听性脑干反应中枢性损害分类对脑瘫高危儿的诊断价值

Analysis of the diagnostic value the classification of central lesion by ABR in infants at high risk of cerebral palsy

目的探讨听性脑干反应(auditory brainstem response,ABR)中枢性损害分类方法对脑瘫高危儿的诊断价值。方法收集驻马店市第一人民医院2017-01—2019-12常规筛查ABR的2177例婴幼儿资料,对ABR分类为中枢性损害的354例婴幼儿结果进行回顾性分析。结果ABR分类中枢性损害354例,占总体受检患儿的16.3%。本组病例ABR中枢性损害以Ⅲ波潜伏时延迟,Ⅲ、Ⅴ波潜伏时联合延迟最常见;其次为Ⅲ波分化不良,Ⅲ~Ⅴ/Ⅰ~Ⅲ>1等多种因素。中枢性损害婴幼儿Ⅴ波阈值增高主要集中在50 dB以下(79.1%),低分贝组与高分贝组对比及各组间两两比较均有极显著性差异(P<0.001)。总体数据显示6月龄以下患儿中枢性损害发病率较高,与其他亚组间对比差异有统计学意义(P<α’);9月龄后发病率显著减少,亚组对比差异无统计学意义(P>α’)。混合性损害资料占统计总数的20.1%,提示ABR周围性损害与中枢性脑损害常见共存。本组资料未显示单双耳或左右耳有明确差别。结论ABR中枢性损害的分类方法在脑瘫高危儿的诊断中具有重要的临床提示意义,早期发现ABR中枢性损害,能为脑瘫高危儿中枢性损害的诊断提供早期重要价值。

Objective To explore the clinical application value of auditory brainstem response(ABR)in the classification of central lesion in infants at high risk of cerebral palsy.Methods The data of 2177 infants who passed the routine screening of ABR from January 2017 to December 2019 were collected,and the results of 354 infants whose ABR was classified as central lesion were analyzed retrospectively.Results Totally 354 cases of ABR were classified as central lesions,accounting for 16.3%of the total in⁃fants.In this group,the most common factors of central lesion of ABR were the delay ofⅢwave peak latency,the joint delay ofⅢwave and V wave peak latency;the second factors included the poor waveform formation ofⅢwave,Ⅲ-Ⅴ/Ⅰ-Ⅲ>1 and other as⁃pects.For infants classified as central lesion in ABR,the increase of V wave threshold was mainly concentrated below 50dB(79.1%).There were significant differences between the low decibel group and the high decibel group and between every two groups(P<0.001).Overall data showed that the incidence rate of central lesion was higher in infants under 6 months old.The difference be⁃tween other subgroups was statistically significant(P<α’),and the incidence rate of above 9-month-old was significantly reduced.There was no significant difference between the subgroups(P>α’).The mixed lesion accounted for 20.1%of the statistical data,which suggested that the peripheral lesion and the central brain lesion of ABR coexisted frequently.There is no clear difference be⁃tween single ear and double ears,or left and right ear.Conclusion The classification method of central lesion in ABR has important clinical significance in the diagnosis of infants with Children at high risk of cerebral palsy.Early detection of ABR central lesion can provide early important values for the diagnosis of infants at high risk of cerebral palsy central lesion in infants,which is worthy of fur⁃ther clinical application.