The Relationship Between Peripheral Blood Viral Load With Hearing And Prognosis In Infants Cytomegalovirus Infection

BackgroundThe population is generally susceptible to human cytomegalovirus(HCMV),and infants are the main victims.Infant cytomegalovirus infection is hard to be found which is likely to cause neurological complications such as sensorineural hearing loss(SNHL).Cytomegalovirus infection is also one of the main causes of non-hereditary deafness in children.If hearing loss occur,it will reduces children’s learning ability and seriously endangers their health.Whether the peripheral blood viral load in infants cytomegalovirus infection is related to hearing loss and the recovery of long-term hearing loss which is valued in clinic.ObjectiveThis study will:1.Explore the relationship between the cytomegalovirus load and hearing loss in peripheral blood in infants cytomegalovirus infection;2.Observe the impact of changes in peripheral blood cytomegalovirus-viral load after antiviral treatment with ganciclovir or valganciclovir on hearing prognosis;3.Follow-up to observe hearing loss and liver function recovery after anti-cytomegalovirus treatment regular.MethodsCollected 120 cases that diagnosed cytomegalovirus infection in the Department of Infectious Diseases and Neonatology Department in Guangzhou Women and Children’s Medical Center from January 2017 to January 2020,aged0-6 months,with an average age of 1.96 months.80 of them were males,40females.We chose the 35 patients with hearing loss(28 males,7 females)as the observation group,the rest 85 cases without hearing loss(52 males,33 females)as the control group.Completed blood routine,blood biochemistry,TORCH,urine HCMV-DNA,peripheral blood HCMV-DNA,brainstem auditory evoked potential tests after admission.All the cases which meet the crieria in antiviral therapy should be treated with ganciclovir or valganciclovir treatment.The observation group was followed up for 3-6 months after antiviral treatment with ganciclovir or valganciclovir.The peripheral blood viral load of the observation group and the control group did not meet the normal distribution,should transform the peripheral blood viral load into logarithms form.Use t test to compare the peripheral blood cytomegalovirus viral load in the observation group with the control group.We will drawn the ROC curve of peripheral blood viral load and hearing loss.Observe the changes in peripheral blood cytomegalovirus load before and after treatment with ganciclovir antiviral or valganciclovir.All the collected data are statistically analyzed by SPSS 25.0 statistical software.Results1.General conditions in observation group and control group:there were no statistical difference in gender(male/female 28/7,52/33),birth weight,alanine aminotransferase,aspartate aminotransferase,total bilirubin,direct bilirubin,hemoglobin,platelets and white blood between the two groups(P>0.05).2.The mean age in the control group was 2.14±0.14 months higher than that of the observation group 1.55±0.12 months.and there was a statistically significant difference between the age and hearing loss(P<0.05).The area under the receiver operating characteristic curve of age and hearing loss was 0.617,and the standard error was 0.052,(95%confidence interval:0.514-0.719),P<0.05.3.After logarithmic transformation,the mean peripheral blood viral load of the observation group was 3.54±0.10 higher than that of the control group 3.16±0.05,and the peripheral blood CMV-DNA load and hearing loss were statistically significant(P<0.05).The area under the ROC curve between peripheral blood viral load and hearing loss is 0.703,standard error is 0.053,(95%confidence interval:0.600-0.807),P value<0.05,peripheral blood viral load is 3.473(index form was2.97×10~3copies/ml)has a prediction sensitivity of 57.1%and specificity of 77.6%for hearing impairment.4.All the 35 cases in the observation group met the indications for antiviral treatment,of which 20 cases with high viral load,3 cases had hearing deterioration after treatment,the rest 17 case had hearing improved.15 cases with low viral load,and 3 cases had deteriorated after antiviral treatment,the rest 12 cases improved,P>0.05.The initial peripheral blood viral load had no significant difference in the hearing prognosis.5.The peripheral blood viral load declined fastest in 1 week after antiviral treatment therapy,P<0.05,the peripheral blood viral load declined slowest after maintenance treatment in observation group.6.The main biochemical indicators of 35 cases in the observation group before and after antiviral treatment:ALT(234.74±45.25,127.06±28.29)U/L,AST(293.26±50.22,148.97±37.79)U/L,TB(133.54±13.83,88.68)±14.66)umo/L,DB(93.29±10.54,64.56±9.34)umo/L,TBA(110.07±12.72,75.27±8.18)umo/L,P<0.05,there is a statistical difference.After 3-6 months of follow-up,30 cases of liver function completely recovered,4 cases of liver function improved gradually,and 1case of liver function showed progressive deterioration and need to have a liver transplantation.Conclusions1.Cytomegalovirus infection in infants has a significantly higher risk of hearing loss with the peripheral blood HCMV DNA higher than 3.473(index form is2.97×10~3 copies/ml).2.The level of peripheral blood viral load before antiviral treatment of ganciclovir or valganciclovir has no predictive value for hearing prognosis.The changes in viral load of antiviral treatment cannot significantly improve the prognosis of severe and extremely severe hearing impairment.3.The cases that meet antivial indications can significantly improve their liver enzymes and bilirubin through anti-cytomegalovirus therapy with ganciclovir or valganciclovir regular.