脑干听觉诱发电位与儿童孤独症谱系障碍的关系研究

Study on correlation of brainstem auditory evoked potential and autism spectrum disorder in children

目的通过对孤独症谱系障碍(ASD)患儿进行脑干听觉诱发电位(BAEP)检查,对比分析ASD患儿与正常儿童间的脑干听觉诱发电位结果,探讨脑干听觉诱发电位检查对ASD的相关意义,并讨论脑干听觉诱发电位与ASD患儿言语理解能力的关系。方法选取18例ASD患儿为实验组,其中高言语理解能力型(高言语理解能力型组)9例、低言语理解能力型(低言语理解能力型组)9例;另选取同期12例非ASD的正常儿童为对照组。两组儿童均行脑干听觉诱发电位检查。对比实验组与对照组,实验组高、低言语理解能力型患儿组间脑干听觉诱发电位的双耳Ⅴ波阈值及传导差异。结果实验组左耳脑干听觉诱发电位的Ⅴ波阈值为(69.72±27.20)dB、右耳为(53.89±16.54)dB,对照组左耳脑干听觉诱发电位的Ⅴ波阈值为(30.00±0)dB、右耳为(30.00±0)dB,实验组高言语理解能力型患儿左耳脑干听觉诱发电位的Ⅴ波阈值为(72.78±27.51)dB、右耳为(44.44±17.40)dB,实验组低言语理解能力型患儿左耳脑干听觉诱发电位的Ⅴ波阈值为(66.67±28.17)dB、右耳为(63.33±31.52)dB。①组间对比:实验组脑干听觉诱发电位的左、右耳Ⅴ波阈值均大于对照组,差异具有统计学意义(P<0.05)。实验组中高、低言语理解能力型组患儿脑干听觉诱发电位的左、右耳Ⅴ波阈值组间对比,差异无统计学意义(P>0.05)。②组内对比:实验组右耳脑干听觉诱发电位的Ⅴ波阈值低于左耳,差异具有统计学意义(P<0.05),提示存在脑干听觉诱发电位右侧优势,对应左侧言语理解中枢(左侧大脑半球)优势。对照组左、右耳脑干听觉诱发电位的Ⅴ波阈值组内对比,差异无统计学意义(P>0.05),提示无偏侧优势。实验组中高言语理解能力型组患儿右耳脑干听觉诱发电位的Ⅴ波阈值低于左耳,差异具有统计学意义(P<0.05),提示存在脑干听觉诱发电位右侧优势,对应左侧言语理解中枢(左侧大脑半球)优势。实验组中低言语理解能力型组患儿左、右耳脑干听觉诱发电位的Ⅴ波阈值组内对比,差异无统计学意义(P>0.05),提示无偏侧优势。结论脑干听觉诱发电位对ASD,特别是对言语理解能力受损的患儿有很好的诊断或辅助诊断意义。而脑干听觉诱发电位的偏侧优势与ASD患儿言语理解能力存在关联。ASD患儿中高言语理解能力患儿存在左侧言语理解中枢(左侧大脑半球)优势。

Objective To compare and analyze the brainstem auditory evoked potential(BAEP)results between children with autism spectrum disorder(ASD)and normal children,explore the significance of brainstem auditory evoked potential examination for children with ASD,and discuss the correlation between brainstem auditory evoked potential and speech comprehension in children with ASD.Methods 18 children with ASD were selected as the experimental group,including 9 patients with high speech comprehension(high speech comprehension group)and 9 patients with low speech comprehension(low speech comprehension group).12 normal children without ASD were selected as the control group.Brainstem auditory evoked potential examination was performed in both groups.Comparison was made on binauralⅤwave threshold and conduction differences of brainstem auditory evoked potentials between the experimental group and the control group,as well as between high speech comprehension group and low speech comprehension group.Results In the experimental group,theⅤwave threshold of brainstem auditory evoked potential was(69.72±27.20)dB in the left ear and(53.89±16.54)dB in the right ear;in the control group,theⅤwave threshold of brainstem auditory evoked potential was(30.00±0)dB in the left ear and(30.00±0)dB in the right ear;in high speech comprehension group,theⅤwave threshold of brainstem auditory evoked potential was(72.78±27.51)dB in the left ear and(44.44±17.40)dB in right ear;theⅤwave threshold of brainstem auditory evoked potential was(66.67±28.17)dB in the left ear and(63.33±31.52)dB in the right ear.(i)Comparison between groups:theⅤwave threshold of brainstem auditory evoked potentials in the left and right ear of experimental group were higher than those of the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference inⅤwave threshold of brainstem auditory evoked potentials in the left and right ear between the high speech comprehension group and low speech comprehension group(P>0.05).(ii)Intra-group comparison:in the experimental group,theⅤwave threshold of brainstem auditory evoked potential in the right ear was lower than that in the left ear,and the difference was statistically significant(P<0.05),suggesting that the right side of brainstem auditory evoked potential was dominant,corresponding to the left speech comprehension center(left cerebral hemisphere).There was no statistically significant difference in theⅤwave threshold of brainstem auditory evoked potentials in the left and right ear in the control group(P>0.05),indicating no lateralization.In high speech comprehension group,theⅤwave threshold of brainstem auditory evoked potential in the right ear was lower than that in the left ear,and the difference was statistically significant(P<0.05),suggesting that the right side of brainstem auditory evoked potential was dominant,corresponding to the left speech comprehension center(left cerebral hemisphere).There was no statistically significant difference in theⅤwave threshold of brainstem auditory evoked potentials in the left and right ear between the high speech comprehension group and low speech comprehension group(P>0.05),suggesting no lateralization.Conclusion Brainstem auditory evoked potential is useful in the diagnosis of ASD,especially in children with impaired speech comprehension.However,the lateralization of brainstem auditory evoked potential was correlated to the speech comprehension in ASD children.There is a left speech comprehension center(left cerebral hemisphere)in the high speech comprehension children with ASD.