目的:使用扩散张量成像(DTI)探讨噪声性听力损失(NIHL)患者的大脑微观结构的变化。
方法:总的来说,122例NIHL(轻度[MP,n=79],相对严重的患者[包括中度和重度;RSP,n=32],和不确定的[失去了随访,n=11])和84名健康对照(HC)入组。所有临床资料,包括年龄,教育水平,听力阈值,职业类型,噪声暴露时间,和一些量表分数(包括迷你精神状态考试[MMSE],耳鸣障碍清单[THI],和汉密尔顿焦虑量表[HAMA]),进行了收集和分析。所有参与者均接受T1WI3DFSPGR和DTI,和基于道的空间统计和感兴趣区域(ROI)分析用于评估。
结果:最终样本包括71MP,28RSP,和75HCs。三组的HAMA评分差异有统计学意义(p<0.05)。噪声暴露时间,听力阈值,MP和RSP的HAMA评分有显著差异(p<0.05)。噪声暴露时间与听阈呈正相关,与HAMA评分呈负相关(p<0.05),而THI评分与听阈呈正相关(p<.05)。DTI分析表明,所有DTI参数(分数各向异性[FA],轴向扩散率[AD],平均扩散率[MD],和径向扩散率[RD])在三组的左下纵束(ILF)和左下额枕骨束(IFOF)中存在显着差异(p<.05)。此外,双侧皮质脊髓束(CST)的FA值显着降低,右桥前束(FPT),右镊子专业,左上纵束(颞部)(SLF),MP和RSP的左扣带(海马)(C-H)比HCs(p<0.05);AD值在双侧CST中显示出不同的变化,左IFOF,右前丘脑放射,右外囊(EC),右SLF,与HC相比,MP和RSP的右上小脑花梗(SCP)(p<.05)。然而,3组患者双侧听觉皮层ROI比较差异无统计学意义(p>.05)。左IFOF/ILF的FA和HAMA评分之间存在显著负相关,右FPT,左SLF,三组左C-H(p<0.05)。三组的左IFOF/ILF和右EC的AD和HAMA评分之间存在显着正相关(p<0.05)。三组左IFOF/ILF中RD/MD和HAMA评分均呈显著正相关(p<0.05)。右侧SCP组AD与MP组和RSP组噪声暴露时间呈显著负相关(p<0.05)。AD,MD,左侧ROI和RD与MP和RSP组的听力阈值呈显著正相关(p<0.05),而右侧ROI的FA与三组的HAMA评分呈显著正相关(p<.05)。
结论:白质(WM)微结构的变化可能与噪声暴露引起的听力损失有关,NIHL患者的WM结构异常主要位于颞枕区的联合纤维,影响了听觉和语言通路。这证实NIHL患者的听觉通路具有异常的构造连通性。
OBJECTIVE: To explore the changes in the cerebral microstructure of patients with noise-induced hearing loss (NIHL) using diffusion tensor imaging (DTI).
METHODS: Overall, 122 patients with NIHL (mild [MP, n = 79], relatively severe patients [including moderate and severe; RSP, n = 32], and undetermined [lost to follow-up, n = 11]) and 84 healthy controls (HCs) were enrolled. All clinical data, including age, education level, hearing threshold, occupation type, noise exposure time, and some scale scores (including the Mini-Mental State Examination [MMSE], tinnitus handicap inventory [THI], and Hamilton Anxiety Scale [HAMA]), were collected and analyzed. All participants underwent T1WI3DFSPGR and DTI, and tract-based spatial statistics and region of interest (ROI) analysis were used for assessment.
RESULTS: The final sample included 71 MP, 28 RSP, and 75 HCs. The HAMA scores of the three groups were significantly different (p < .05). The noise exposure times, hearing thresholds, and HAMA scores of the MP and RSP were significantly different (p < .05). The noise exposure time was positively correlated with the hearing threshold and negatively correlated with the HAMA scores (p < .05), whereas the THI scores were positively correlated with the hearing threshold (p < .05). DTI analysis showed that all DTI parameters (fractional anisotropy [FA], axial diffusivity [AD], mean diffusivity [MD], and radial diffusivity [RD]) were significantly different in the left inferior longitudinal fasciculus (ILF) and left inferior fronto-occipital fasciculus (IFOF) for the three groups (p < .05). In addition, the FA values were significantly lower in the bilateral corticospinal tract (CST), right fronto-pontine tract (FPT), right forceps major, left superior longitudinal fasciculus (temporal part) (SLF), and left cingulum (hippocampus) (C-H) of the MP and RSP than in those of the HCs (p < .05); the AD values showed diverse changes in the bilateral CST, left IFOF, right anterior thalamic radiation, right external capsule (EC), right SLF, and right superior cerebellar peduncle (SCP) of the MP and RSP relative to those of the HC (p < .05). However, there were no significant differences among the bilateral auditory cortex ROIs of the three groups (p > .05). There was a significant negative correlation between the FA and HAMA scores for the left IFOF/ILF, right FPT, left SLF, and left C-H for the three groups (p < .05). There was a significant positive correlation between the AD and HAMA scores for the left IFOF/ILF and right EC of the three groups (p < .05). There were significantly positive correlations between the RD/MD and HAMA scores in the left IFOF/ILF of the three groups (p < .05). There was a significant negative correlation between the AD in the right SCP and noise exposure time of the MP and RSP groups (p < .05). The AD, MD, and RD in the left ROI were significantly positively correlated with hearing threshold in the MP and RSP groups (p < .05), whereas FA in the right ROI was significantly positively correlated with the HAMA scores for the three groups (p < .05).
CONCLUSIONS: The changes in the white matter (WM) microstructure may be related to hearing loss caused by noise exposure, and the WM structural abnormalities in patients with NIHL were mainly located in the syndesmotic fibers of the temporooccipital region, which affected the auditory and language pathways. This confirmed that the auditory pathways have abnormal structural connectivity in patients with NIHL.