脑干听觉诱发电位在后循环脑梗死中的临床应用价值研究

Value of Brainstem Auditory Evoked Potential in the Diagnosis of Post-circulation Cerebral Infarction

目的通过分析急性和慢性后循环脑梗死患者脑干听觉诱发电位变化特点,探讨脑干听觉诱发电位(brainstem auditory evoked potential,BAEP)在后循环脑梗死早期识别和诊断方面的临床应用价值.方法选择2018年8月-2019年3月在上海第六人民医院神经内科就诊的后循环脑梗死患者为研究对象,分为急性脑梗死组和慢性脑梗死组,同时设立健康对照组.比较3组BAEP的Ⅰ、Ⅲ、Ⅴ各波峰潜伏期(peak latency,PL),Ⅰ~Ⅲ波、Ⅲ~Ⅴ波和Ⅰ~Ⅴ波峰间潜伏期(interpeak latency,IPL),Ⅲ~Ⅴ波/Ⅰ~Ⅲ波IPL的比值等指标的特点.结果研究共入组急性脑梗死组患者36例,慢性脑梗死组32例,健康对照组32例.急性脑梗死组Ⅲ波、Ⅴ波PL较慢性脑梗死组(P<0.001、P=0.005)和对照组(均为P<0.001)均延长;慢性脑梗死组Ⅴ波PL较对照组延长(P<0.001).急性脑梗死组Ⅰ~Ⅲ波、Ⅰ~Ⅴ波IPL较慢性脑梗死组延长(P<0.001、P=0.029);急性脑梗死组Ⅰ~Ⅲ波(P<0.001)、Ⅲ~Ⅴ波(P=0.006)和Ⅰ~Ⅴ波(P<0.001)IPL较对照组延长;慢性脑梗死组Ⅲ~Ⅴ波IPL(P=0.003)较对照组延长.慢性脑梗死组Ⅲ~Ⅴ/Ⅰ~Ⅲ波IPL比值异常者有9例(25.0%),急性脑梗死组2例(6.3%),两组差异有统计学意义(P=0.001).结论①BAEP检查能灵敏地检测出急性和慢性后循环脑梗死患者的听觉感觉通路的电生理异常.②急性脑梗死患者BAEP的Ⅲ波和Ⅴ波PL、Ⅰ~Ⅲ波和Ⅰ~Ⅴ波IPL均显著延长,以Ⅲ波PL、Ⅰ~Ⅲ波IPL延长为主;慢性脑梗死患者BAEP以Ⅴ波PL、Ⅲ~Ⅴ波IPL的延长为主.

Objective Based on the characteristics of brainstem auditory evoked potentials (BAEP) in acute and chronic post-circulation cerebral infarction, to explore the clinical value of BAEP in early identification and diagnosis of post-circulation cerebral infarction. Methods The patients with posterior circulation infarction from Department of Neurology of Shanghai Sixth People’s Hospital from August, 2018 to March 2019 were included in this study. According to cerebral MRI, all the patients were divided into acute infarction group and chronic infarction group, and the patients without cerebrovascular diseases in the same period are selected as control group. The characteristics of peak latency (PL) of BAEP Ⅰ,Ⅲ, and V wave, and the inter-peak latency (IPL) of BAEP Ⅰ-Ⅲ,Ⅲ-V and I-V wave, and Ⅲ-V/Ⅰ-Ⅲ IPL ratio in the three groups were compared. Results Finally, 36 patients in acute infarction group, 32 patients in chronic infarction group, and 32 ones in control group. The BAEP Ⅲ and V wave PL in acute infarction group were longer than that in chronic infarction group (P <0.001 and P =0.005) and control group (both P <0.001). The BAEP V wave PL in chronic group was significantly longer than that in control group (P <0.001). The BAEP Ⅰ-Ⅲ wave (P <0.001),Ⅲ-V wave (P =0.006) and Ⅰ-V wave (P <0.001) IPL in acute infarction group were all longer than that in control group;and the Ⅰ-Ⅲ wave (P <0.001) and Ⅰ-V wave (P =0.029) IPL in acute infarction group than that in chronic infarction group;and the Ⅲ-V wave (P =0.003) IPL in chronic infarction group was longer than that in control group. There were 9 cases (25.0%) with abnormal Ⅲ-V/Ⅰ-Ⅲ wave IPL ratio in chronic infarction group, and 2 cases (6.3%) in acute infarction group, the difference between the two groups was statistically significant (P =0.001). Conclusions The abnormal electrophysiological changes of auditory sense pathway in patients with acute and chronic post-circulation infarction can be detected by BAEP examination. The BAEP Ⅲ and V wave PL,Ⅰ-Ⅲ and Ⅰ-V wave IPL were all prolonged in acute infarction group, especially Ⅲ wave PL and Ⅰ-Ⅲ wave IPL;and the prolonged potentials were mainly the V wave PL and Ⅲ-V wave IPL in chronic infarction group.