Walter S, Atkinson C, Sharland M, Rice P, Raglan E, Emery V C, Griffiths P D
St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK.
Arch Dis Child Fetal Neonatal Ed. 2008 Jul;93(4):F280-5. doi: 10.1136/adc.2007.119230. Epub 2007 Nov 26.
To investigate the relation between cytomegalovirus (CMV) viral load on dried blood spots (DBS) from newborn biochemical screening ("Guthrie") cards, and sensorineural hearing loss (SNHL) in congenital CMV.
Cross-sectional study with retrospective case-note review.
Seven paediatric audiology departments in the United Kingdom.
84 children, median age 7 years: 43 with known congenital CMV, 41 with unexplained SNHL.
Half a DBS was tested for CMV DNA viral load by quantitative real-time polymerase chain reaction (PCR).
Pure tone average hearing thresholds (0.5-4 kHz).
DBS CMV DNA viral load significantly correlated with hearing thresholds for the worse and better hearing ears (Spearman's rank correlations: r = 0.445, p = 0.008 and r = 0.481, p = 0.004 respectively). Multivariable logistic regression showed that the effect of DBS viral load on the risk of SNHL remained important, when age and central nervous system involvement had been taken into account (odds ratio (OR) 2.76, 95% confidence interval (CI) 1.14 to 6.63, p = 0.024). The mean log DBS viral load was significantly higher in children with SNHL than in those with normal hearing (2.69 versus 1.64, 95% CI -1.84 to -0.27, p = 0.01). 8/35 (23%) children with unexplained SNHL tested positive for CMV DNA on DBS. One false positive result was obtained.
The risk of SNHL increased with DBS viral load. Further studies should investigate whether DBS CMV testing has a role in identifying asymptomatic congenitally infected neonates at risk of SNHL, and whether antiviral treatment can reduce this risk.
研究新生儿生化筛查（“古思里”）卡片上干血斑（DBS）中的巨细胞病毒（CMV）病毒载量与先天性CMV所致感音神经性听力损失（SNHL）之间的关系。
采用回顾性病例笔记审查的横断面研究。
英国的七个儿科听力学部门。
84名儿童，中位年龄7岁：43名已知先天性CMV感染，41名原因不明的SNHL患者。
通过定量实时聚合酶链反应（PCR）检测半张DBS的CMV DNA病毒载量。
纯音平均听阈（0.5 - 4 kHz）。
DBS中CMV DNA病毒载量与听力较差和较好耳朵的听阈显著相关（斯皮尔曼等级相关性：r = 0.445，p = 0.008和r = 0.481，p = 0.004）。多变量逻辑回归显示，在考虑年龄和中枢神经系统受累情况后，DBS病毒载量对SNHL风险的影响仍然显著（优势比（OR）2.76，95%置信区间（CI）1.14至6.63，p = 0.024）。SNHL儿童的平均DBS病毒载量对数显著高于听力正常儿童（2.69对1.64，95% CI -1.84至 -0.27，p = 0.01）。35名原因不明的SNHL儿童中有8名（23%）DBS的CMV DNA检测呈阳性。获得了1例假阳性结果。
SNHL风险随DBS病毒载量增加。进一步研究应调查DBS CMV检测在识别有SNHL风险的无症状先天性感染新生儿方面是否有作用，以及抗病毒治疗是否能降低这种风险。
