巨细胞病毒感染患儿的听力特点分析及临床随访

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摘要目的：探讨巨细胞病毒（HCMV）感染后脑干诱发电位（ABR）的变化，并对听力异常患儿随访，以期为临床诊治提供参考。方法：收集温州医科大学附属第二医院育英儿童医院于2013年至2014年拟诊HCMV感染的住院患儿158例。回顾性分析HCMV感染患儿ABR特点，对听力异常患儿进行门诊随访，间隔3～6个月复查ABR。结果：初次ABR检查，听力正常120例，听力异常38例（55耳），其中轻度异常42耳（占76%），中度异常7耳（占12.7%），重度异常3耳（占5.5%），极重度异常3耳（占5.5%）。按照月龄分成3组，分别为≤3个月组、3～6个月组、≥6个月组，3组患儿听力损害率比较差异有统计学意义（χ2=7.830，P=0.020）。3组间两两比较，3～6个月组听力损害高于≤3个月组，差异有统计学意义（χ2=5.725，P=0.017）。听力正常的HCMV感染患儿的I、III、V波峰尖潜伏期较正常儿童参考值均有延长，差异有统计学意义（P＜0.05）。针对38例（55耳）听力异常患儿进行随访，复查ABR示听力持续异常5例（7耳），有3耳为感音神经性耳聋。有2例为症状性HCMV感染，听力为双侧异常；有3例为非症状性HCMV感染，听力为单侧异常。结论：HCMV感染可能导致患儿听力损害，以轻度损害为主，严重时出现感音神经性耳聋，不同月龄患儿听力损害发生率不尽相同。听力损害具有可逆性，不论初次听力检查正常与否，都建议长期听力随访。

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	章虎
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	李昌崇

关键词 ：巨细胞病毒, 听力, 随访, 感音神经性耳聋

Abstract：Objective: To explore the difference of auditory brainstem response (ABR) after human cytomegalovirus (HCMV) infection, then follow-up the children with hearing loss, so as to provide theory basis for clinical diagnosis and treatment. Methods: One hundred fifty-eight hospitalized cases of children with HCMV infection were collected from 2013 to 2014 in the Second Affiliated Hospital & Yuying Children’s Hospital of Wenzhou Medical University. All of the patients were performed by ABR testing. The children with hearing loss were followed up in out-patient, and underwent ABR testing once again about 3-6 months later. Results: In the first ABR tested 158 cases, there were 120 cases with normal hearing , and 38 cases (55 ears) with hearing loss, among whom 42 ears (76%) were mild abnormal, 7 ears (12.7%) were moderate abnormal, 3 ears (5.5%) were severe loss and 3 ears (5.5%) were profound loss. All of the children were divided into three groups according to the months of age, respectively for≤3 months, 3 to 6 months, ≥6 months comparison difference in three groups
of children with hearing impairment was statistically significant (χ2=7.830, P=0.020). Compared two among three groups, the hearing impairment of 3 to 6 months group was higher than that of≤3 months group, and the difference was significant (χ2=5.725, P=0.017). The incubation period in normal hearing ear I, III, V wave pointed compared with normal children, the difference was statistically significant (P<0.05). 38 cases (55 ears) of children who had hearing loss were followed up, and performed ABR testing again. Five cases (7 ears) of children had persistent anomalies on hearing loss, among whom 3 ears were sensorineural hearing loss. 2 cases of children, who had bilateral hearing loss, were symptomatic HCMV infection. Three cases of children, who had unilateral hearing impairment, were asymptomatic infection. Conclusion: HCMV infection may resulted in hearing impairment, they usually are mild injury, sometimes are sensorineural hearing loss. The incidence rate of hearing impairment among children with different months is different. Hearing impairment has the characteristics of reversibility, regardless of first hearing testing is normal or not, long-term follow-up and hearing testing are suggested.

Key words： cytomegalovirus hearing follow up sensorineural hearing loss

收稿日期: 2017-01-09

基金资助:温州市科技计划项目（Y20150127）。

通讯作者: 李昌崇，主任医师，博士生导师，Email：wzlichch@21cn.com

作者简介: 章虎（1986-），男，浙江温州人，住院医师，在职硕士生。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I8/599

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