Abstract:

Objective　To explore the correlations between serum cysteine-aspartic protease-3 (Caspase-3) and soluble vascular endothelial growth factor receptor 1 (sFIt-1) levels and condition and prognosis in patients with sudden hearing loss. Methods　This study retrospectively analyzed 78 patients with sudden hearing loss treated at Shaanxi Provincial People's Hospital from January 2022 to January 2024 as a research group, including 46 males and 32 females, aged 32-76 (47.92±4.65) years, with a body mass index of 20.37-27.94 (24.57±3.24) kg/m². Additionally, 38 healthy individuals undergoing physical examinations were selected as a reference group, including 21 males and 17 females, aged 34-63 (48.23±4.81) years, with a body mass index of 19.86-22.51 (20.87±2.39) kg/m². Pure tone audiometry (PTA) was used to evaluate the patients with sudden hearing loss, and the patients were divided into 16 cases in the severe group (PTA >60 dBHL), 39 cases in the moderate group (PTA >40-60 dBHL), and 23 cases in the mild group (PTA 20-40 dBHL). All patients received treatments such as steroids and neurotrophic drugs for 10 days as a course of treatment, and the prognosis was evaluated after 10 days. According to the prognosis, the patients with sudden hearing loss after treatment were divided into a good prognosis group (57 cases) and a poor prognosis group (21 cases). Serum Caspase-3 and sFIT-1 levels were detected by enzyme-linked immunosorbent assay (ELISA). General data of the subjects were collected, including gender, age, body mass index, course of disease, clinical symptoms, site of hearing loss, degree of hearing loss, and underlying diseases. Independent sample t test, repeated measure ANOVA, and χ² test were used for statistical analysis. Spearman rank correlation coefficient was used for correlation analysis. Multivariate logistic regression analysis was used to identify factors influencing poor prognosis in patients with sudden hearing loss. The receiver operating characteristic curve (ROC) was plotted to analyze the diagnostic value of serum Caspase-3 and sFIt-1 in predicting the prognosis of sudden hearing loss patients. Results　Serum Caspase-3 and sFIT-1 levels in the study group were higher than those in the reference group [(17.27±3.14) ng/L vs. (6.63±1.67) ng/L, (157.82±13.47) ng/L vs. (81.67±10.63) ng/L] (both P<0.05). Serum Caspase-3 and sFIT-1 levels in the severe and moderate groups were higher than those in the mild group, and the above indexes in the severe group were higher than those in the moderate group (all P<0.05). Spearman correlation analysis showed that serum Caspase-3 and sFIT-1 levels in patients with sudden hearing loss were positively correlated with the severity of the disease (r=0.881 and 0.841, both P<0.05). There were statistically significant differences in the age, severity of hearing loss, and serum Caspase-3 and sFIT-1 levels between the poor prognosis group and the good prognosis group (all P<0.05). Multivariate logistic regression analysis showed that the severity of hearing loss (OR: 0.009, 95%CI: 0.000-0.209), age (OR: 1.165, 95%CI: 1.049-1.293), and serum Caspase-3 (OR: 1.546, 95%CI: 1.183-2.022) and sFIT-1 levels (OR: 1.058, 95%CI: 1.015-1.104) were the prognostic factors in patients with sudden hearing loss (all P<0.05). ROC analysis results showed that the area under the curve (AUC) predicted by serum Caspase-3 combined with sFIt-1 was greater than that predicted by serum Caspase-3 and sFIt-1 alone. The sensitivity of joint prediction was 66.67%, the specificity was 87.72%, and the AUC was 0.819 (0.712-0.925); the sensitivity of Caspase-3 was 52.38%, the specificity was 82.46%, and the AUC was 0.721 (0.593-0.849); the sensitivity of FIT-1 was 52.38%, the specificity was 84.21%, and the AUC was 0.703 (0.573-0.832). Conclusions　Serum levels of Caspase-3 and sFIt-1 are significantly correlated with the degree of hearing loss and prognosis in patients with sudden hearing loss. Combined detection of these biomarkers can effectively predict the severity and prognosis of the disease, serving as biological indicators for evaluating the prognosis of this condition.

