CAJ | 학술논문

目的：根据临床资料建立预测高压氧（hyperbaric oxygen，HBO）综合治疗突发性耳聋（sudden deafness，SD）预后的评分模型，并评价科学性。方法连续选择188例（221耳）接受高压氧综合治疗的SD患者，随机分为两组：训练样本168例（201耳），验证样本20例（20耳）。采用自身前后对照试验方案，根据训练样本实际疗效分为有效和无效两组，应用X2检验筛选出有统计学意义的危险因素并赋值，建立评分模型，并进行受试者工作特征曲线（receiver operator characteristic curve，ROC）分析。结果 SD伴眩晕、听力曲线呈下降/全聋型、发病至就诊时间≥15 d、HBO治疗疗程＜2个疗程、HBO开始治疗时间≥15 d、就诊平均听力损失≥60 dB HL、SD合并高血压（high blood pressure，HBP）或糖尿病（diabetes mellitus，DM）或二者兼有是影响高压氧综合治疗突发性耳聋预后的危险因素。应用ROC分析该评分模型，曲线下面积(area under the curve,AUC)为0.967，与完全随机情况下获得的曲线下面积(0.5)相比有显著差异，P<0.05。经验证样本前瞻性误判概率评估，误判率约10％。结论根据临床资料建立预测HBO综合治疗SD预后的评分模型可以预估SD预后，对临床治疗有一定指导意义。
목적：근거림상자료건립예측고압양（hyperbaric oxygen，HBO）종합치료돌발성이롱（sudden deafness，SD）예후적평분모형，병평개과학성。방법련속선택188례（221이）접수고압양종합치료적SD환자，수궤분위량조：훈련양본168례（201이），험증양본20례（20이）。채용자신전후대조시험방안，근거훈련양본실제료효분위유효화무효량조，응용X2검험사선출유통계학의의적위험인소병부치，건립평분모형，병진행수시자공작특정곡선（receiver operator characteristic curve，ROC）분석。결과 SD반현훈、은력곡선정하강/전롱형、발병지취진시간≥15 d、HBO치료료정＜2개료정、HBO개시치료시간≥15 d、취진평균은력손실≥60 dB HL、SD합병고혈압（high blood pressure，HBP）혹당뇨병（diabetes mellitus，DM）혹이자겸유시영향고압양종합치료돌발성이롱예후적위험인소。응용ROC분석해평분모형，곡선하면적(area under the curve,AUC)위0.967，여완전수궤정황하획득적곡선하면적(0.5)상비유현저차이，P<0.05。경험증양본전첨성오판개솔평고，오판솔약10％。결론근거림상자료건립예측HBO종합치료SD예후적평분모형가이예고SD예후，대림상치료유일정지도의의。
Objective To establish a scoring model that predicts the prognosis of patients with sudden deafness after hyperbaric oxygen therapy based on clinical data and to evaluate the efficacy of the model. Methods 188 patients with sudden deafness(221 ears)who received hyperbaric oxygen therapy were divided into two groups: 168 patients(201 ears) in training group and 20 patients(20 ears)in testing group. With a self-controlled experimental design, the training group were divided into the effective group and ineffective group. Chi-square test was applied to choose statistically significant risk factors which were used to establish a scoring model. Receiver operator characteristic (ROC) curve was then used to analyze the scoring model. Results The factors that had adverse effects on the prognosis of patients with sudden deafness after hyperbaric oxygen therapy included sudden deafness with vertigo, descending/completely deaf audiogram, prehospital delay time≥15 d, hyperbaric oxygen therapy<2 courses, beginning time of treatment≥fifteen days after onset, average hearing loss at the first visit≥60 dB HL, sudden deafness with HBP(high blood pressure)/DM(diabetes mellitus)or both. The ROC curve analysis revealed that the area under the curve (AUC) for the scoring model was 0.967, which was significantly different from the AUC(0.5) under the completely random circumstances(P<0.05). The appraisal of prospective misjudge possibility was applied to the scoring model in testing samples and the results showed the misjudgement rate was about 10%. Conclusion This scoring model based on clinical data can be used to predict the prognosis of patients with sudden deafness after hyperbaric oxygen therapy.