National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
J Pediatric Infect Dis Soc. 2022 Jan 27;11(1):16-23. doi: 10.1093/jpids/piab095.
Long-term hearing outcomes among children with symptomatic congenital cytomegalovirus (CMV) disease who received 6-week ganciclovir therapy early in life are unknown.
Longitudinal study of 76 children with symptomatic congenital CMV disease, born 1983-2005, who were categorized into three groups: group A treated with ganciclovir; group B untreated who had microcephaly, chorioretinitis, or sensorineural hearing loss (SNHL; ≥25 dB) diagnosed in the first month of life (congenital); and group C untreated who did not meet criteria for group B.
Patients in groups A (n = 17), B (n = 27), and C (n = 32) were followed to median age of 13, 11, and 13 years, respectively. In group A, patients received ganciclovir for median of 40 (range, 11-63) days; 7 (41%) had grade 3 or 4 neutropenia. Congenital SNHL was diagnosed in 11 (65%) patients in group A, 15 (56%) in group B, and none in group C. Early-onset SNHL was diagnosed between ages ≥1-12 months in an additional 4 (24%), 6 (22%), and 8 (25%) patients in groups A, B, and C, respectively. By the end of follow-up, 12 (71%), 16 (59%), and 7 (22%) of patients in groups A, B, and C, respectively, had severe (>70 dB) SNHL in the better-hearing ear.
In this study, most patients with symptomatic congenital CMV disease and congenital or early-onset SNHL eventually developed hearing loss severe enough to have been potential candidates for cochlear implantation, with or without 6-week ganciclovir therapy. Understanding long-term hearing outcomes of patients treated with 6-month oral valganciclovir (current standard of care) is needed.
接受早期生命 6 周更昔洛韦治疗的有症状先天性巨细胞病毒（CMV）病患儿的长期听力结果尚不清楚。
对 1983 年至 2005 年间出生的 76 名有症状先天性 CMV 病患儿进行了纵向研究，这些患儿分为三组：A 组接受更昔洛韦治疗；B 组未接受治疗，出生后第一个月内诊断为小头畸形、脉络膜视网膜炎或感音神经性听力损失（≥25dB）（先天性）；C 组未接受治疗且不符合 B 组标准。
A 组（n=17）、B 组（n=27）和 C 组（n=32）的患者分别随访至中位年龄 13、11 和 13 岁。A 组患者接受更昔洛韦治疗的中位数为 40（范围，11-63）天；7（41%）例出现 3 或 4 级中性粒细胞减少症。A 组 11（65%）例患者诊断为先天性感音神经性听力损失，B 组 15（56%）例，C 组无患者。A、B 和 C 组中，另有 4（24%）、6（22%）和 8（25%）例患者分别在 1-12 个月龄时诊断为早发性感音神经性听力损失。随访结束时，A、B 和 C 组分别有 12（71%）、16（59%）和 7（22%）例患者在较好耳存在重度（>70dB）感音神经性听力损失。
在这项研究中，大多数有症状先天性 CMV 病且存在先天性或早发性感音神经性听力损失的患儿最终发展为重度听力损失，这些患儿可能是耳蜗植入的候选者，无论是否接受 6 周更昔洛韦治疗。需要了解接受 6 个月口服缬更昔洛韦（当前的标准治疗）治疗的患者的长期听力结果。
