乌干达东部镰状细胞病儿童和青少年听力损失的患病率、模式及相关因素：一项横断面研究

文献信息

中文摘要

背景： 镰状细胞病（SCD）在撒哈拉以南非洲造成沉重负担，而耳蜗易受该病特征性的血管闭塞和慢性贫血影响。乌干达SCD儿童的听力损失仍缺乏描述，包括该国SCD负担最重的Mbale周边东部地区。本研究旨在确定在Mbale区域转诊医院就诊的SCD儿童和青少年中听力损失的患病率、模式及相关因素。
方法： 一项基于医院的横断面研究纳入了225名在镰状细胞门诊就诊、临床状态稳定的5至18岁儿童和青少年。由听力学家进行纯音测听，按照世界卫生组织的定义，听力损失定义为在500、1000和2000 Hz处较差耳平均气导阈值高于20 dB。使用Firth惩罚logistic回归检验与听力损失相关的因素，并报告粗比值比和调整比值比及其95%置信区间。
结果： 225名参与者中有52人存在听力损失，患病率为23.1%（95% CI 18.1至29.0）。单侧损失29例，双侧损失23例，大多数为轻度损失。中枢神经系统事件（调整比值比[aOR] 3.54；95% CI 1.01至12.43；p = 0.049）和耳部感染史（aOR 2.42；95% CI 1.01至5.82；p = 0.048）与听力损失独立相关。三次或以上输血显示出相近的关联，但刚好未达到显著性（aOR 2.16；95% CI 0.99至4.73；p = 0.054）。
结论： 在这家转诊医院，四分之一的SCD儿童和青少年存在听力损失，受累儿童带有严重疾病和中耳病变的标志。应将听力测定纳入常规镰状细胞病照护，以便在听力损失损害语言和学习之前发现它。

英文摘要

BACKGROUND: Sickle cell disease (SCD) imposes a substantial burden in sub-Saharan Africa, and the cochlea is vulnerable to the vaso-occlusion and chronic anaemia that characterise the condition. Hearing impairment in children with SCD remains poorly described in Uganda, including the eastern districts around Mbale that carry one of the highest SCD burdens in the country. This study determined the prevalence, patterns, and factors associated with hearing impairment among children and adolescents with SCD attending Mbale Regional Referral Hospital.
METHODS: A hospital-based cross-sectional study enrolled 225 children and adolescents aged 5 to 18 years attending the sickle cell clinic in a steady clinical state. An audiologist performed pure-tone audiometry, and hearing impairment was defined as a worse-ear average air-conduction threshold above 20 dB at 500, 1000, and 2000 Hz, following the World Health Organization definition. Factors associated with hearing impairment were examined using Firth penalised logistic regression, with crude and adjusted odds ratios reported with 95% confidence intervals.
RESULTS: Hearing impairment was present in 52 of 225 participants, a prevalence of 23.1% (95% CI 18.1 to 29.0). Impairment was unilateral in 29 and bilateral in 23, and most losses were mild. A central nervous system event (adjusted odds ratio [aOR] 3.54; 95% CI 1.01 to 12.43; p = 0.049) and a history of ear infection (aOR 2.42; 95% CI 1.01 to 5.82; p = 0.048) were independently associated with hearing impairment. Three or more transfusions showed a comparable association that just missed significance (aOR 2.16; 95% CI 0.99 to 4.73; p = 0.054).
CONCLUSION: One in four children and adolescents with SCD at this referral hospital had hearing impairment, and the affected children carried markers of severe disease and middle-ear pathology. Audiometry should be integrated into routine sickle cell care to detect impairment before it harms language and learning.