先天性巨细胞病毒感染对听力影响的多中心研究  

A multicenter study on the effects of congenital cytomegalovirus infection on hearing loss

作　　者：胡波飞 刘鑫鑫[1] 詹灿阳[2] 袁天明[2] 陈理华[2] 梁建凤[3] 孙靖[4] 林梅芳 何缦 魏素玲 张解宁 朱佳骏[7] 陈英虎[1] Hu Bofei;Liu Xinxin;Zhan Canyang;Yuan Tianming;Chen Lihua;Liang Jianfeng;Sun Jing;Lin Meifang;He Man;Wei Suling;Zhang Jiening;Zhu Jiajun;Chen Yinghu(Department of Infection,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310051,China;Department of Neonatology,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310051,China;Statistics Office,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310051,China;Hearing Center,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Child Health,Hangzhou 310051,China;Department of Neonatology,Huzhou Maternity and Child Health Care Hospital,Huzhou 313000,China;Department of Pediatrics,Jiaxing Maternity and Child Health Care Hospital,Jiaxing 314000,China;Department of Neonatology,Women's Hospital School of Medicine Zhejiang University,Hangzhou 311215,China)

机构地区：[1]浙江大学医学院附属儿童医院感染科、国家儿童健康与疾病临床研究中心,杭州310051 [2]浙江大学医学院附属儿童医院新生儿科、国家儿童健康与疾病临床研究中心,杭州310051 [3]浙江大学医学院附属儿童医院统计室、国家儿童健康与疾病临床研究中心,杭州310051 [4]浙江大学医学院附属儿童医院听力中心、国家儿童健康与疾病临床研究中心,杭州310051 [5]湖州市妇幼保健院新生儿科,湖州313000 [6]嘉兴市妇幼保健院儿内科,嘉兴314000 [7]浙江大学医学院附属妇产科医院新生儿科,杭州311215

出　　处：《中华儿科杂志》2024年第8期721-726,共6页Chinese Journal of Pediatrics

基　　金：国家自然科学基金(82071812,82371829);中央引导地方科技发展专项(S20A0003)。

摘　　要：目的探讨新生儿先天性巨细胞病毒(cCMV)感染所致感音神经性耳聋(SNHL)患儿的临床特征、抗病毒治疗情况,并推测听力结局不良的危险因素。方法多中心前瞻性队列研究,纳入2021年3月1日至2024年4月30日浙江省4家医院176例cCMV感染的新生儿为研究对象,记录出生时临床特征并随访听力。根据出生时cCMV感染情况分为无症状组、轻度症状组和中重度症状组;根据出生时气导脑干听结果分为SNHL组和听力正常组;根据抗病毒治疗情况分为治疗组和未治疗组。采用Mann-WhitneyU检验、χ^(2)检验进行组间比较,分析临床特征在不同病情分组间的差异,并分析临床特征、抗病毒治疗等对听力改善的影响。采用Logistic回归分析法筛选影响听力结局的危险因素。结果176例cCMV感染患儿中男90例、女86例。无症状组79例、轻度症状组12例、中重度症状组85例。SNHL组50例,其中听力水平轻度30例、中度9例、重度5例、极重度6例;听力正常组121例,其中2例(1.7%)出生时听力正常的患儿出现晚发型听力损伤。81例(46.0%)患儿完成听力随访,听力结局良好者71例(87.7%)、听力结局不良者10例(12.3%);81例患儿中29例(35.8%)出生时存在SNHL,随访听力阈值好转19例(65.5%),维持稳定7例(24.1%),进展3例(10.3%)。治疗组40例,均为中重度cCMV。完成听力随访的治疗组26例,未治疗组55例。完成听力随访的治疗组听力好转率高于未治疗组[13例(50.0%)比6例(10.9%),χ^(2)=15.00,P<0.01];治疗组听力好转可能性是未治疗组的4.58倍(RR=4.58,95%CI 1.96~10.70,P<0.05);抗病毒治疗组和未治疗组的听力结局差异无统计学意义(RR=0.90,95%CI 0.57~1.41,P=0.517)。Logistic多因素分析示SNHL(OR=11.58,95%CI 2.10~63.93,P=0.005)、早产(OR=4.98,95%CI 1.06~23.41,P=0.042)均为听力结局不良的独立危险因素。结论cCMV感染所致SNHL在出生时均为症状性感染,抗病毒治疗能改善SNHL。出生时存在SNHL及早�Objective To assess the clinical features and effectiveness of antiviral therapy in newborns with sensorineural hearing loss(SNHL)caused by congenital congenital cytomegalovirus(cCMV)infection,and to speculate the risk factors for poor hearing outcomes.Methods A multicenter prospective cohort study wasconducted,enrolling 176 newborns diagnosed with cCMV at four research centers in Zhejiang Province from March 1,2021,to April 30,2024.Clinical characteristics at birth were recorded and hearing was followed up.The children were divided into groups based on their condition at birth,specifically into asymptomatic,mild symptom,and moderate to severe symptom groups.Additionally,they were divided into SNHL and normal hearing groups based on the results of air conduction brainstem audiometry at birth.And they were also divided into treatment and untreated groups according to antiviral treatment.Mann Whitney U test,and chi square test were used for inter group comparison to analyze the differences in clinical features between different disease groups,and to analyze the effects of clinical features,antiviral therapy,and other factors on hearing improvement.Logistic regression analysis was employed to identify the risk factors influencing hearing outcomes.Results Among the cohort of 176 children diagnosed infection with cCMV,90 cases were male and 86 cases were female.Of these,79 cases were asymptomatic,12 cases classified as mild cCMV and 85 cases as moderate to severe cCMV.Fifty cases belonged to SNHL group,with different degrees of severity,including 30 cases of mild,9 cases of moderate,5 cases of severe,and 6 cases of extremely severe SNHL.Among the 121 cases in the normal hearing group,2 cases(1.7%)exhibited late-onset hearing loss despite having normal hearing at birth.Among 81 cases(46.0%)who completed the hearing follow-up,71 cases(87.7%)had good hearing outcomes and 10 cases(12.3%)had poor hearing outcomes.Among the 81 children,29 cases(35.8%)had SNHL at birth.During follow-up,the hearing threshold improved in 19 ca

关 键 词：巨细胞病毒感染 听力障碍 听觉丧失 队列研究 

分 类 号：R764.43[医药卫生—耳鼻咽喉科] R722.1[医药卫生—临床医学]