283例全频下降型突聋患者的临床特征及预后分析

Clinical Characteristics and Prognosis Analysis of 283 Patients with Sudden Deafness with Full-Frequency Hearing Loss

摘要: 目的：探讨全频下降型突发性聋患者的临床特征及预后影响因素。方法：回顾性分析283例全频下降型突聋患者，按疗效分为有效组(167例)与无效组(116例)。比较两组基线及实验室指标，采用单因素分析、多因素Logistic回归分析预后影响因素，并采用线性趋势检验分析就诊延误时间与预后的剂量–反应关系。结果：总有效率59.0%。单因素分析显示年龄、就诊延误时间、听力曲线分型、PLR、SII、FIB、PT组间差异有统计学意义(均P < 0.05)。多因素Logistic回归显示，年龄增大(OR = 1.107, 95% CI: 1.064, 1.152)、就诊延误时间延长(OR = 1.222, 95% CI: 1.122, 1.332)、纤维蛋白原升高(OR = 2.442, 95% CI: 1.398, 4.264)是预后不良的独立危险因素(均P < 0.05)。剂量–反应分析显示，随就诊延误时间延长，有效率呈阶梯式下降(≤3天：76.5%；4~7天：59.0%；8~14天：50.0%；>14天：35.3%)，线性趋势检验差异有统计学意义(χ² = 28.643, P < 0.001)。结论：全频下降型突聋预后与年龄、就诊延误时间、FIB密切相关，就诊延误时间与预后存在明确剂量–反应关系。临床应尽早干预，重点关注高危患者。

Abstract: Objective: To investigate the clinical characteristics and prognostic factors of patients with sudden sensorineural hearing loss (SSNHL) with full-frequency decline. Methods: A retrospective analysis was conducted on 283 patients with full-frequency decline SSNHL, who were divided into a favorable outcome group (n = 167) and an unfavorable outcome group (n = 116) according to treatment response. Baseline characteristics and laboratory parameters were compared between the two groups. Univariate analysis and multivariate logistic regression were used to identify prognostic factors. The dose-response relationship between treatment delay and prognosis was examined using the linear-by-linear association test. Results: The overall response rate was 59.0%. Univariate analysis showed significant differences between the two groups in age, treatment delay, audiogram classification, PLR, SII, FIB, and PT (all P < 0.05). Multivariate logistic regression identified increased age (OR = 1.107, 95% CI: 1.064, 1.152), prolonged treatment delay (OR = 1.222, 95% CI: 1.122, 1.332), and elevated fibrinogen (FIB, OR = 2.442, 95% CI: 1.398, 4.264) as independent risk factors for poor prognosis (all P < 0.05). Dose-response analysis demonstrated a stepwise decrease in response rate with longer treatment delay (≤3 days: 76.5%; 4~7 days: 59.0%; 8~14 days: 50.0%; >14 days: 35.3%; χ² = 28.643, P < 0.001). Conclusion: The prognosis of full-frequency decline SSNHL is closely associated with age, treatment delay, and FIB level. A clear dose-response relationship exists between treatment delay and prognosis. Early intervention and close monitoring of high-risk patients are recommended.