基于倾向得分匹配研究乳突气化程度与内淋巴囊发育的关系

doi:10.6040/j.issn.1673-3770.0.2021.369

摘要/Abstract

摘要： 目的探讨乳突气化程度与内淋巴囊发育情况的关系。方法回溯收集2019年1月至2021年5月就诊于耳鼻喉科且行颞骨CT检查的患者共145例(290耳),经过筛选后,根据患者乳突气化程度分为气化良好及气化不良,对其采用1∶1最临近匹配,倾向得分(PS)设置为0.02,基于年龄、中耳炎对协变量进行倾向得分匹配(PSM),该分析共产生了58对配对数据,随即测量后半规管中段至颞骨岩部后缘最短距离(P-P值),以其间接反映内淋巴囊发育情况,对不同乳突气化程度的P-P值进行统计学分析。结果 P-P值的中位数(四分位间距)为2.26(1.49,3.08)mm;乳突气化程度与P-P值之间的差异无统计学意义,即乳突气化程度与内淋巴囊发育情况无关;经PSM处理后的协变量与乳突气化之间的差异均无统计学意义,即倾向得分匹配在临床研究中可以有效地处理非随机实验数据中的选择性偏倚问题;乳突气化程度与中耳炎之间的差异有统计学意义,即乳突气化程度与中耳炎性疾病相关,且乳突气化程度良好组,中耳炎发生率较低。结论乳突气化程度与内淋巴囊发育情况无关。

关键词: 内淋巴囊发育, 乳突气化程度, 后半规管中段至颞骨岩部后缘最短距离, 倾向得分匹配, 宝石能谱CT

Abstract: Objective To explore the relationship between the degree of mastoid pneumatization and the development of the endolymphatic sac. Methods A retrospective study of 145 patients(290 ears)who underwent temporal bone CT examination from January 2019 to May 2021 in the Department of Otolaryngology. After screening, the patients were divided into the well- pneumatized and the poorly-pneumatized groups, according to the degree of mastoid pneumatization. The 1∶1 closest match was adopted. The propensity score(PS)was set at 0.02. The propensity score matching(PSM)analysis was performed on covariates based on age and otitis media. The analysis produced 58 sets of paired data. The shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)was used to indirectly reflect the development of the endolymphatic sac. The shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)of different degrees of pneumatization was analyzed statistically. Results The median(interquartile range)of the shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)was 2.26(1.49, 3.08)mm. The difference between the degree of mastoid pneumatization and the shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface(P-P value)was not statistically significant. That is, the degree of mastoid pneumatization was not associated with the development of the endolymphatic sac. There were no statistically significant differences in the general data processed after PSM in the two mastoid pneumatization groups. That is, the propensity score matching was effective in managing the selection deviation of non-random experimental data in clinical research. There was a statistically significant difference in the degree of mastoid pneumatization and otitis media; in the group with good mastoid pneumatization, the incidence of otitis media is lower. Conclusion There is no correlation between the degree of mastoid pneumatization and the development of the endolymphatic sac.

Key words: Endolymphatic sac development, Degree of mastoid pneumatization, The shortest distance between the middle of the posterior semicircular canal and the posterior edge of the posterior petrous surface, Propensity score matching, Gem energy spectrum CT

中图分类号:

R764.3

韩书慧, 范新泰, 王娜, 王喆, 侯凌霄, 许安廷. 基于倾向得分匹配研究乳突气化程度与内淋巴囊发育的关系[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 22-26.

HAN Shuhui, FAN Xintai, WANG Na, WANG Zhe, HOU Lingxiao, XU Anting. A study on the relationship between mastoid pneumatization degree and endolymphatic sac development based on a propensity score matching analysis[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2022, 36(4): 22-26.

