巨细胞病毒感染新生儿听力损害与尿液病毒负荷量的相关性研究

Relationship between viral burden in urine and hearing loss in neonates with cytomegalovirus infection

摘要:

目的：研究新生儿巨细胞病毒(CMV)负荷量与听力损害的关系。方法：分析我院2006 年 4 月至 2010 年 1 月确诊的22例CMV感染新生儿的尿液中CMV病毒含量及其听力损失情况，并对其中20例进行为期3~6月的随访，复查脑干听觉诱发电位，分析病毒负荷量与听力损害的相关性并绘制受试者工作曲线(ROC)，确定诊断听力损害的病毒负荷界点。结果：CMV感染新生儿脑干听觉诱发电位(BAEP)异常组尿液病毒负荷量平均值显著高于BAEP正常组（5.06±1.50 vs 3.73±0.86, P<0.05），建立的ROC曲线下面积为0.752，界点为5.1时（即CMV DNA指数为1.27×105拷贝/mL）预测病毒负荷量导致听力损伤的灵敏度为54.5%，特异度100%，5.1以上组听力损害率显著高于5.1以下组(P<0.05)。听力损伤类型与病毒含量的高低（以病毒负荷量5.1为界点）无相关性(P＞0.05)。随访的20例中6例出现听阈损失，与病毒含量在5.1以下组相比，5.1以上组听力损害更严重(P<0.05)。结论：新生儿尿液CMV负荷量的水平可提示导致听力损伤的几率大小；当病毒负荷量达1.27×105拷贝/mL时，更容易出现听力损害。

Abstract:

OBJECTIVE: To determine the relationship between viral burden in urine and hearing loss in neonates with cytomegalovirus (CMV) infection. METHODS: Twenty-two neonates with CMV infection between April 2006 and January 2010 were enrolled. Their viral burden in urine and hearing loss information were studied. The receiver operating characteristic curve (ROC) was constructed and the cutoff was determined based on their medical information. The hearing levels were evaluated by brain stem auditory evoked potential (BAEP) during the age of 3 to 6 months in 20 patients. RESULTS: The viral burden in urine in neonates with abnormal BAEP was higher than that in neonates with normal BAEP (5.06±1.50 vs 3.73±0.86, P<0.05). Hearing loss was predicted with a sensitivity of 0.545 and a specificity of 1.0 by using ROC at the cutoff point of 5.1 which were defined after logarithmic conversion at 1.27×105 copies/mL of CMV burden in urine. The incidence of hearing loss during the age of 3 to 6 months was strikingly higher in high viral burden group than that in low viral load group (P<0.05). CONCLUSIONS: The viral burden in urine can predict the possibility of hearing loss in neonates with CMV infection. Hearing loss is likely to be developed when viral burden in urine ≥1.27×105 copies/mL in neonates with CMV infection.