CAJ | 학술논문

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30dB nHL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6kHz、8kHz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6kHz、8kHz，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 kHz）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。
목적：관찰박류약물재실체류인동화료과정중대은력적영향，고찰박류화료약도치은력손상적상관위험인소。방법회고성분석우2014년1월지2015년4월재북경인동의원혈액종류중심진행화료적실체류인동림상자료，소유환인화료과정중균사용박류화료약，분별재제1、3、6차화료전진행규범은역학검사，포괄순음측은、기변산물이성발사화은성뇌간반응。결과공납입0.2-12.5세실체류환인47명，공계94이，진행화료적평균차수위5.4차(3-10차)。ABR검사중이임의일이은역대우30dB nHL위은력손상，제6료정은력이상발생솔위6.4%（6/94），여기선수평대비，차이유통계학의의（p＜0.05）。제3、6료정ABR역치여기선수평상비，ABR역치명현승고，균유현저통계학차이（p＜0.001）；PTA검사중제6료정6kHz、8kHz측은결과여기선수평상비균유통계학차이（p＜0.05），상응역치명현제고；DOPAE제시제6료정6kHz、8kHz，통과솔명현하강，여기선수평비교유현저통계학차이。Logistic회귀모형중년령시박류약물이독성적위험인소，（p＜0.05，OR치=0.912），제시년령월소박류약물적이독성월역현현。결론박류약물용우인동실체종류화료가인기은력손상，재고빈부분（6-8 kHz）우위현저。DOPAE、순음측은급ABR가작위감측、평개박류약물이독성적중요지표。인동년령월저칙박류약물인기은력손상적위험월대，저령인동사용박류약물시경수가강은력감측。
Objective To study effects on hearing by platinum drugs in children with solid tumors and risk factors for platinum drugs related hearing loss. Methods Clinical data of children with solid tumors was collected from January 2014 to April 2015, who received platinum drugs for chemotherapy. Audiologic exami-nations were performed before the 1st, 3rd and 6th courses of chemotherapy, including pure tone audiometry (PTA), distortion product otoacoustic emissions (DPOAE) and auditory brainstem responses (ABR). Results A total of 47 children (94 ears) with solid tumors were included, aging from 0.2 to 12.5 years who received an average 5.4 courses of chemotherapy (ranging 3-10 courses). In ABR examination, hearing loss rate at the 6th course was 6.4%, significantly higher compared to the baseline level (p<0.001). In PTA examination at 6 and 8 kHz, thresholds at the 6th courses were also significantly different compared to the baseline hearing level (p<0.05). In DOPAEs, the pass rates at 6 and 8 kHz at the 6th course declined significantly compared to the baseline level. Logistic regression model indicated age as one of the risk factors for hearing loss (p<0.05, OR=0.192), suggesting that the younger the patients was, the more prominent the platinum drugs related ototoxici-ty would be. Conclusion The use of platinum drugs in chemotherapy for pediatric solid tumors can cause hearing loss, especially in the high frequency range (6-8 kHz). DOPAEs, PTA and ABRs can be used as im-portant methods in the evaluation of early hearing changes caused by platinum drugs. Age may be one of the risk factors of platinum drugs related ototoxicity.