自动听性脑干反应在新生儿听力筛查中的应用  

Automatic auditory brainstem response in neonatal hearing screening.

作　　者：李晓璐[1] 卜行宽[1] 陆玲[1] 许景[2] 韩树萍[3] 童梅玲[2] 徐霞[1] 刘丞[1] 

机构地区：[1]南京医科大学第一附属医院耳鼻咽喉科,江苏南京210029 [2]南京市妇幼保健院儿童保健所,江苏南京210029 [3]南京市妇幼保健院新生儿科,江苏南京210029

出　　处：《中国儿童保健杂志》2008年第1期47-50,共4页Chinese Journal of Child Health Care

摘　　要：【目的】探讨将自动听性脑干反应(automatic auditory brainstem response,AABR)作为首选工具,进行新生儿听力初筛的可行性。【方法】192例(384耳)高危新生儿,检测AABR(Natus Algo3i听力筛查仪)和筛查型瞬态诱发性耳声发射(transient evoked otoacoustic emissions,TEOAE)(Madsen Accuscreen听力筛查仪),比较单用AABR、单用TEOAE、AABR+TEOAE筛查的结果。筛查未通过的患儿6月龄时作全面听力学评估,测试听性脑干反应(ABR)、诊断型TEOAE(Madsen901耳声发射议)和1kHz探测音声导抗(Madsen Otoflex 100中耳分析仪),用诊断性实验方法评估AABR的可行性。【结果】AABR组、TEOAE组和AABR+TEOAE组未通过率分别为9.4%(36/384)、8.1%(31/384)和7.0%(27/384),三组测试结果差异无显著性(χ2=1.382,P>0.05)。有6例(12耳)确诊为听力损失(3.1%),且AABR组和金标准组的结果差异有显著性(χ2=12.800,P<0.001)。诊断性实验分析示AABR组测试的一致百分率为93.23%±3.57%,灵敏度为0.92,特异度为0.93,漏诊率β=0.08,误诊率α=0.07,Youden指数J=0.85,阳性似然比为13.14,阴性似然比为0.086,ROC曲线下面积Az=0.97,提示其诊断准确性较高。本次调查发现1例复查符合听神经病临床表现。【结论】首选AABR进行初筛,不通过者给予全面听力学评估,是新生儿听力筛查的有效方法。[Objective] To investigate the feasibility of using automatic auditory brainstem response（AABR） as the first choice in the newborn hearing screening. [Methods] AABR and transient evoked otoacoustic emissions （TEOAE） were recorded with Natus Algo3i and Madsen Accuscreen in 192 （384 ears） high risk neonates. The results of AABR, TEOAE and AABR＋TEOAE were compared. When the babies, who were refer in the first hearing screening test, were six months old, the complete hearing evaluation was given by lkHz probe tone tympanogram （Madsen Otoflex 100）, TEOAE（Madsen 901）, and ABR （ICS Charter）. Using the second hearing evaluation results as the ＂gold standard＂, investigate the following parameters of AABR： sensitivity （Sen）, specificity （Spe）, α, β, relative operating characteristic （ROC） curve and Az. [Results] The refer rate of AABR only was 9.4% （36/384）, while the refer rate of TEOAE only was 8.1% （31/384）, the refer rate of AABR＋TEOAE was 7.0% （27/384）. Chi-square test showed there was no statistic meaning between the differences of these three groups （x^2 = 1. 382, P〉0.05）. But the difference between the result of AABR and that of the ＂gold standard＂ had statistic meaning （x^2= 12. 800, P〈0.01）. Diagnostic test statistic analysis of AABR only showed： the consistency rate was 93.23 % ± 3. 57 %, the sensitivity of AABR test was 0.92, the specificity was 0.93, false positive rate α=0.07, false negative rate β=0.08, positive likelihood ratio （LR＋） was 13.14, negative likelihood （LR_） was 0. 086, ROC curve Az=0.97. AABR test had high accuracy. Besides, there were 2 ears passing the TEOAE screening showed no Ⅰ, Ⅲ and Ⅴ wave in ABR test with 97dBHL click stimulus, no acoustic reflex, and ＂singlepeak＂ tympanogram-auditory neuropathy. [Conclusions] Using AABR as the first choice in neonatal hearing screening is sensitive, objective, accurate, time-saving and of course, lower cost. For those who were refer in the first hearing

关 键 词：自动听性脑干反应 瞬态诱发性耳声发射 新生儿听力筛查 

分 类 号：R722.1[医药卫生—儿科]