先天性及围生期巨细胞病毒感染患儿的听力研究及随访  

Research on hearing impairment and follow-up of infants with congenital and perinatal cytomegalovirus infection

作　　者：任伟[1] 梁兰梅[1] 谢惠源[1] 龙晓玲[1] 周涛[1] 付四毛[1] Ren Wei;Liang Lanmei;Xie Huiyuan;Long Xiaoling;Zhou Tao;Fu Simao(Department of Pediatrics,Bo′ai Hospital of Zhongshan City,Zhongshan 528403,China)

机构地区：[1]中山市博爱医院儿科,528403

出　　处：《国际儿科学杂志》2020年第6期425-430,共6页International Journal of Pediatrics

基　　金：中山市科技计划项目(编号2018B1102)。

摘　　要：目的探讨中山市博爱医院先天性及围生期患儿人巨细胞病毒(human cytomegalovirus,HCMV)感染及听力受损情况、听力受损的危险因素及临床转归。方法回顾性分析2016年1月至2018年12月在该院诊断的243例先天性及围生期HCMV感染患儿的临床资料及听性脑干诱发电位(brain stem auditory evoked potentials,BAEP)结果,采用多因素Logistic回归分析听力受损的危险因素,对听力异常的患儿进行随访。结果2016年至2018年,该院先天性及围生期婴儿HCMV感染率分别为4.56%(121/2654)、2.76%(74/2686)和3.15%(85/2701)。243例患儿中,BAEP正常者107例(44.03%),可疑异常者33例(13.58%),听力受损者103例(42.39%)。多因素Logistic回归显示:入院时年龄小于1个月(P=0.034)和CMV-DNA阳性(P=0.003)是听力损害的独立危险因素。听力损害表现形式多样。20例可疑异常者未接受更昔洛韦治疗,19例BAEP恢复正常;67例听力受损者接受了随访,其中47例接受了规范更昔洛韦抗病毒治疗,30例BAEP转归正常,12例情况改善,3例无明显变化,2例加重。20例未行抗病毒治疗患儿中5例BAEP转归正常,8例情况改善,3例无明显变化,4例加重。结论先天性及围生期婴儿的HCMV感染率以及感染患儿的听力受损率均较高,入院时年龄小于1个月和CMV-DNA阳性患儿更易出现听力受损。仅单纯听阈值轻微升高的患儿可临床观察,规范的更昔洛韦抗病毒治疗对于听力改善效果明显。Objective To investigate the human cytomegalovirus(HCMV)infection and hearing impairment in infants with congenital and perinatal diseases of the Bo′ai Hospital in Zhongshan City, and to explore the risk factors of hearing impairment and clinical outcomes.Methods A total of 243 cases of infants with congenital and perinatal HCMV infection were collected from Bo′ai Hospital from January 2016 to December 2018.Clinical data and brainstem auditory evoked potential(BAEP)results were analyzed retrospectively.Logistic regression analysis was performed to identify the risk factors of hearing impairment.The children with hearing loss were followed up in out-patient.Results Positive rates of congenital and perinatal HCMV infection in infants were 4.56%(121/2654), 2.76%(74/2686)and 3.15%(85/2701)from 2016 to 2018 in our hospital respectively.In 243 cases, there were 107 cases with normal hearing(44%), 33 cases with suspicious hearing impairment(14%)and 103 cases with hearing impairment(42%). Multivariate logistic regression analysis showed that the age less than 1 month(P=0.034)and CMV-DNA positive(P=0.003)were independent risk factors for hearing impairment.The manifestations of hearing impairment were various.Twenty cases with suspected hearing impairment were not treated with ganciclovir, in which 19 cases BAEP became normal.Sixty-seven cases with hearing impairment were followed up, of whom 47 cases received standardized ganciclovir antiviral therapy: 30 cases returned to normal, and 12 cases improved, and 3 cases showed no significant changes, and 2 cases aggravated.Twenty cases did not received the antiviral therapy: 5 cases returned to normal, and 8 cases improved, and 3 cases showed no significant changes, and 4 cases aggravated.Conclusion There was a high rate of HCMV infection of congenital and perinatal infants in our hospital.Infected infants have a higher proportion of hearing impairment.Infants less than 1 month and CMV-DNA positive are more likely to suffer from hearing impairment.It can be considered for

关 键 词：巨细胞病毒 婴幼儿 听力损害 

分 类 号：R725.1[医药卫生—儿科]