儿童细菌性脑膜炎听力损失573例的特征与转归  

Characteristics and recovery of hearing loss in 573 patients with bacterial meningitis

作　　者：史吉峰 刘海红 窦珍珍[3] 郭凌云[3] 冯文雅[3] 周怡[1] 李颖[1] 金欣[1] 胡惠丽[3] 郑之芃 刘冰[1] 胡冰[3] 陈天明[3] 郭欣[3] 陈荷英[3] 刘钢[3] Shi Jifeng;Liu Haihong;Dou Zhenzhen;Guo Lingyun;Feng Wenya;Zhou Yi;Li Ying;Jin Xin;Hu Huili;Zheng Zhipeng;Liu Bing;Hu Bing;Chen Tianming;Guo Xin;Chen Heying;Liu Gang(Department of Otolaryngology-Head and Neck Surgery,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Beijing Key Laboratory for Pediatric Diseases of Otolaryngology-Head and Neck Surgery,Beijing Pediatric Research Institute,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China;Key Laboratory of Major Diseases in Children,Ministry of Education,Department of Infectious Diseases,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院儿童耳鼻咽喉头颈外科,100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院北京市儿科研究所,儿童耳鼻咽喉头颈外科疾病北京市重点实验室,100045 [3]国家儿童医学中心,首都医科大学附属北京儿童医院感染内科,儿科重大疾病研究教育部重点实验室,100045

出　　处：《中华儿科杂志》2021年第8期633-639,共7页Chinese Journal of Pediatrics

基　　金：京津冀基础研究合作专项(H2018316006);中国医学科学院中央级公益性科研院所基本科研业务费用专项(2019XK320080);北京市医院管理局儿科学科协同发展中心儿科专项(XKYB201826);北京市医院管理局儿科学科协同发展中心儿科专项(XTZD20180501);北京市百千万人才工程(2019A34);北京市卫生健康科技成果和适宜技术推广项(BHTPP202045)。

摘　　要：目的分析细菌性脑膜炎患儿听力损失的特征及转归。方法回顾性队列研究,以2010至2016年首都医科大学附属北京儿童医院入院、起病年龄大于28日龄且小于18岁、临床诊断为细菌性脑膜炎的573例患儿为研究对象,回顾患儿的临床信息及住院期间听力评估结果,并对住院期间存在听力损失的患儿进行随访,收集出院后听力复查结果,并通过父母评估孩子听说能力表现量表对随访时听力状态进行评估。按照患儿住院期间听力损失情况分为听力损失组和非听力损失组,采用Logistics回归分析细菌性脑膜炎听力损失危险因素。结果纳入的573例患儿,包括男347例,女226例,起病年龄为29日龄至15.8岁。病原学阳性患者246例,肺炎链球菌脑膜炎92例,占37.4%。住院期间发现听力损失患儿为160例,听力损失发生率为27.9%,涉及240耳。永久性听力损失20例(16.9%),涉及32耳。出现永久性听力损失耳中87.5%(28/32)在住院期间听力评估显示为重度或极重度听力损失。Logistics回归分析发现,肌张力障碍、脑脊液蛋白浓度大于1 g/L、脑脊液糖浓度<1 mmol/L和硬膜下积液是听力损失的独立危险因素[OR=2.426(1.450~4.059)、1.865(1.186~2.932)、1.544(1.002~2.381)和1.904(1.291~2.809)]。结论听力损失是细菌性脑膜炎常见的后遗症,大部分患儿为暂时性听力损失,出现重度或极重度听力损失的患者发展为永久性听力损失风险更高。Objective To analyze the characteristics and prognosis of hearing loss in children with bacterial meningitis.Methods This was a single-center retrospective cohort study.Patients diagnosed with bacterial meningitis who were hospitalized in Beijing Children′s Hospital between 2010 and 2016 and older than 28 days and younger than 18 years at symptom onset were included in this study(n=573).All clinical information including hearing assessment results during hospitalization were reviewed.All patients with hearing loss were followed up to repeat their hearing test and assess their hearing condition with parents′evaluation of aural and(or)oral performance of children(PEACH).Patients were grouped according to their hearing assessment results,and Logistic regression analysis was used to analyze the risk factors for hearing loss in patients with bacterial meningitis.Results Five hundred and seventy-three patients were enrolled in this study,including 347 males and 226 females.The onset age ranged from 29 days to 15.8 years.Two hundred and forty-six patients had identified causative pathogens,among whom 92 cases(37.4%)were pneumococcal meningitis cases.Hearing loss was found in 160 cases(27.9%)during hospitalization,involving 240 ears.Permanent hearing loss was found in 20 cases(16.9%),involving 32 ears.In the patients with permanent hearing loss,87.5%(28/32)of ears were identified as severe or profound hearing loss during hospitalization.Logistic regression analysis showed that dystonia,the protein concentration level in cerebrospinal fluid>1 g/L,glucose concentration level lower than 1 mmol/L and subdural effusion were independent risk factors for hearing loss(OR=2.426(1.450-4.059),1.865(1.186-2.932),1.544(1.002-2.381)and 1.904(1.291-2.809)).Conclusions Hearing loss is a common sequela of bacterial meningitis in children.Most patients have transient hearing loss,but patients with severe or profound hearing impairment have a higher risk of developing permanent hearing loss.

关 键 词：脑膜炎 细菌性 听力 随访研究 

分 类 号：R742.9[医药卫生—神经病学与精神病学] R764[医药卫生—临床医学]