不同听觉任务下人工耳蜗植入儿童听觉皮层诱发电位特征研究

Study on the feature of cortical auditory evoked potential under different auditory tasks in cochlear implant children

目的探索人工耳蜗(cochlear implant,CI)植入儿童在纯音、音节、声调任务诱发下皮层听觉诱发电位(cortical auditory evoked potential,CAEP)波形特征值的变化规律及影响因素。方法2018年8月至2019年5月在首都医科大学附属北京儿童医院进行CI手术及随访调试的46例患儿参与研究,其中男17例、女29例,年龄19~103月龄。随机数字表法将受试者分为三组(纯音组17例、音节组13例、声调组16例),分别以纯音(1000、2000 Hz)、音节(/ba/、/pa/)和声调(/ba1/、/ba4/)作为刺激声进行声场下CAEP测试。分析不同听觉任务难度下CAEP的P1和失匹配负波(mismatch negative,MMN)的引出率、潜伏期及波幅,并探索CI儿童听觉任务难度、受试者CI使用时长、重至极重度听力损失时长、CI植入术前助听器佩戴史、术前残余听力与P1和MMN潜伏期及波幅的相关性。数据采用SPSS 25.0软件进行统计学分析。结果纯音、音节、声调组P1引出率分别为100%(17/17)、100%(13/13)和75.0%(12/16),引出率差异有统计学意义(χ^(2)=8.214,P=0.016),其中纯音组与声调组引出率差异有统计学意义(χ^(2)=4.836,P=0.028),纯音组与音节组、音节组与声调组P1引出率差异均无统计学意义(P值均>0.05)。纯音、音节、声调组MMN引出率分别为94.1%(16/17)、84.6%(11/13)和62.5%(10/16),引出率差异无统计学意义(χ^(2)=0.066,P=0.066)。不同听觉任务难度的三组间P1及MMN的潜伏期与波幅差异均无统计学意义(P值均>0.05)。多因素线性回归分析显示,P1潜伏期与听觉任务难度、术前残余听力正相关,与CI使用时长、CI植入前助听器佩戴史负相关。MMN潜伏期与听觉任务难度正相关,与CI使用时长负相关。结论纯音听觉任务下CAEP的P1引出率高于声调听觉任务。听觉任务难度、CI使用时长、CI植入前助听器佩戴史、术前残余听力对P1潜伏期有显著影响;听觉任务难度、CI使用时长对MMN潜伏期有显著影响。

Objective To investigate the variation regularity and influencing factors of cortical auditory evoked potential(CAEP)evoked by pure tone,syllable and tone stimuli in cochlear implant(CI)children.Methods Cortical auditory evoked potential(CAEP)responses were collected from 46 CI children in the sound field.Pure tones with frequencies of 1 kHz and 2 kHz were used as the standard and the deviant respectively in the pure tone stimulation condition.The Chinese Mandarin tokens/ba/-/pa/and/ba1/-/ba4/pairs were used as the stimuli respectively in the syllable and tone stimulation condition.The latency,amplitude and presence rate of P1 and mismatch negative(MMN)were obtained and the correlation between the difficulty of auditory task,the age of hearing month,the duration of severe-profound hearing loss,the wearing history of hearing aid before CI,the hearing threshold of the better ear before CI and the latency and amplitude of P1 and MMN were analyzed.All statistical analyses and figures were conducted using SPSS 25.0.Results The P1 presence rate of pure tone,syllable and tone group was 100%(17/17),100%(13/13)and 75.0%(12/16),respectively,with significant difference(χ^(2)=8.214,P=0.016).There was significant difference between pure tone group and tone group(χ^(2)=4.836,P=0.028),but no significant difference between pure tone group and syllable group,syllable group and tone group.The MMN presence rate of pure tone,syllable and tone group was 94.1%(16/17),84.6%(11/13)and 62.5%(10/16),respectively,but no significant difference among the three groups with different auditory tasks(χ^(2)=0.066,P=0.066).No significant difference was observed among the three groups of different auditory tasks in the latency and amplitude of P1 and MMN.Multiple linear regression analysis showed that the latency of P1 was positively correlated with the difficulty of auditory task and the hearing threshold of the better ear before CI,and negatively correlated with hearing age and the history of hearing aid before CI.The latency of MMN was positively correlated with the difficulty of auditory task,and negatively correlated with hearing age.Conclusions The P1 presence rate of pure tone auditory task is significantly higher than that of tone auditory task.The difficulty of auditory task,hearing age,the history of hearing aid before CI,and the hearing threshold of the better ear before CI has significant effects on the P1 latency.The difficulty of auditory task and hearing age has significant effects on the MMN latency.