论文部分内容阅读
目的观察铂类药物在实体瘤儿童化疗过程中对听力的影响,考察铂类化疗药导致听力损伤的相关危险因素。方法回顾性分析于2014年1月至2015年4月在北京儿童医院血液肿瘤中心进行化疗的实体瘤儿童临床资料,所有患儿化疗过程中均使用铂类化疗药,分别在第1、3、6次化疗前进行规范听力学检查,包括纯音测听、畸变产物耳声发射和听性脑干反应。结果共纳入0.2-12.5岁实体瘤患儿47名,共计94耳,进行化疗的平均次数为5.4次(3-10次)。ABR检查中以任意一耳听阈大于30d B n HL为听力损伤,第6疗程听力异常发生率为6.4%(6/94),与基线水平对比,差异有统计学意义(p<0.05)。第3、6疗程ABR阈值与基线水平相比,ABR阈值明显升高,均有显著统计学差异(p<0.001);PTA检查中第6疗程6k Hz、8k Hz测听结果与基线水平相比均有统计学差异(p<0.05),相应阈值明显提高;DOPAE提示第6疗程6k Hz、8k Hz,通过率明显下降,与基线水平比较有显著统计学差异。Logistic回归模型中年龄是铂类药物耳毒性的危险因素,(p<0.05,OR值=0.912),提示年龄越小铂类药物的耳毒性越易显现。结论铂类药物用于儿童实体肿瘤化疗可引起听力损伤,在高频部分(6-8 k Hz)尤为显著。DOPAE、纯音测听及ABR可作为监测、评价铂类药物耳毒性的重要指标。儿童年龄越低则铂类药物引起听力损伤的危险越大,低龄儿童使用铂类药物时更需加强听力监测。
Objective To observe the effect of platinum on hearing during chemotherapy in children with solid tumors and to investigate the related risk factors of platinum-based chemotherapy drugs on hearing loss. Methods The clinical data of children with solid tumors who underwent chemotherapy in the Hematological Oncology Center of Beijing Children’s Hospital from January 2014 to April 2015 were retrospectively analyzed. All the patients were treated with platinum chemotherapeutic drugs during chemotherapy. 6 times prior to chemotherapy for audiological examination, including pure tone audiometry, distortion product otoacoustic emission and auditory brainstem response. Results A total of 47 children with solid tumors of 0.2-12.5 years old were enrolled, a total of 94 ears. The average number of chemotherapy was 5.4 times (3-10 times). The hearing loss threshold was greater than 30 days for any one ear in the ABR test, and the hearing loss rate was 6.4% (6/94) in the sixth course of treatment. The difference was statistically significant (p <0.05) compared with the baseline level. ABR thresholds at 3 and 6 were significantly higher than those at baseline (P <0.001). The 6k Hz and 8k Hz audiometry results of the 6th course of PTA were significantly lower than those at baseline (P <0.05), and the corresponding thresholds were significantly increased. DOPAE suggested that the pass rates of 6k Hz, 8k Hz in the 6th course of treatment decreased significantly compared with the baseline levels. There was significant statistical difference between the two groups. Logistic regression model of age is a risk factor for platinum drugs ototoxicity (p <0.05, OR = 0.912), suggesting that the younger age platinum drug ototoxicity easier to show. Conclusion The platinum drugs used in solid tumors of children with chemotherapy can cause hearing loss, especially in the high frequency part (6-8 k Hz). DOPAE, pure tone audiometry and ABR can be used as an important indicator to monitor and evaluate the ototoxicity of platinum drugs. The lower the age of children, the greater the risk of hearing loss caused by platinum drugs, the younger children need to strengthen the monitoring of hearing when using platinum drugs.