高胆红素血症对婴幼儿听力损失程度的影响

Effect of hyperbilirubinemia on the degree of hearing loss in infants

目的探讨高胆红素血症对婴幼儿听力损失程度的影响,为患儿的临床治疗提供参考。方法选取2014年1月-2017年1月在该院接受治疗的高胆红素血症患儿84例(168耳)为研究对象,依据患儿总胆红素的水平分成两组:试验一组(39例,78耳),患儿血清总胆红素水平在410μmol/L以下,试验二组(45例,90耳),患儿血清总胆红素水平在410μmol/L及以上;同时选取该院正常的婴幼儿50例(100耳)为对照组;对3组婴幼儿分别进行听觉脑干诱发电位(ABR)和畸变产物耳声发射(DPOAE)的检测,对检测结果进行对比分析。结果 DPOAE检测显示试验一组患儿异常耳占53.16%,试验二组异常耳占62.22%,两组间对比差异无统计学意义(P>0.05);ABR检测显示试验一组患儿异常耳占60.76%,试验二组异常耳占92.22%,两组间对比差异有统计学意义(P<0.05);对照组婴幼儿的ABR平均阈值为(35.01±4.89)dB nHL,试验一组为(56.08±25.17)dB nHL,试验二组为(77.64±22.94)dB nHL,两试验患儿的平均阈值比对照组婴幼儿升高,差异有统计学意义(均P<0.05),试验二组比试验一组升高更多,差异有统计学意义(P<0.05);试验一组、试验二组和对照组对比,Ⅰ、Ⅲ和Ⅴ波的潜伏期均延长,各波间期也均延长,差异有统计学意义(均P<0.05);试验一组和试验二组患儿在听力轻度、中度受损方面对比差异无统计学意义(均P>0.05),在听力重度受损和听神经病方面对比差异有统计学意义(均P<0.05)。结论高胆红素血症对患儿听觉通路的损坏一般是蜗后,也伴随耳蜗受损,随着患儿血清中总胆红素浓度的升高,其听力损坏几率、出现重度听力受损几率和听神经病的发生率都会随着升高。

Objective To explore the effect of hyperbilirubinemia on the degree of hearing loss in infants,and provide a reference for clinical treatment of hyperbilirubinemia. Methods Eighty-four infants with hyperbilirubinemia treated in Qingdao Women and Children＇s Hospital from January 2014 to January 2017 were selected and divided into experimental one group（ 39 infants,78 ears,serum total bilirubin410 μmol/L） and experimental two group（ 45 infants,90 ears,serum total bilirubin≥410 μmol/L） according to the levels of total bilirubin. Fifty normal infants（ 100 ears） were selected from the hospital as control group. Auditory brainstem response（ ABR） and distortion product otoacoustic emission（ DPOAE） were performed in the three groups, then the results were compared and analyzed.Results DPOAE showed that the proportions of infants with abnormal ears accounted for 53. 16% in experimental one group and 62. 22% in experimental two group,respectively,there was no statistically significant difference between the two groups（ P〈0. 05）. ABR test showed that the proportions of infants with abnormal ears accounted for 60. 76% in experimental one group and 92. 22% in experimental two group,respectively,there was statistically significant difference between the two groups（ P 0. 05）. The average thresholds of ABR in control group,experimental one group,and experimental two group were（ 35. 01 ± 4. 89） d B n HL,（ 56. 08 ± 25. 17） d B n HL,and（ 77. 64 ±22. 94） d B n HL,respectively. The average thresholds of ABR in experimental one group and experimental two group were statistically significantly higher than that in control group（ P 0. 05）,the average threshold of ABR in experimental two group was statistically significantly higher than that in experimental one group（ P〈0. 05）. Compared with control group,the latent period of Ⅰ wave,Ⅲ wave,Ⅴ wave,interphase phases of waves in experimental one group and experimental two group were longer,there were statistically significant differences（ all P〈0. 05）. There was no statistically significant difference in the incidence rates of mild and moderate hearing loss between experimental one group and experimental two group（ P〈0. 05）. There were statistically significant differences in the incidence rates of severe hearing loss and auditory neuropathy between experimental one group and experimental two group（ P〈0. 05）. Conclusion Hyperbilirubinemia is usually associated with retrocochlear damage of auditory pathway in infants,but it is also complicated with cochlea damage. With the increase of serum total bilirubin levels,the incidence rates of hearing loss,severe hearing loss,and auditory neuropathy increase.