参考文献

[1] 卜慧, 陈平. 大前庭水管综合征影像学相关研究进展[J]. 临床耳鼻咽喉头颈外科杂志, 2018, 32(8): 639-642. doi:10.13201/j.issn.1001-1781.2018.08.021. BU Hui, CHEN Ping. Research progress in imaging of large vestibular aqueduct syndrome[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2018, 32(8): 639-642. doi:10.13201/j.issn.1001-1781.2018.08.021.
[2] Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions[J]. BMJ, 2016, 355: 4919. doi:10.1136/bmj.i4919.
[3] 黄选兆,汪吉宝,孔维佳. 实用耳鼻咽喉头颈外科学[M]. 2版. 北京: 人民卫生出版社, 2008.
[4] Ertugrul S, Keskin NK. Relationship between the degree of mastoid pneumatization and the presence of persistent foramen of Huschke[J]. Int J Oral Maxillofac Surg, 2019, 48(8): 1072-1076. doi:10.1016/j.ijom.2019.01.022.
[5] 陆银萍, 刘平, 闫鑫. 慢性中耳炎患者双侧乳突气化程度不对称性分析[J]. 中国耳鼻咽喉头颈外科, 2020, 27(1): 1-3. doi:10.16066/j.1672-7002.2020.01.001. LU Yinping, LIU Ping, YAN Xin. Asymmetric analysis of bilateral mastoid pneumatization in patients with unilateral chronic otitis media[J]. Chinese Archives of Otolaryngology-Head and Neck Surgery, 2020, 27(1): 1-3. doi:10.16066/j.1672-7002.2020.01.001.
[6] 杨名保, 韩晓东, 赵海亮, 等. 正常成人乳突气腔容积与儿童期中耳炎病史的相关性研究[J]. 听力学及言语疾病杂志, 2016, 24(2): 145-148. doi:10.3969/j.issn.1006-7299.2016.02.009. YANG Mingbao, HAN Xiaodong, ZHAO Hailiang, et al. The correlation of normal adult mastoid pneumatization volume and the history of otitis media in childhood[J]. Journal of Audiology and Speech Pathology, 2016, 24(2): 145-148. doi:10.3969/j.issn.1006-7299.2016.02.009.
[7] 赵赫, 杨艳平, 蔡青, 等. 梅尼埃病内淋巴积水机理研究进展[J]. 中国耳鼻咽喉颅底外科杂志, 2019, 25(5): 567-572. doi:10.11798/j.issn.1007-1520.201905025. ZHAO He, YANG Yanping, CAI Qing, et al. Research progress on mechanism of endolymphatic hydronephrosis in Meniere's disease[J]. Chinese Journal of Otorhinolaryngology-Skull Base Surgery, 2019, 25(5): 567-572. doi:10.11798/j.issn.1007-1520.201905025.
[8] Li H, Rajan GP, Shaw J, et al. A synchrotron and micro-CT study of the human endolymphatic duct system: is Meniere's disease caused by an acute endolymph backflow? [J]. Front Surg, 2021, 8: 662530. doi:10.3389/fsurg.2021.662530.
[9] Ito T, Inui H, Miyasaka T, et al. Relationship between changes in hearing function and volumes of endolymphatic Hydrops after endolymphatic sac drainage[J]. Acta Otolaryngol, 2019, 139(9): 739-746. doi:10.1080/00016489.2019.1630757.
[10] Liu YP, Yang J, Duan ML. Current status on researches of Meniere's disease: a review[J]. Acta Otolaryngol, 2020, 140(10): 808-812. doi:10.1080/00016489.2020.1776385.
[11] Nevoux J, Barbara M, Dornhoffer J, et al. International consensus(ICON)on treatment of Ménière's disease[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2018, 135(1S): S29-S32. doi:10.1016/j.anorl.2017.12.006.
[12] Flores García ML, Llata Segura C, Cisneros Lesser JC, et al. Endolymphatic sac surgery for ménière's disease-current opinion and literature review[J]. Int Arch Otorhinolaryngol, 2017, 21(2): 179-183. doi:10.1055/s-0037-1599276.
[13] Scarpa A, Ralli M, de Bonis E, et al. Pharmacological, surgical and diagnostic innovations in Meniere's disease: a review[J]. Transl Med UniSa, 2020, 23: 48-52.
[14] Ito T, Inui H, Miyasaka T, et al. Three-dimensional magnetic resonance imaging reveals the relationship between the control of Vertigo and decreases in endolymphatic Hydrops after endolymphaticsac drainage with steroids for Meniere's disease[J]. Front Neurol, 2019, 10: 46. doi:10.3389/fneur.2019.00046.
