胆红素／清蛋白比值及脑干听觉诱发电位与胆红素神经毒性的相关性  

Relationship between bilirubin/albumin ratio, auditory brainstem responses and bilirubin-induced neurotoxicity

作　　者：王丹[1] 杨波[1] 郑瑞平[2] 

机构地区：[1]山东大学附属省立医院新生儿科,济南250021 [2]山东大学附属省立医院脑干听觉诱发电位室,济南250021

出　　处：《中华实用儿科临床杂志》2013年第8期621-623,共3页Chinese Journal of Applied Clinical Pediatrics

摘　　要：目的探讨高胆红素血症患儿血清总胆红素（TBIL）、总胆红素／清蛋白比值（B／A比值）与胆红素神经毒性的相关性，分析高胆红素血症患儿脑干听觉诱发电位（ABRs）中脑干功能损伤及听神经功能损伤敏感程度。方法将91例足月高胆红素血症患儿根据ABRs结果分为A组（未见明显异常）、B组（仅脑干功能受损）、C组（仅听神经受损）、D组（脑干功能及听神经均受损），比较各组间TBIL、B／A比值的差异并分析二者与ABRs的关系。结果A组与B组比较，TBIL差异无统计学意义（t=1．566，P〉0．05），B／A比值差异有统计学意义（t=1．898，P〈0．05）；B组与C组TBIL、B／A比值比较差异均有统计学意义（t_TBIL=2．372，P_TBIL〈0．05；t_B/A=2．794，P_B/A〈0．01）；A组与C组比较、A组与D组比较、B组与D组比较，TBIL比值差异均有统计学意义（t=2．452、3．328、2．256，P均〈0．05）；A组与C组比较、A组与D组比较、B组与D组比较，B／A比值差异均有统计学意义（t=2．571、4．680、2．657，P均〈0．05、0．01）；C组与D组比较，TBIL、B／A比值差异均无统计学意义（t_TBIL=0．705，P_TBIL〉0．05；t_B/A=0．636，P_B／A〉0．05）。TBIL、B／A比值的受试者工作特征曲线（ROC）下面积分别为0．919、0．829。TBIL、B／A比值与ABRs有显著相关性（r=0．495、0．564，P均〈0．05）。结论B／A比值是预测足月儿胆红素神经毒性的良好指标，ABRs异常中脑干功能较听神经易受损。Objective To explore the relationship between serum total bilirubin（ TBIL）, total bilirnbin/albu- min ratio （B/A ratio） and bilirnbin-induced neurotoxicity, and to analyze the sensitivity of brainstem function and audi- tory nerval function in auditory brainstem responses （ ABRs ） in full-term newborn infants with hyperbilirubinemia. Methods Ninety-one cases of full-term neonates with hyperbilirubinemia were divided into 4 groups according to the findings of ABRs：group A（ with normal ABRs）, group B （only brainstem dysfunction）, group C （only auditory neural damage） ,group D（ brainstem dysfunction and auditory nerval damage ）. TBIL, B/A ratio were compared among these groups and the relationships were analyzed between TBIL, B/A ratio and ABRs. Results Between group A and group B, there was no significant difference in TBIL（ t = 1. 566, P 〉 0.05 ）, but there was a significant difference in B/A ratio （ t = 1. 898, P 〈 0.05 ） , the TBIL and B/A ratio in group C were significantly higher than those in group B （ t_TBIL = 2. 372 ,P_TBIL 〈 0. 05;t_B/A = 2. 794 ,P_B/A 〈 0.01 ）. Between group A and group C , group A and group D, group B and group D, the TBIL had significant differences（ t = 2. 452,3. 328,2. 256, all P 〈 0.05 ） ; Between group A and group C , group A and group D, group B and group D, the B/A ratio had significant differences （t = 2. 571,4. 680,2. 657, all P 〈0.05,0.01 ）;there were no significant difference in TBIL and B/A ratio between group C and group D（t_TBIL = 0. 705, P_TBIL 〉0. 05 ;t_B/A = 0. 636, PS/A 〉 0. 05 ）. The ROC of the TBIL and B/A ratio were 0. 919 ,0. 829 ,TBIL and B/ A ratio were well correlated with ABRs （ r = 0. 495,0. 564, all P 〈 0.05 ）. Conclusions The B/A ratio is a good indi- cator for bilirubin-induced neurotoxicity in full-term infants. Brainstem function is more subjected than auditory nerve damage in ABR dysfunction.

关 键 词：高胆红素血症 总胆红素 清蛋白比值 脑干听觉诱发电位 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]