高胆红素血症新生儿听力变化随访

The Hearing Change of the Follow-up of Newborns with Hyperbilirubinemia

目的研究高胆红素血症新生儿听力损失程度与血清胆红素水平的相关性。方法选择2012年1月～2014年3月在我院进行诊治的高胆红素血症新生儿82例，检测并观察听性脑干反应阈值正常和异常患儿血清胆红素水平、黄疸出现时间；比较轻中度听力损失组和重度听力损失组黄疸出现时间及血清胆红素水平；分别对黄疸出现时间及血清胆红素值与听性脑干反应阈值进行单变量线性相关性分析。结果82例高胆红素血症新生儿中，听性脑干反应闽正常23例，占28．05％，异常59例，占71．95％；DPOAE检测正常69例，异常13例，异常率15．85％。ABR正常的23例DPOAE均正常，ABR异常59例中DPOAE检测异常13例，正常46例。血清胆红素水平〈342μmol／L时，黄疸出现时间≤48h组的重度听力损失者有15例，占50％，明显高于黄疸出现时间〉48h组的10％（P〈0．05）；血清胆红素水平≥342μmol／L时，黄疸出现时间≤48h组和黄疸出现时间〉48h组的轻中度和重度听力损失者的比例相比均无明显差异（P〉0．05）；经直线相关性分析，血清胆红素水平与听性脑干反应闽呈明显正相关（r=0．652，P〈0．05），黄疸出现时间与听性脑干反应闽呈明显负相关（r=-0．756，P〈0．05）。结论高胆红素血症新生儿的血清胆红素水平越高，出现黄疸的时间越早，听力损失程度越严重。

Ojectivo To analyze the correlation of hearing loss and the level of serum bilirubin in neonatal hyperbilirubinemia.Mothods 82 cases of neonate with hyperbilirubinemia were selected and they were treated at our hospital from January 2012 to March 2014.The brainstem response thresholds were obtained and compared with different levels of serum bilirubin and jaundice occurrence time. The jaundice occurrence time and serum bilirubin level in mild-to-moderate hearing loss group were compared with the severe hearing loss group. The correlation between brainstem response thresholds and corresponding jaundice occurrence time and serum bilirubin value were studied respectively,by using univariate linear correlation analysis. The follow-up lasted for 2 years and the brainstem response thresholds for the recovery were monitored. Results In 82 cases with neonatal hyperbilirubinemia, 23 cases had normal brainstern response thresholds, accounted for 28.05% （23/82）, 59 cases abnormal, accounted for 71.95% （59/82）. 69 cases with normal DPOAE,accounted for 84.14%,13 cases with abnormal, accounted for 18.86%; 23 cases with normal and 46 cases with abnormal brainstem response threshold had normal DPOAE, 13 cases with abnormal brainstem response threshold had abnormal DPOAE;When the serum bilirubin levels were 〈 342μmol/L and the jaundice occurrence time at 〈48 h, 15 cases had severe hearing loss, 50.00%, significantly higher than the jaundice occurrence time〉48 h group for 10.00% （3/30） （P〈0.05）. When the serum bilirubin levels were 〉342μmol/L, and the jaundice occurrence time was 〈48 h and 〉48 h , there were no significant differences （P〉0.05） between the mild-to-moderate and severe hearing loss groups. The serum bilirubin level and brainstem response threshold were significantly positively correlated （r=0.652, P〈0.05）, while the jaundice occurrence time and brainstem response thresholds were significantly negatively correlated （r=0.756,P〈0.05）.Conclusion The higher the serum bilirubin levels were in neonatal hyperbilirubinemia, the earlier jaundice occured, the hearing loss was more severe.