肿瘤患儿顺铂化疗前后DPOAE变化分析

A clinical analysis on cisplatin changes DPOAE in childhood tumor

目的应用357Hz～5649Hz畸变产物耳声发射(DPOAE)测试对顺铂耳毒性进行临床分析,观察肿瘤患儿使用顺铂化疗后发生DPOAE变化的情况,探讨顺铂的耳毒性特点及相关危险因素。方法对2012年2月-2017年4月中山大学孙逸仙纪念医院儿童肿瘤专科收治住院的25例使用顺铂化疗的肿瘤患儿的病例资料进行回顾性临床分析,比较顺铂化疗前后DPOAE的变化,分析DPOAE变化特点及相关危险因素。结果(1)25例患儿使用顺铂化疗后,有3例(12%)出现耳鸣及眩晕症状。DPOAE检查发现有14例(56%)结果异常,DPOAE平均幅值对比化疗前在高频区(2822Hz、3991 Hz、5649 Hz)下降明显。(2)本组患儿累积使用铂类药物剂量为100～800mg/m^2;DPOAE首次出现异常时中位铂类累积量为500mg/m^2。(3)多因素logistic回归分析提示年龄(≤10岁)、单疗程顺铂最大用量(≥100mg/m^2)是肿瘤患儿使用顺铂化疗发生DPOAE变化的独立危险因素(P<0.05)。结论儿童肿瘤患儿使用顺铂化疗可引起DPOAE变化,以高频段损伤最明显。年龄、单疗程顺铂最大用量是肿瘤患儿使用顺铂化疗发生DPOAE变化的独立危险因素,对于年龄≤10岁、单疗程顺铂最大用量≥100mg/m^2的肿瘤患儿化疗时应加强听力监测。

Objective To investigate the ototoxicity of cisplatin and related risk factors,we analyzed the ototoxicity of cisplatin by distortion product otoacoustic emission(DPOAE)on 357Hz-5649Hz and observed the changes of DPOAE after cisplatin chemotherapy in children with tumor.Methods Clinical data of 25 cases of solid tumor received cisplatin chemotherapy from February 2012 to April 2017 in Pediatric Hematology/Oncology of SUN Yat-Sen Memoral Hospital were analyzed retrospectively.The amplitudes of DPOAE in patients before and after cisplatin administration were compared and the characteristics of DPOAE changes and related risk factors were analyzed.Results (1)Among 25 patients who received cisplatin,3(12%)cases had tinnitus and dizziness,14 cases(56%)showed abnormal DOPAE results,the pass rates at 2822Hz、3991Hz and 5649Hz declined significantly compared to the pre-treated level.(2)The cumulative dosage of platinum drugs was 100~800 mg/m^2,and the median platinum accumulation was 500 mg/m^2 when DPOAE first appeared abnormal.(3)Logistic regression model indicated age(≤10 year)and single course cisplatin maximum dosage(≥100mg/m^2)were independent risk factors for DPOAE changes(P﹤0.05).Conclusions The use of cisplatin in chemotherapy for pediatric solid tumors can cause DPOAE changes,especially in the high frequency range.Age and single course cisplatin maximum dosage may be risk factors of cisplatin related ototoxicity.For patients Less than 10 years old or the single treatment of cisplatin≥100 mg/m^2,hearing monitoring should be strengthened.