维生素B12缺乏对听觉和前庭功能的影响：基于客观测试的系统综述

文献信息

中文摘要

目的： 评估客观听力学和前庭评估在检测与维生素B12缺乏相关的功能变化方面的有效性。
数据来源： 在PubMed、Scopus、Web of Science和EMBASE数据库中进行了全面的文献检索。
综述方法： 本系统综述已在PROSPERO注册（CRD420251049105），遵循基于PICO框架的结构化检索策略。两名独立评审员筛选了符合条件研究的标题、摘要和全文。使用混合方法评估工具（MMAT）独立进行数据提取和质量评估，分歧由第三名评审员解决。纳入研究调查了维生素B12缺乏个体的客观听觉和前庭评估，包括听性脑干反应（ABR）、耳声发射（OAE）和前庭诱发肌源性电位（VEMP）。
结果： 11项研究符合纳入标准。证据表明，维生素B12缺乏影响神经传导和耳蜗功能，表现为ABR潜伏期延长以及瞬态诱发OAE（TEOAE）和畸变产物OAE（DPOAE）振幅降低。前庭发现不一致，一些研究报告cVEMP反应缺失，而另一些在ENG/VNG评估中未发现显著关联。在婴儿人群中，维生素B12补充导致听觉传导部分或完全恢复。
结论： 维生素B12缺乏对神经传递和耳蜗微力学产生不利影响。客观电生理评估，如ABR和OAE，是亚临床神经病变的敏感指标。尽管前庭受累仍无定论，但整合电生理和行为评估可能有助于早期诊断和及时干预，以防止不可逆的听觉功能障碍。

英文摘要

OBJECTIVE: To evaluate the effectiveness of objective audiological and vestibular assessments in detecting functional changes associated with vitamin B12 deficiency.
DATA SOURCES: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and EMBASE databases.
REVIEW METHODS: This PROSPERO-registered systematic review (CRD420251049105) followed a structured search strategy based on the PICO framework. Two independent reviewers screened titles, abstracts, and full texts of eligible studies. Data extraction and quality assessment were performed independently using the Mixed Methods Appraisal Tool (MMAT), with disagreements resolved by a third reviewer. Studies investigating objective auditory and vestibular assessments, including Auditory Brainstem Response (ABR), Otoacoustic Emissions (OAE), and Vestibular Evoked Myogenic Potentials (VEMP), in individuals with vitamin B12 deficiency were included.
RESULTS: Eleven studies met the inclusion criteria. Evidence suggests that vitamin B12 deficiency affects neural conduction and cochlear function, as demonstrated by prolonged ABR latencies and reduced Transient Evoked OAEs (TEOAE) and Distortion Product OAEs (DPOAE) amplitudes. Vestibular findings were inconsistent, with some studies reporting absent cVEMP responses and others finding no significant association in ENG/VNG assessments. In infant populations, vitamin B12 supplementation resulted in partial or complete recovery of auditory conduction.
CONCLUSION: Vitamin B12 deficiency adversely affects neural transmission and cochlear micromechanics. Objective electrophysiological assessments, such as ABR and OAE, are sensitive indicators of subclinical neuropathy. Although vestibular involvement remains inconclusive, integrating electrophysiological and behavioral assessments may facilitate early diagnosis and timely intervention to prevent irreversible auditory dysfunction.