Lee Sang-Yeon, Jeon Heong Won, Ahn So-Yeon, Oh Seung-Ha, Kim Bong Jik, Choi Byung Yoon
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea; Sensory Organ Research Institute, Seoul National University Medical Research Center, Seoul, South Korea.
Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
Int J Pediatr Otorhinolaryngol. 2023 May;168:111555. doi: 10.1016/j.ijporl.2023.111555. Epub 2023 Apr 14.
To determine the diagnostic role of viral markers for cytomegalovirus (CMV) when tested after the diagnostically critical period (postnatal 3 weeks) in children with sensorineural hearing loss (SNHL).
A retrospective review of 104 subjects who underwent CMV diagnostic tests after the critical period of 3 postnatal three weeks but before 24 months of age. Infants included had not passed universal newborn hearing screening tests in at least one ear and thus underwent obligatory follow up audiology testing as well as either exome sequencing or magnetic resonance imaging in cases of SNHL. Our cohort was classified into four subgroups depending on the results from audiological and etiologic diagnostic tests (genetic and radiological tests): congenital CMV (cCMV)-related SNHL (Group 1, n = 9), SNHL with another clear etiology (Group 2, n = 34), and SNHL classified as neither Group 1 nor 2 (Group 3, n = 18). We added age-matched, normal-hearing children (Group 4, n = 43) as a control group. CMV related viral metrics were compared among these four groups.
CMV PCR positivity, PCR titers, and culture positivity successfully differentiated Group 1 from Groups 2 and 4. Group 3 showed values of these parameters that were significantly different from Groups 2 and 4, while being more similar to those in Group 1, suggesting that a substantial portion of Group 3 truly had cCMV deafness. A hypothetical formula was developed to predict cCMV infections using logistic regression analysis.
This is the first study to propose the clinical significance of CMV test results obtained after 3 weeks post-birth in children with SNHL and to suggest how we can utilize them.
确定在感音神经性听力损失（SNHL）儿童的诊断关键期（出生后3周）之后进行检测时，巨细胞病毒（CMV）病毒标志物的诊断作用。
回顾性分析104名在出生后3周关键期之后但在24个月龄之前接受CMV诊断检测的受试者。纳入的婴儿至少有一只耳朵未通过普遍新生儿听力筛查测试，因此在出现SNHL的情况下接受了强制性的后续听力测试以及外显子组测序或磁共振成像。根据听力和病因诊断测试（基因和放射学测试）的结果，我们的队列被分为四个亚组：先天性CMV（cCMV）相关的SNHL（第1组，n = 9），具有另一种明确病因的SNHL（第2组，n = 34），以及既不属于第1组也不属于第2组的SNHL（第3组，n = 18）。我们添加了年龄匹配的听力正常儿童（第4组，n = 43）作为对照组。比较这四组之间与CMV相关的病毒指标。
CMV PCR阳性、PCR滴度和培养阳性成功地将第1组与第2组和第4组区分开来。第3组显示这些参数的值与第2组和第4组有显著差异，同时与第1组更相似，这表明第3组中有很大一部分人确实患有cCMV耳聋。使用逻辑回归分析开发了一个预测cCMV感染的假设公式。
这是第一项提出出生后3周后在SNHL儿童中获得的CMV检测结果的临床意义并建议如何利用这些结果的研究。
