慢性中耳炎I型鼓室成形术前血清总IgE分类与术后6个月鼓室压图状态的关系

文献信息

中文摘要

目的： 评估术前血清总IgE（按分类变量和连续变量分析）是否与慢性中耳炎I型鼓室成形术后6个月鼓室压图状态相关。同时检查鼓膜闭合和听力图结果。方法：本回顾性研究纳入171例慢性中耳炎患者的171只手术耳，均接受I型鼓室成形术。分类分析采用本机构检测方法的上限参考值60 IU/mL；另一项分析将IgE作为经log2转换的连续变量处理。术后6个月评估鼓膜闭合、鼓室压图和听力图。异常鼓室压图状态定义为可测峰值压力< -50 daPa或B型鼓室压图。采用多变量logistic回归评估与异常鼓室压图状态相关的因素。结果：171例患者中，101例血清总IgE ≤ 60 IU/mL，70例IgE > 60 IU/mL。6个月异常鼓室压图状态分别发生于22/89（24.7%）和29/61（47.5%）只耳（p = 0.005）。鼓膜闭合分别为96/98（98.0%）对61/68（89.7%）（p = 0.033）。6个月气骨导差（ABG）≤ 20 dB分别见于87/94（92.6%）对54/64（84.4%）（p = 0.121）。在完整病例多变量分析中，IgE > 60 IU/mL（OR，3.46；95% CI，1.56-7.70；p = 0.002）和乳突气化不良（OR，4.68；95% CI，2.15-10.21；p < 0.001）与异常鼓室压图状态相关。在单独的连续变量分析中，IgE每翻倍与异常鼓室压图状态的校正比值比升高相关（OR，1.25；95% CI，1.03-1.52；p = 0.023）。结论：术前血清总IgE在分类和连续分析中均与6个月异常鼓室压图状态相关。60 IU/mL截断值是检测方法特异的参考限值，而非经过验证的术后风险阈值。这些发现并未确立预测或预后效用、临床定义的过敏或过敏介导的因果机制。

英文摘要

Objective: To evaluate whether preoperative serum total IgE, analyzed categorically and continuously, was associated with 6-month postoperative tympanometric status after type I tympanoplasty for chronic otitis media. Tympanic membrane closure and audiometric outcomes were also examined. Methods: This retrospective study included 171 operated ears from 171 unique patients with chronic otitis media who underwent type I tympanoplasty. The categorical analysis used the institutional assay upper reference limit of 60 IU/mL; a separate analysis treated IgE as a log2-transformed continuous variable. Tympanic membrane closure, tympanometry, and audiometry were assessed at 6 months. Abnormal tympanometric status was defined as a measurable peak pressure < -50 daPa or a type B tympanogram. Multivariable logistic regression evaluated factors associated with abnormal tympanometric status. Results: Of 171 patients, 101 had serum total IgE ≤ 60 IU/mL and 70 had IgE > 60 IU/mL. Abnormal 6-month tympanometric status occurred in 22/89 (24.7%) and 29/61 (47.5%) ears, respectively (p = 0.005). Tympanic membrane closure was 96/98 (98.0%) versus 61/68 (89.7%) (p = 0.033). A 6-month ABG ≤ 20 dB occurred in 87/94 (92.6%) versus 54/64 (84.4%) (p = 0.121). In complete-case multivariable analysis, IgE > 60 IU/mL (OR, 3.46; 95% CI, 1.56-7.70; p = 0.002) and poor mastoid pneumatization (OR, 4.68; 95% CI, 2.15-10.21; p < 0.001) were associated with abnormal tympanometric status. In the separate continuous analysis, each doubling of IgE was associated with higher adjusted odds of abnormal tympanometric status (OR, 1.25; 95% CI, 1.03-1.52; p = 0.023). Conclusions: Preoperative serum total IgE was associated with abnormal 6-month tympanometric status in both categorical and continuous analyses. The 60 IU/mL cutoff was an assay-specific reference limit rather than a validated postoperative risk threshold. The findings do not establish predictive or prognostic utility, clinically defined allergy, or an allergy-mediated causal mechanism.