loss, and the changes of DTI parameters are closely related to prognosis, and the ADC values of transverse temporal gyrus, superior temporal gyrus, auditory radiation and superior olivary nucleus are negatively correlated with postoperative hearing recovery effect, but the FA values of trapezoid body, transverse temporal gyrus, superior temporal gyrus, medial geniculate body, auditory radiation, superior olivary nucleus and inferior colliculus are positively correlated with the postoperative hearing recovery effect, which have an important guiding role in clinical diagnosis and treatment.

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  • 收稿日期:2021-08-26
  • 最后修改日期:2021-11-23
  • 录用日期:2021-11-24
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