ROC曲线评价血清总胆红素、振幅整合脑电图和脑干听觉诱发电位对新生儿急性胆红素脑病的早期诊断价值

Comprehensive evaluation of total serum bilirubin, amplitude integrated electroencephalogram and brainstem auditory evoked potential and in combination on the early diagnosis of neonatal acute bilirubin encephalopathy by receiver operating characteristic curve

目的 应用受试者工作特征（receiver operating characteristic，ROC）曲线评价血清总胆红素（TSB）水平、振幅整合脑电图（aEEG）监测、脑干听觉诱发电位（BAEP）检查以及三者联合应用对新生儿急性胆红素脑病早期诊断的价值。方法 回顾性分析152例高胆红素血症患儿（胆红素脑病组33例和非胆红素脑病组129例）的血清胆红素峰值、aEEG监测、BAEP检查及三者联合检测结果并进行ROC曲线分析。结果 TSB水平、aEEG监测、BAEP检查以及三者联合应用诊断的曲线下面积分别为0.900、0.738、0.767、0.925，在最佳临界点，对应的敏感性（特异性）分别为90.91%（78.15%）、87.88%（59.66%）、65.52%（87.91%）、93.10%（82.42%）；ROC曲线显示三者联合应用所得的曲线下面积最大，其诊断敏感性联合特异性的综合评价优于单一检测方法。结论 TSB水平、aEEG、BAEP方法在诊断新生儿胆红素脑病中发挥重要作用，三者联合诊断更能提高诊断的准确性。

Objective To evaluate the levels of total serum bilirubin （TSB）, amplitude integrated electroencephalogram（aEEG） monitoring and brainstem auditory evoked potential （BAEP） individually and in combination for the early diagnosis of neonatal acute bilirubin encephalopathy by receiver operating charac- teristic （ROC） curve. Methods Clinical data was retrospectively analyzed. A total of 152 infants were diag- nosed with hyperbilirubinemia, including 119 cases of non-bilirubin encephalopathy group and 33 cases of bil- irubin encephalopathy group. The detection results of peak serum bilirubin, aEEG, BAEP combined with the three methods were determined with ROC curve analysis. Results The areas under ROC curve of TSB lev- el, aEEG, BAEP and in combination were 0. 900,0. 738,0. 767,0. 925, respectively, the corresponding sensi- tivity（specificity） in the cut-off point were 90. 91% （78.15%） ,87. 88% （59. 66% ） ,65.52% （87.91%）, 93.10% （82.42%） ,respectively. It showed that the area under ROC curve of the maximum,the comprehen- sive assessment in diagnostic sensitivity and specificity of the combination of three methods were better than any single detection method by ROC curve. Conclusion The methods of TSB level, aEEG and BAEP play an important role in the diagnosis of neonatal bilirubin encephalopathy, and combination with the three meth- ods can improve the accuracy of diagnosis.