血清胆红素和甲状腺素水平与新生儿听力损失程度的相关性

Correlation between serum bilirubin, thyroxine levels and the severity of neonatal hearing loss

目的 分析血清胆红素和甲状腺素水平与新生儿听力损失程度的相关性。方法 选取2019年1月至2021年9月在宝鸡市妇幼保健院新生儿科诊断为高胆红素血症的1 000例足月新生儿为研究对象,检测并比较不同疾病严重程度新生儿的听性脑干反应(ABR)、血清总胆红素(TSB)和甲状腺素(T4)水平,采用Pearson相关性分析TSB、T4、黄疸出现时间与ABR反应阈值之间关系。结果 1 000例高胆红素血症新生儿中普通型高胆红素血症患儿970例(97.00%),重度型高胆红素血症患儿20例(2.00%),极重度高胆红素血症患儿5例(0.50%),危险性高胆红素血症患儿5例(0.50%);ABR检测结果显示,1 000例高胆红素血症新生儿中发生脑干听觉诱发电位(BAEP)轻度损伤患儿共75例(7.50%),发生BAEP中度损伤患儿共2例(0.20%),发生BAEP重度损伤患儿共5例(0.50%),ABR反应阈值随BAEP损伤程度加重而升高,差异均有统计学意义(P<0.05);TSB水平随着高胆红素血症患儿严重程度的增加而升高,T4水平随着高胆红素血症患儿严重程度的增加而降低,而黄疸出现时间则随着高胆红素血症患儿严重程度的增加缩短,差异均有统计学意义(P<0.05);听力重度损伤患儿TSB≥342μmol/L占比多于听力轻度损伤患儿,差异有统计学意义(P<0.05),听力重度损伤患儿黄疸出现时间≤48 h占比多于听力轻度损伤患儿,差异有统计学意义(P<0.05),听力中度损伤TSB≥342μmol/L、黄疸出现时间≤48h占比与轻度损伤患儿比较差异无统计学意义(P<0.05);经Pearson相关性分析结果显示,高胆红素血症新生儿TSB水平与T4、黄疸出现时间呈负相关性(r=-0.347、-0.304,P<0.05),高胆红素血症新生儿ABR反应阈值与TSB水平呈正相关性(r=0.384,P<0.05),与T4、黄疸出现时间呈负相关性(r=-0.354、-0.367,P<0.05)。结论 高胆红素血症患儿听力损伤与其机体TSB、T4水平具有相关性;TSB升高,T4不足者黄疸出现时间明显缩短,患儿听力损失风险及加重风险明显升高。

Objective To analyze the correlation between serum bilirubin, thyroxine levels and the severity of neonatal hearing loss. Methods A total of 1 000 full-term neonates with hyperbilirubinemia in Department of Neonatology, Baoji Maternal and Child Health Hospital between January 2019 and September 2021 were enrolled as the research objects. The auditory brainstem response(ABR), serum total bilirubin(TSB), and thyroxine(T4) were detected and compared among children with different disease severity. The relationship between TSB, T4, appearance time of jaundice and the threshold of ABR reaction was analyzed by Pearson correlation analysis. Results Among the 1 000 neonates with hyperbilirubinemia, there were 970(97.00%) cases with common hyperbilirubinemia, 20(2.00%) cases with severe hyperbilirubinemia, 5(0.50%) cases with extremely severe hyperbilirubinemia, and 5(0.50%) cases with very severe hyperbilirubinemia. ABR test results showed that in the 1 000 neonates with hyperbilirubinemia, there were 75 cases(7.50%) with mild brainstem auditory evoked potential(BAEP) injury, 2 cases(0.20%) with moderate BAEP injury, and5 cases(0.50%) with severe BAEP injury. ABR response threshold was increased with the aggravation of BAEP injury(P<0.05). With the aggravation of hyperbilirubinemia, TSB level was increased, T4 level was decreased, and appearance time of jaundice was shortened(P<0.05). The proportion of cases with TSB ≥342 μmol/L in children with severe hearing loss was higher than that in children with mild hearing loss(P<0.05), and proportion of cases with appearance time of jaundice≤48 h was higher than that in children with mild hearing loss(P<0.05). There was no significant difference in the proportions of cases with TSB ≥342 μmol/L and appearance time of jaundice≤48 h between children with moderate and mild hearing loss(P<0.05). Pearson correlation analysis showed that TSB level was negatively correlated with T4 and appearance time of jaundice(r=-0.347,-0.304, P<0.05);the threshold of ABR reaction was positively correlated with TSB level(r=0.384, P<0.05), but negatively correlated with T4 and appearance time of jaundice(r=-0.354,-0.367,P<0.05). Conclusion The hearing loss is related to TSB and T4 in neonates with hyperbilirubinemia. In those with increased TSB and insufficient T4, appearance time of jaundice is significantly shortened, the risk of hearing loss and exacerbation risk are significantly increased.