The Clinical Characteristics And Related Factors Of Hearing Damage In167Infants Caused By Cytomegalovirus Infection

PART ONEClinical manifestation and effect of ganciclovir therapy in CMV-infectied infantsObjective To explore the clinical characteristics and therapeutic effect of ganciclovirand the long-term prognosis in CMV-infected infantsMethods We have choosed167infants infected by CMV,hospitallized in PediatricsGeneral Hospital of Ningxia Medical University from January,2010toDecember,2013.Retrospectively reviewed the reasons of treatment, clinical manifestationsand laboratory test results.Ganciclovir-based anti-virus and liver jaundice comprehensivetreatment.Ganciclovir induction therapy two weeks,5mg/kg, adding5-10%glucoseintravenous injection over1h,2times/day, continuous14d; maintenance period5mg/kg,daily, continuous3d/week,4-8weeks.Dynamic observation of clinical symptoms before andafter treatment, and laboratory parameters (liver function, jaundice index,, CMV-IgM,CMV-DNA, etc.) changes and adverse drug reactions.Using SPSS17.0statistical analysis,paired t test itself, P <0.05statistically significant difference,compare liver enzymes(AST,ALT), jaundice index (TB, DB, IB) before and after treatment with ganciclovir whether thedifference was statistically significant.Result The main reason of CMV-infected infants for treatment is jaundice (49.1%),followed by liver dysfunction (17.4%), pneumonia (15.6%);CMV infection in children oftenaccompanied by multiple organ abnormalities, congenital heart disease is the most common,followed by umbilical hernia, inguinal hernia.167patients treat with ganciclovir,145casescure, and5cases improving, unhealing15case（s5deaths）,2cases lose access. The difference of liver function(AST、ALT)before and after treatment with ganciclovir have statisticalsignificance(P <0.05).. The difference of jaundice index(TB, DB) before and after treatmentwith ganciclovir have statistical significance(P <0.05).The difference of IB between2timesmaintenance therapy with ganciclovir and4times was not statistically significant (P>0.05).During Ganciclovir treatment,35patients neutropenia decrease (absolute value <1.0×109/L),23cases of children has increased stool frequency.Conclusions The clinical manifestations of CMV infection are vary,the efficacy ofcombined treatment with ganciclovir, Yinzhihuang, compound liquorice anhydride by the vastmajority of children is good.But the prognosis of that combined with hepatocirrhosis,poorimmunity or immune deficiency small-month-old baby combined with respiratory infection isvery dangerous.During ganciclovir treatment with CMV infection neutrophil counts decreaseis common adverse reaction. PART TWOAnalysis of related factors of hearing damage in infants of CMV infectionObjective To investigate the characteristics of BAEP in CMV-infected infants withhearing damage, explore the possible factors related to hearing damage, by doing thebrainstem auditory evoked potential(BAEP).Methods We have collected167infants infected by CMV, hospitallized inDepartment of Pediatrics,General Hospital of Ningxia Medical University, fromJanuary,2010to December,2013,75cases were taken BAEP examination, including48males and27females;1-3months58cases,≤6months13cases,≤12months4cases;40cases merger with jaundice, including31cases of mild jaundice,8cases of moderatejaundice,1case of severe jaundice,Recording Ⅰ,Ⅲ,ⅴ-wave latency, amplitude andwaveform differentiation and waveform repeating,analyze the characteristics of BAEP inCMV-infected children with hearing loss.Using SPSS17.0statistical software, and χ2test onage, gender, jaundice index have anything to do with abnormal BAEP;Using the geometricmean of two sample t test, analyze peripheral blood CMV-DNA load whether have differencesin BAEP normal infants and BAEP abnormalities infants.If they have differences, furtheranalyze the critical value of CMV-DNA load,when the BAEP is abnormal,Result The main characteristics of CMV-infected infant with hearing loss is Ⅰ,Ⅲ-wave waveform differentiation poor,followed by Ⅰ,Ⅲ,ⅴ-wave latency,The analysis ofrelated factors of BAEP abnormalities show that it is related to age,further do spearmananalysis show that age and BAEP abnormalities are negatively correlated;gender, jaundiceindex have no correlation with abnormal BAEP.The CMV-DNA load of BAEP abnormalitiesBaby is higher than the normal infants,draw ROC curve showed peripheral CMV-DNA>4.78×103copies/ml, infants are more likely BAEP abnormalities.Conclusions CMV infection can lead to infants different degrees of hearing loss,BAEPcan detect infant hearing abnormalities early.The main characteristics of infants CMV infection hearing loss are cochlear and central damage.The infants with CMV-infected lessthan3months old are more likely to hearing damage,as CMV-DNA load increases, the risk ofhearing loss increase in CMV-infected infants.