[15] 于浩然, 杨军. 内淋巴囊手术治疗梅尼埃病的历史演变与新进展[J]. 临床耳鼻咽喉头颈外科杂志, 2016, 30(17): 1410-1414. doi:10.13201/j.issn.1001-1781.2016.17.019. YU Haoran, YANG Jun. Historical evolution and frontier of endolymphatic sac surgery for treatment of Ménière's disease[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2016, 30(17): 1410-1414. doi:10.13201/j.issn.1001-1781.2016.17.019.
[16] 鹿培泉, 马芙蓉. 梅尼埃病病因学研究进展[J]. 中国医学文摘(耳鼻咽喉科学), 2006, 21(3): 179-181. doi:10.19617/j.issn1001-1307.2006.03.016. LU Peiquan, MA Furong. Research progress on the etiology of Meniere's disease[J]. Chinese Medical Abstracts Otorhinolaryngology, 2006, 21(3): 179-181. doi:10.19617/j.issn1001-1307.2006.03.016.
[17] 肖本杰, 庄建华. 梅尼埃病研究进展[J]. 中国现代神经疾病杂志, 2019, 19(2): 81-84. doi:10.3969/j.issn.1672-6731.2019.02.002. XIAO Benjie, ZHUANG Jianhua. Research advances in Ménière disease[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2019, 19(2): 81-84. doi:10.3969/j.issn.1672-6731.2019.02.002.
[18] Fukushima M, Akahani S, Inohara H, et al. Case report: positive pressure therapy combined with endolymphatic sac surgery in a patient with ménière disease[J]. Front Surg, 2021, 8: 606100. doi:10.3389/fsurg.2021.606100.
[19] 何白慧, 杨军. 梅尼埃病内淋巴囊手术不同术式的机制[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(1): 91-95. doi:10.13201/j.issn.1001-1781.2020.01.023. HE Baihui, YANG Jun. A review of endolymphatic sac-related surgeries and their possible mechanisms[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2020, 34(1): 91-95. doi:10.13201/j.issn.1001-1781.2020.01.023.
[20] 王辉兵, 孙悍军, 李健, 等. 半规管阻塞术与内淋巴囊减压术治疗中晚期梅尼埃病的远期疗效[J]. 中华耳科学杂志, 2021, 19(4): 546-550. doi:10.3969/j.issn.1672-2922.2021.04.001. WANG Huibing, SUN Hanjun, LI Jian, et al. Long-term efficacy comparison between semicircular canal occlusion and endo-lymphatic sac decompression in intractable meniere's disease[J]. Chinese Journal of Otology, 2021, 19(4): 546-550. doi:10.3969/j.issn.1672-2922.2021.04.001.
[21] Yazawa Y, Kitahara M. Computed tomographic findings around the vestibular aqueduct in meniere's disease[J]. Acta Oto Laryngol, 1991, 111(sup481): 88-90. doi:10.3109/00016489109131353.
[22] le HB, Zhang HH, Tao WJ, et al. Clinicoradiologic characteristics of endolymphatic sac tumors[J]. Eur Arch Otorhinolaryngol, 2019, 276(10): 2705-2714. doi:10.1007/s00405-019-05511-8.
[23] 卢飞燕, 卢永田, 周俊伟, 等. 内镜下经外耳道耳蜗下径路切除岩尖病变的应用解剖学研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(5): 62-68.doi:10.6040/j.issn.1673-3770.0.2019.177. LU Feiyan, LU Yongtian, ZHOU Junwei, et al. Applied anatomy of endoscopic resection of the petrous apex through the transcanal infracochlear approach[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(5): 62-68.doi:10.6040/j.issn.1673-3770.0.2019.177.
[24] Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects[J]. Biometrika, 1983, 70(1): 41-55. doi:10.1093/biomet/70.1.41.
[25] Austin PC, Jembere N, Chiu M. Propensity score matching and complex surveys[J]. Stat Methods Med Res, 2018, 27(4): 1240-1257. doi:10.1177/0962280216658920.
[26] 徐浩, 王婉宜, 肖川, 等. 倾向得分法与倍差法在我国卫生政策评估领域的应用[J]. 中国预防医学杂志, 2016, 17(6): 451-454. doi:10.16506/j.1009-6639.2016.06.012. XU Hao, WANG Wanyi, XIAO Chuan, et al.The application of propensity scoring method and double difference method in the field of health policy evaluation in China[J]. Chinese Preventive Medicine, 2016, 17(6): 451-454. doi:10.16506/j.1009-6639.2016.06.012.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed