儿童期进行性听力损失——预后因素系统综述。

文献信息

中文摘要

引言： 儿童期进行性听力损失（PHL）可显著影响言语、语言和教育结局。尽管PHL的先天性和获得性病因已有充分记录，但其对听力恶化的影响及PHL的轨迹仍不明确。了解预后因素对于实现针对性监测和及时干预至关重要。
方法： 进行了一项PROSPERO注册的系统综述（ID：CRD42023492129），以识别和评估与儿童期PHL相关的预后因素。检索了MEDLINE、EMBASE和Cochrane Library数据库，纳入2000年至2025年间以英文发表的研究，研究对象为0-18岁、确诊为永久性听力损失的患者。使用CHARMS-PF评估研究设计质量，并使用QUIPS评估偏倚风险。由于定义和结局的异质性，进行了叙述性综合。
结果： 18项研究（参与者n=1,497）被纳入叙述性综合并有资格进行偏倚风险评估；仅两项被判定为低风险。探索性预后因素包括先天性巨细胞病毒感染、前庭导水管扩大、铂类化疗和放疗。这些因素对听力损失速度和严重程度的影响各不相同，且当前证据不足以进行荟萃分析或得出明确的预后结论。
结论： 关于PHL预后因素的证据有限且异质性大。需要高质量、方法学稳健的研究来确认这些因素并开发预测性多变量模型。此类模型可指导个性化监测和干预策略，使临床医生能够在最佳时机提供正确的干预，并改善有PHL风险儿童的长期听觉和发育结局。

英文摘要

INTRODUCTION: Progressive hearing loss (PHL) in childhood can significantly impact speech, language, and educational outcomes. While congenital and acquired aetiological factors for PHL are well documented, their influence on hearing deterioration and the trajectory of PHL remains unclear. Understanding prognostic factors is essential to enable targeted surveillance and timely intervention.
METHODS: A PROSPERO-registered systematic review (ID: CRD42023492129) was conducted to identify and evaluate prognostic factors associated with childhood PHL. MEDLINE, EMBASE, and Cochrane Library databases were searched for studies published between 2000 and 2025 in English, including patients aged 0-18 years, with confirmed permanent hearing loss. Study design quality was assessed using CHARMS-PF, and risk of bias was evaluated with QUIPS. Due to heterogeneity in definitions and outcomes, a narrative synthesis was performed.
RESULTS: Eighteen (participants n= 1,497) studies were included in the narrative synthesis and eligible for risk of bias assessment; only two were deemed low risk. Exploratory prognostic factors included congenital cytomegalovirus infection, enlarged vestibular aqueduct, platinum-based chemotherapy, and radiotherapy. The influence of these factors on the rate and severity of hearing loss was variable, and current evidence was insufficient for meta-analysis or definitive prognostic conclusions.
CONCLUSION: Evidence on prognostic factors for PHL is limited and heterogeneous. High-quality, methodologically robust studies are needed to confirm these factors and develop predictive, multivariable models. Such models could guide personalised surveillance and intervention strategies, enabling clinicians to deliver the right intervention at the optimal time and improving long-term auditory and developmental outcomes for children at risk of PHL.