阿米卡星治疗是否会导致囊性纤维化患者出现亚临床听力损失？
Does amikacin treatment cause subclinical hearing loss in patients with cystic fibrosis?
作者信息
Solmaz Fevzi, Gündoğdu Ercan, Akduman Davut, Haksever Mehmet, Dikici Oğuzhan, Ünal Fatih
机构信息
Bursa Training and Research Hospital, Department of Otorhinolaryngology, Bursa, Turkey.
Duzce University, Medical Faculty, Department of Otorhinolaryngology, Duzce, Turkey.
出版信息
Toxicol Rep. 2016 Mar 22;3:401-404. doi: 10.1016/j.toxrep.2016.03.010. eCollection 2016.
INTRODUCTION
Aminoglycosides (AGs) have been widely used for potential life-threatening bacterial infections. Although AGs are well known for their ototoxic side effects, some AGs such as amikacin are considered less harmful to auditory functions; thus, auditory monitoring is mostly neglected during treatment with these drugs.
OBJECTIVE
To reflect the potential auditory hazards of repeated amikacin use on the patients with cystic fibrosis (CF).
METHOD
32CF patients with prior exposure to at least 3 courses of amikacin (the CF group) and 35 non-CF patients visiting the outpatient clinic with any complaint other than hearing loss and no history of treatment with any AG(the control, or C group) were compared with pure-tone audiometry(PTA). The diagnosis of CF was made by Nanoduck sweat test.
RESULTS
The average age of the participants were 8.25 ± 2.76 years in the CF group and 8.58 ± 2.00 years in the C group (ranging from 5 to 13 years). 29 (43.28%) of the cases were female and 38 (56.71%) were male. Clinical SNHL(sensorineural hearing loss) was detected in 4 of the 32 subjects in the CF group. None of the subjects in the C group exhibited clinical SNHL. There was no statistically significant difference between the groups with regard to presence or absence of clinical SNHL (p > 0.05). However, hearing levels of the CF group were around 20 dB(decibel) HL(hearing loss), whereas hearing levels of the C group were around 5 dB. This difference was statistically significant for the pure tone averages of both all frequencies and speech frequencies (p < 0.05).
CONCLUSION
Repetitive exposure to AGs can cause permanent, although mild, sensorineural hearing loss. For prevention, hearing status of the patient should be closely monitored and treatment of choice should be precisely tailored according to the audiological evaluation. This is especially important in patients with CF who frequently experience medical conditions necessitating AGs use.
引言
氨基糖苷类药物（AGs）已被广泛用于治疗可能危及生命的细菌感染。尽管AGs因其耳毒性副作用而广为人知，但一些AGs如阿米卡星被认为对听觉功能的危害较小；因此，在使用这些药物治疗期间，听觉监测大多被忽视。
目的
反映重复使用阿米卡星对囊性纤维化（CF）患者潜在的听觉危害。
方法
对32例既往至少接受过3个疗程阿米卡星治疗的CF患者（CF组）和35例除听力损失外无其他主诉且无任何AG治疗史的门诊非CF患者（对照组，或C组）进行纯音听力测定（PTA）比较。CF的诊断通过Nanoduck汗液试验进行。
结果
CF组参与者的平均年龄为8.25±2.76岁，C组为8.58±2.00岁（年龄范围为5至13岁）。病例中29例（43.28%）为女性，38例（56.71%）为男性。CF组32名受试者中有4名检测到临床感音神经性听力损失（SNHL）。C组受试者均未表现出临床SNHL。两组在是否存在临床SNHL方面无统计学显著差异（p>0.０5）。然而，CF组的听力水平约为20分贝（dB）听力损失（HL），而C组的听力水平约为5dB。这一差异在所有频率和言语频率的纯音平均值方面具有统计学显著性（p<0.０5）。
结论
反复接触AGs可导致永久性的、尽管是轻度的感音神经性听力损失。为预防起见，应密切监测患者的听力状况，并根据听力学评估精确调整治疗方案。这在经常因病情需要使用AGs的CF患者中尤为重要。
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