巨细胞病毒肝炎患儿的听力损伤及更昔洛韦的疗效研究

Clinical investigation of hearing impairment in cytomegalovirus hepatitis and the curative effect of ganciclovir

目的:分析巨细胞病毒(CMV)肝炎患儿的听力损伤情况,探讨更昔洛韦对CMV肝炎的听力损伤疗效。方法:103例CMV肝炎患儿随机分为治疗组(65例)和对照组(38例)。治疗组使用更昔洛韦,辅以护肝利胆等对症治疗,对照组仅使用护肝利胆等对症治疗。定期检查血常规、生化常规、血CMV-pp65及尿CMV-DNA,检测脑干听觉诱发电位(ABR)。结果:治疗组患儿治疗前后CMV-pp65、CMV-DNA阳性率之间差异具有统计学意义(P<0.01);对照组治疗前后CMV-pp65、尿CMV-DNA阳性率变化差异无统计学意义(P>0.05)。103例CMV肝炎患儿治疗前ABR测试,听力损伤27耳(13.1%)。其中治疗组65例,听力损伤17耳(13.08%),对照组38例听力损伤10耳(13.16%),更昔洛韦治疗后1年,治疗组听力损伤15耳(11.54%),对照组听力损伤17耳(22.37%),两组相比,听力损伤率差异有统计学意义(P<0.05)。结论:部分CMV肝炎患儿存在听力损伤,更昔洛韦治疗能使患儿血CMV-pp65及尿CMV-DNA阴转,降低其听力损伤发病率。

AIM： To analvze the hearing impairment rate of cytomegalovirus （CMV） hepatitis and explore the curative effect of ganeiclovir. METHODS： 103 cases of CMV hepatitis patients were randomly divided into treatment group （65 cases ） and control group （38 cases）. Treatment group used Ganciclovir, supplemented symptomatic treatment, the control group used only symptomatic treatment. The blood, biochemical routine, levels of blood CMV-pp65 and urine CMVDNA were determined regularly , and the brain stem auditory.＇ evoked potential （ABR） was detected. RESULTS： The positive rate of CMV-pp65, CMV-DNA of patients before and after treatment in treatment group had significant difference （ P 〈 0.01 ） ; The changes of positive rate of CMV-pp65 and urine CMV-DNA before and after treatment in control group had no significant difference （ P 〉 0.05 ）. The ABR of 103 cases of CMV hepatitis patients was tested before treatment, 27 ears were hearing impairment （ 13.1% ）. There were 17 ears hearing impairment （13.08%） in treatment group 65 cases patients, and 10 ears hearing impairment （13.16%） in control group 38 cases patients, after one year with ganciclovir treatment, 15 ears were hearing impairment （ 11.54% ） in treatment group and 17 ears were hearing impairment （22.37%） in control group. Compared with the two groups, the rate of hearing impairment had significant difference （ P 〈 0.05）. CONCLUSION： There are the hearing impairment in part of children with CMV hepatitis, after Ganciclovir treatment the blood CMV-pp65 and urine CMV-DNA in patients were negative and the incidence of hearing impairment was decreased.