Key words:

Sudden hearing loss, Cysteine-aspartic protease-3, Soluble vascular endothelial growth factor receptor 1, Prognosis, Relationship

摘要：

目的　探讨血清半胱氨酸天冬氨酸蛋白酶3（Caspase-3）、可溶性血管内皮生长因子受体-1（sFIt-1）水平与突发性耳聋患者病情及预后的关系。方法　选取2022年1月至2024年1月陕西省人民医院收治的78例突发性耳聋患者作为研究组。男46例，女32例；年龄32～76（47.92±4.65）岁；体重指数20.37～27.94（24.57±3.24）kg/m²。另外，选取同期38例体检健康志愿者作为参照组，男21例，女17例，年龄34～63（48.23±4.81）岁；体重指数19.86～22.51（20.87±2.39）kg/m²。采用纯音测听检查评估突发性耳聋患者病情，并根据严重程度进行分组，重度组16例［纯音平均听阈（PTA）>60 dBHL］、中度组39例（PTA >40～60 dBHL）、轻度组23例（PTA 20～40 dBHL）。所有患者均给予激素、营养神经等治疗，10 d为1个疗程，10 d后评估患者预后。根据预后情况将治疗后突发性耳聋患者分为预后良好组（57例）和预后不良组（21例）。采用酶联免疫吸附法检测受试者血清Caspase-3、sFIt-1水平。收集受试者一般资料，包括性别、年龄、体重指数、病程、临床症状、耳聋部位、听力损失程度、基础疾病等。采用独立样本t检验、重复测量方差分析和χ²检验进行统计学分析。采用Spearman秩相关系数进行相关性分析。采用多因素logistic回归分析突发性耳聋患者预后的影响因素。采用受试者操作特征曲线（ROC）分析血清Caspase-3、sFIt-1水平对突发性耳聋患者预后的预测效能。结果　研究组血清Caspase-3、sFIt-1水平均高于参照组［（17.27±3.14）ng/L比（6.63±1.67）ng/L、（157.82±13.47）ng/L比（81.67±10.63）ng/L］（均P<0.05）。重度、中度组Caspase-3、sFIt-1水平均高于轻度组，重度组上述指标均高于中度组（均P<0.05）。Spearman相关性分析显示，突发性耳聋患者血清Caspase-3、sFIt-1水平与病情严重程度呈正相关（r=0.881、0.841，均P<0.05）。预后不良组和预后良好组年龄、听力损伤程度、血清Caspase-3、sFIt-1水平比较，差异均有统计学意义（均P<0.05）。多因素logistic回归分析显示，听力损失程度（OR：0.009，95%CI：0.000～0.209）、年龄（OR：1.165，95%CI：1.049～1.293）、血清Caspase-3（OR：1.546，95%CI：1.183～2.022）、sFIt-1（OR：1.058，95%CI：1.015～1.104）水平均是突发性耳聋患者预后的影响因素（均P<0.05）。ROC分析结果显示，血清Caspase-3、sFIt-1水平联合预测的曲线下面积（AUC）大于血清Caspase-3、sFIt-1水平单独预测。其中联合预测灵敏度66.67%，特异度87.72%，AUC为0.819（0.712～0.925）；Caspase-3灵敏度52.38%，特异度82.46%，AUC为0.721（0.593～0.849）；sFIt-1灵敏度52.38%，特异度84.21%，AUC为0.703（0.573～0.832）。结论　血清Caspase-3、sFlt-1水平升高可反映突发性耳聋患者病情严重程度，二者联合检测可更准确评估患者预后情况。

关键词:

突发性耳聋, 半胱氨酸天冬氨酸蛋白酶3, 可溶性血管内皮生长因子受体-1, 预后, 关系