Pepsin, trypsin, and MUC5B are independent risk factors for hearing impairment in patients with laryngopharyngeal reflux-related chronic secretory otitis media

This study evaluated the potential diagnostic utility of pepsin, trypsin, and mucin 5B (MUC5B) in hearing impairment in patients with laryngopharyngeal reflux (LPR)-related chronic secretory OM (CSOM). Patients with LPR-related CSOM were enrolled and assigned into the normal hearing (NH), and mild (Mi-HI) and moderate-to-severe hearing impairment (Mo-HI) groups. Pepsin, trypsin, and MUC5B contents were determined by ELISA, with their correlations with Eustachian tube dysfunction questionnaire-7 (ETDQ-7) score and inflammatory factors (interleukin [IL]-2, IL6, IL-8), and diagnostic performance in hearing impairment assessed by Pearson, Spearman, and ROC curves. Factors influencing hearing impairment were identified using logistic regression models. Pepsin, trypsin, and MUC5B contents were upregulated in patients’ middle ear effusion as hearing impairment worsened. The three indicators correlated to EDTQ-7 and inflammatory factors, and exhibited high diagnostic value for hearing impairment in LPR-related CSOM patients. Remarkably, their combination created significantly higher diagnostic value than a single indicator. Abundantly-increased pepsin, trypsin, and MUC5B amplified hearing impairment incidence. Pepsin, trypsin, and MUC5B are independent risk factors for hearing impairment in LPR-related CSOM patients. Their combination assists hearing impairment diagnosis in patients, providing a tool in clinical practice to stratify patients and offering a theoretical basis for exploring therapeutic targets.

本研究评估了胃蛋白酶（pepsin）、胰蛋白酶（trypsin）及黏蛋白5B（MUC5B）在喉咽反流（laryngopharyngeal reflux, LPR）相关慢性分泌性中耳炎（chronic secretory otitis media, CSOM）患者听力损害中的诊断应用潜力。研究纳入喉咽反流相关慢性分泌性中耳炎患者，将其分为听力正常（normal hearing, NH）组、轻度听力损害（mild hearing impairment, Mi-HI）组及中重度听力损害（moderate-to-severe hearing impairment, Mo-HI）组。采用酶联免疫吸附试验（enzyme-linked immunosorbent assay, ELISA）检测患者中耳积液中胃蛋白酶、胰蛋白酶及MUC5B的含量；通过Pearson相关分析、Spearman相关分析及受试者工作特征曲线（receiver operating characteristic curve, ROC），分析上述指标与咽鼓管功能障碍问卷7（Eustachian tube dysfunction questionnaire-7, ETDQ-7）评分、炎症因子[白细胞介素（interleukin, IL）-2、IL-6、IL-8]的相关性，并评估其对听力损害的诊断效能。采用逻辑回归模型（logistic regression model）筛选影响听力损害的相关因素。结果显示，随着听力损害程度加重，患者中耳积液中胃蛋白酶、胰蛋白酶及MUC5B的含量显著上调。三项指标与ETDQ-7评分及炎症因子水平均存在相关性，且对LPR相关CSOM患者的听力损害具有较高的诊断价值。值得注意的是，三项指标联合检测的诊断效能显著优于单一指标检测。胃蛋白酶、胰蛋白酶及MUC5B的高水平表达会增加听力损害的发生风险。胃蛋白酶、胰蛋白酶及MUC5B是LPR相关CSOM患者发生听力损害的独立危险因素。三者联合检测可辅助临床开展听力损害诊断工作，为临床分层管理患者提供实用工具，同时也为探索治疗靶点提供了理论依据。