Cytomegalovirus shedding and delayed sensorineural hearing loss: results from longitudinal follow-up of children with congenital infection.
Cytomegalovirus shedding and delayed sensorineural hearing loss: results from longitudinal follow-up of children with congenital infection.
复制标题
DOI：
10.1097/inf.0b013e318198c724
复制
发表时间：
2009-06
期刊：
影响因子：
--
通讯作者：
Cannon MJ
中科院分区：
文献类型：
--
作者：
Rosenthal LS;Fowler KB;Boppana SB;Britt WJ;Pass RF;Schmid SD;Stagno S;Cannon MJ
背景：巨细胞病毒(CMV)相关性听力损失的发病机制尚不清楚。目的：探讨先天性巨细胞病毒(CMV)持续脱落与迟发性感音神经性听力损失的关系。方法：对580例确诊为先天性CMV感染的患儿进行系列听力学检查及尿液和唾液CMV培养。结果：CMV培养阳性率在出生3周岁时降至50%左右，7周岁后降至5%左右。28%的儿童出现间歇性脱皮。77名儿童在出生时听力损失，38名儿童在随访结束时出现迟发性听力损失。在多因素分析中，延迟听力损失与出生时有症状的感染密切相关(OR=5.9，95%CI：1.8~18.9)，与最近一次培养阳性就诊时的年龄较大(OR=1.6，95%CI：1.1~2.0，比较1岁年龄差异)观察到的延迟听力损失发生率出生时无症状儿童为0.79/100人年，出生时有症状儿童为4.29/100人年。在6个月到8岁之间，我们预计6.9%的无症状儿童和33.7%的有症状儿童会发生迟发性听力损失。结论：出生时CMV相关症状是迟发性听力损失的最大危险因素，但许多无症状儿童也会发生迟发性听力损失。CMV脱落持续时间较长也可能是迟发性听力损失的预测指标。
Background:The pathogenesis of cytomegalovirus (CMV)-related hearing loss is not well understood.Objective:To evaluate the relationship between persistent CMV shedding and delayed sensorineural hearing loss in children born with congenital CMV.Methods:Serial audiologic assessments and CMV cultures of urine and saliva were performed on 580 children who had been diagnosed with congenital CMV infection.Results:Prevalence of CMV culture-positivity in any specimen decreased to approximately 50% by the third birthday and approximately 5% after the seventh birthday. Intermittent shedding occurred in 28% of children. Seventy-seven children had hearing loss at birth and 38 children developed delayed hearing loss by the end of follow-up. In multivariate analyses, delayed hearing loss was strongly associated with symptomatic infection at birth (OR= 5.9, 95% CI: 1.8–18.9) and modestly associated with older age at last culture-positive visit (OR= 1.6, 95% CI: 1.1–2.0, comparing 1-year age differences) Observed rates of delayed hearing loss were 0.79 per 100 person-years for children asymptomatic at birth and 4.29 per 100 person-years for children symptomatic at birth. Between the ages of 6 months and 8 years, we would expect delayed hearing loss to occur in 6.9% of asymptomatic children and in 33.7% of symptomatic children.Conclusions:The strongest risk factor for delayed hearing loss was CMV-related symptoms at birth, but many asymptomatic children also developed delayed hearing loss. Longer duration of CMV shedding may also be a predictor of delayed hearing loss.