听性脑干诱发电位Ⅴ波潜伏期耳间差值与新生儿高胆红素血症的相关性研究

Association between the inter-aural latency difference of brainstem auditory evoked potential wave V and neonatal hyperbilirubinemia

摘要:

目的 研究用短声（强度60 dBnHL）刺激患儿产生听性脑干诱发电位，探讨不同血清总胆红素（total serum bilirubin，TSB）水平患儿Ⅴ波潜伏期耳间差值（inter-aural latency difference，ILD）是否有差异性。方法 前瞻性选取2019年5月至2020年10月在浙江省玉环市人民医院新生儿科收治的高胆红素血症患儿。根据TSB水平分为重症组（n=50）、轻症组（n=50）；轻症组根据日龄分为日龄7~10 d亚组（n=20）、日龄11~14 d亚组（n=20），分析ILD在不同TSB水平间的差异及其诊断价值。结果 重症组听阈异常比例、ILD异常比例均高于轻症组（P < 0.05），重症组Ⅴ波ILD大于轻症组（P < 0.05）。轻症组日龄7~10 d亚组单耳Ⅴ波潜伏期长于日龄11~14 d亚组（P < 0.05），而两亚组Ⅴ波ILD差异无统计学意义（P > 0.05）。受试者工作特征曲线分析显示，ILD对新生儿高胆红素血症导致的听力损伤有预测价值（P < 0.05），曲线下面积为0.727，最佳截断值为0.365 ms（接近0.4 ms），灵敏度为52.4%，特异度为90.9%。结论 新生儿血清胆红素浓度影响听性脑干诱发电位的Ⅴ波ILD，在重症高胆红素血症中尤其明显。ILD≥0.4 ms作为诊断新生儿高胆红素血症导致的听力损伤具有潜在价值。

Abstract:

Objective To study brainstem auditory evoked potential (BAEP) in neonates with hyperbilirubinemia using short auditory stimuli (60 dBnHL), and to investigate the differences in the inter-aural latency difference (ILD) of wave V between neonates with different total serum bilirubin (TSB) levels. Methods A prospective study was conducted in neonates with hyperbilirubinemia who were admitted to the Department of Neonatology, Yuhuan People's Hospital of Zhejiang Province, from May 2019 to October 2020. The neonates were divided into a severe group (n=50) and a mild group (n=50) according to their TSB levels. The mild group was divided into two subgroups: 7-10 days (n=20) and 11-14 days (n=20) according to their age. ILD was compared between the neonates with different TSB levels, and its diagnostic value was analyzed. Results Compared with the mild group, the severe group had significantly higher proportions of neonates with abnormal hearing threshold and abnormal ILD (P < 0.05) and a significantly larger ILD of wave V (P < 0.05). The latency of wave V (left ear) in the 7-10 days subgroup was significantly longer than that in the 11-14 days subgroup (P < 0.05), but there was no significant difference in the ILD of wave V between the two groups (P > 0.05). The receiver operating characteristic (ROC) analysis showed that ILD had predictive value for hearing impairment caused by neonatal hyperbilirubinemia (P < 0.05), with an area under the ROC curve of 0.727 as well as a sensitivity of 52.4% and a specificity of 90.9% at the optimal cut-off value of 0.365 ms. Conclusions Serum bilirubin in neonates affects the ILD of BAEP wave V, especially in those with severe hyperbilirubinemia. ILD at the optimal cut-off value of ≥0.4 ms shows potential value in the diagnosis of hearing impairment caused by neonatal hyperbilirubinemia.