耳声发射和听觉脑干反应在巨细胞病毒相关听力损伤小儿筛查中的重要性及防治策略  

Importance of otoacoustic emission and auditory brainstem response in the screening of children with cytomegalovirus associated hearing loss and the prevention and treatment strategies

作　　者：谢婷 刘爱萍 李彩云 朱友莲 黄姝花 邱小兵 XIE Ting;LIU Aiping;LI Caiyun;ZHU Youlian;HUANG Shuhua;QIU Xiaobing(Department of Child Health Care,Ganzhou Women and Children's Health Care Hospital,Jiangxi Province,Ganzhou341000,China;Department of Otolaryngology,Ganzhou Women and Children's Health Care Hospital,Jiangxi Province,Ganzhou341000,China)

机构地区：[1]江西省赣州市妇幼保健院儿童保健科,江西赣州341000 [2]江西省赣州市妇幼保健院耳鼻喉科,江西赣州341000

出　　处：《中国当代医药》2023年第35期123-126,131,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202312028)。

摘　　要：目的探讨耳声发射(OAE)和听觉脑干反应(ABR)在巨细胞病毒(CMV)相关听力损伤小儿筛查中的重要性及防治策略。方法回顾性分析2022年1月至12月于赣州市妇幼保健院出生的160例新生儿的临床资料,根据是否发生CMV感染分为观察组(发生CMV感染,n=80)与对照组(未发生CMV感染,n=80),分别对其进行OAE、ABR检查,并对影响不同听力损失严重程度患儿的危险因素进行分析。结果观察组的初筛瞬态声诱发耳声发射(TEOAE)、复筛TEOAE、复筛畸变产物耳声发射(DPOAE)、复筛ABR通过率均低于对照组,差异有统计学意义(P<0.05)。观察组筛查的160耳中,共145耳通过ABR复筛,确认15耳听力损失,其中轻度听力损失率为46.67%,中度损伤率为33.33%,重度损伤率为20.00%。单因素分析结果显示,听力损伤与听力正常患儿的不同血小板计数、尿CMV-DNA病毒载量、血CMV-DNA病毒载量比较,差异有统计学意义(P<0.05)。多因素logistic回归分析结果显示,血小板计数(β=1.265,OR=3.254,95%CI=1.245~8.461)、患儿血CMV-DNA病毒载量(β=0.982,OR=2.584,95%CI=1.105~8.265)、患儿尿CMV-DNA病毒载量(β=1.156,OR=3.984,95%CI=1.102~8.365)均是CMV感染相关重度听力损失的影响因素(P<0.05)。结论OAE与ABR可有效筛查巨细胞病毒感染所引起的小儿听力损失,且ABR测试还能明确其疾病严重程度,而血小板计数、CMV-DNA病毒载量等的变化均可能会导致CMV感染新生儿引发听力损失,只有加强CMV感染新生儿的早期筛查,并根据其影响因素开展针对性的干预,才能降低新生儿听力损失的风险。Objective To investigate the importance of otoacoustic emission(OAE)and auditory brainstem response(ABR)in the screening of children with cytomegalovirus(CMV)associated hearing loss and the prevention and treatment strategies.Methods The clinical data of 160 newborns born in Ganzhou Women and Children's Health Care Hospital from January to December 2022 were retrospectively analyzed.According to the presence or absence of CMV infection,they were divided into the observation group(CMV infection,n=80)and the control group(no CMV infection,n=80).OAE and ABR examinations were performed,and the risk factors affecting children with different degrees of hearing loss were analyzed.Results The passing rates of initial screening transiently evoked otoacoustic emission(TEOAE),secondary screening TEOAE,secondary screening distortion product otoacoustic emission(DPOAE),and secondary screening ABR in the observation group were lower than those in the control group,and the differences were statistically significant(P<0.05).Among the 160 ears screened in the observation group,145 ears were re-screened by ABR,and 15 ears were confirmed to have hearing loss.The rate of mild hearing loss was 46.67%,the rate of moderate hearing loss was 33.33%,and the rate of severe hearing loss was 20.00%.Univariate analysis showed that there were significant differences in different platelet counts,urine CMV-DNA viral load,and blood CMV-DNA viral load between children with hearing impairment and those with normal hearing(P<0.05).Multivariate logistic regression analysis showed that platelet count(β=1.265,OR=3.254,95%CI=1.245-8.461),CMV-DNA viral load(β=0.982,OR=2.584,95%CI=1.105-8.265)and urine CMV-DNA load(β=1.156,OR=3.984,95%CI=1.102-8.365)were the influencing factors of severe hearing loss related to CMV infection(P<0.05).Conclusion OAE and ABR can effectively screen for hearing loss in children caused by CMV infection,and ABR test can also determine the severity of the disease.Changes in platelet count and CMV-DNA viral load may lead to hea

关 键 词：耳声发射 听觉脑干反应 巨细胞病毒相关听力损失小儿 防治策略研究 

分 类 号：R764[医药卫生—耳鼻咽喉科]