Application Of CCK-8 Test Of Glucocorticoid Sensitivity In SSNHLand Its Correlation With Prognosis

Objective:Sudden sensorineural hearing loss(SSNHL)is one of the most common emergencies in otolaryngology.Currently,the incidence of SSNHL is about 5/100,000-30/100,000,and some studies suggest that the incidence can be as much as 160/100,000.Due to its complex etiology,uncertain outcome and prognosis,the consequences of hearing loss cannot be ignored.Currently,the internationally recognized treatment drug in SSNHL is glucocorticoid(GC),but some patients show the treatment of GC is invalid.The prognostic factors of SSNHL and the relationship of GC sensitivity and prognosis in SSNHL are still inconclusive,GC proliferation inhibition(GCPI)of PBMCs in vitro can be used to estimate GC sensitivity in many chronic inflammatory diseases.Whether the prognosis of SSNHL is related to GC sensitivity and the relationship of GCPI of PBMCs in vitro and GC sensitivity are not clear.Therefore,we apply CCK-8 test of dexamethasone(DEX)sensitivity of PBMC in vitro to determining the GC sensitivity in SSNHL,and thus to study the feasibility of CCK-8 test in clinical application and the role of GCPI of PBMCs in vitro in estimating the prognosis of SSNHL.Besides,we compare the relevant factors with the prognosis of SSNHL.Methods:A total of 126 patients with SSNHL were included in this study,and of which initial group contains 35 patients and refrectory group contains 91 contains.The pure tone threshold in 0.25-8kHz was more than 60dB HL before treatment.Before treatment venous blood were collected and used to isolate PBMC for GCPI:group A 1640 cell culture medium,group B:A+LPS(1ug/ml),group C:B+DEX(10-6M).PBMCs were cultured in 5%CO2 incubator for 48 hours at 37?.The cell proliferation was observed by CCK8 assay,the absorbance at the length of 490nm wave can reflect the cell proliferation inhibition.and the formula(B-C)/(B-A)was used to determine the proliferation inhibition rate.The effects of age,gender,tinnitus and vertigo,the degree of hearing loss,affeced ear side,interval from onset to treatment on the prognosis of SSNHL were analyzed.Results:Total of 126 cases:age,gender,tinnitus and vertigo,the degree of hearing loss has no relation with DEX inhibition rate(rank and inspection,P<0.05),DEX inhibition rate in initial group was obviously higher than that of refractory group(Z=3.146,P=3.146).DEX inhibition rate in GC sensitive group was significantly higher than that of GC insensitive group(Z=9.28,P=0.000).there was significant better hearing improvement in the GC sensitive group compared to the GC insensitive group(P<0.05)in all patients,and the same result happened in the frequency of 0.25-8kHz(P<0.05).The hearing improvement value in the sensitive group was decreased from low frequency to high frequency in both primary and refractory groups.initial groups:age,gender,tinnitus,degree of hearing loss has nothing to do with the prognosis of SSNHL,there was statistical difference between vertigo and prognosis(P=0.027).There was a statistical difference between time interval from onset to treatment and hearing improvement(P=0.039),The negative linear correlation between time interval from onset to treatment and hearing improvement value(R2=0.266,P=0.002)was obtained.There was a statistical difference between DEX inhibitory rate and hearing improvement(P=0.000).The higher the DEX inhibition rate,the better the efficacy.Furthermore,the relationship between DEX inhibition rate and hearing improvement value was further analyzed.The positive linear correlation between DEX inhibition rate and hearing improvement value(R2=0.915)was obtainedRefractory group:there were no relationship between hearing improvement and age,sex,affected ear side,tinnitus and vertigo,degree of hearing loss,the local use of GC.There was a statistical difference between time interval from onset to treatment and hearing improvement(?2=11.578,P=0,003),The negative linear correlation between time interval from onset to treatment and hearing improvement value(R2=0.118,P=0.001)was obtained.62.6%of patients took local injection of methylprednisolone,37.4%took intratympanic methylprednisolone perfusion.The total effective rate was 39.6%,and the efficiency was 17.6%.There was a statistical difference in the effective and efficacy rate between the two groups of different DEX inhibitory rates(Z=39.163,P=0.000).There was also a positive linear correlation between DEX inhibition rate and hearing improvement value(R2=0.712).The longer the duration of treatment,the lower the effective rate,but no statistical significance.Conclusion:The above results show that the prognosis of patients with SSNHL is associated with vertigo,time interval from onset to treatment and GC sensitivity.Age,gender,tinnitus,the degree of hearing loss,affeced ear side are not associated with the prognosis.GC sensitivity of SSNHL patients was not affected by gender,affeced ear side,age,tinnitus or vertigo and the degree of hearing loss.With the increase of DEX inhibition rate,hearing improvement value increased,the two values presented positive linear correlation.The patients who were nonresponsed with the Systemic use of glucocorticoid in the early period of treatment,after the local use of glucocorticoid and antioxidant therapy can still improve the hearing of some patients.The DEX inhibition rate detected by cck-8 test can be used to predict the prognosis of SSNHL in clinic,and provide a reference for the personalized treatment of SSNHL.