需换血治疗的重度高胆红素血症患儿的听力变化特点  

The Audiological Characteristics of Neonate with Severe Hyperbilirubinemia Need to be Exchanged Transfusion

作　　者：唐向荣 莫炼 王小青 周雪燕 杨艳 刘华 林楠 张玉 黄丽辉[2] 

机构地区：[1]广西柳州市妇幼保健院耳鼻咽喉科,柳州545001 [2]首都医科大学附属北京同仁医院 北京市耳鼻咽喉科研究所

出　　处：《听力学及言语疾病杂志》2015年第6期581-584,共4页Journal of Audiology and Speech Pathology

基　　金：卫生公益性行业科研专项基金(201202005);首都医学发展科研基金项目(2009-1049);首都临床特色应用研究专项基金(Z131107002213123);广西柳州市应用技术研究与开发计划课题(2010030732)联合资助

摘　　要：目的探讨需换血治疗的重度高胆红素血症患儿的听力变化特点,了解新生儿血清总胆红素峰值浓度与听力损失的相关性。方法对130例确诊为重度高胆红素血症需换血治疗的新生儿进行听性脑干反应(ABR)、畸变产物耳声发射(DPOAE)和1 000Hz声导抗检查,听力异常者于3月龄时复查。以3月龄时的听力情况将130例分为听力正常组、轻度-中度听力损失组、重度-极重度听力损失组,比较三组血清总胆红素峰值浓度与听力损失的相关性。结果 13月龄时听力正常85例(65.38%,85/130);听力异常45例(34.62%,45/130)(88耳,双耳43例,单耳2例),其中轻度-中度组11例22耳(24.44%,11/45)、重度-极重度组34例66耳(75.56%,34/45)。23月龄时16例32耳(12.31%,16/130)提示蜗后听神经病变。3听力正常组、轻度-中度听力损失组、重度-极重度听力损失组血清总胆红素峰值浓度分别为470.80±107.90、493.60±106.79、626.40±187.18μmol/L,三组间差异有统计学意义(F=16.525,P=0.000);ABR反应阈和血清总胆红素峰值浓度之间呈正相关(r=0.584,P<0.001),即随血清总胆红素峰值峰值浓度增加,ABR反应阈逐渐增高。结论需换血治疗的重度高胆红素血症患儿主要表现为双侧极重度感音神经性听力损失,部分患儿表现为蜗后听神经病变;新生儿血清总胆红素峰值浓度越高,发生重度以上听力损失的风险越大。Objective To study the change of audiological characteristics of neonate with severe hyperbilirubinemia need to be exchanged transfusion,and to explore the correlation between the peak concentrations of serum total bilirubin and hearing loss.Methods A total of 130 cases of neonate diagnosed with severe hyperbilirubinemia need to be exchanged transfusion were included in this study.Hearing tests of auditory brainstem response（ABR）,distortion product otoacoustic emission（DPOAE）and acoustic immittance were administered to these neonates and they were followed up three months old.They were divided into the normal group,the mild- moderate group and the severe- extreme group according to the hearing tests results of three months.The peak concentrations of serum total bilirubin and hearing condition among the three groups were analyzed.Results There were 85 neonates with normal hearing（65.38%,85/130）,45 with hearing loss（33.85%,45/130.For 88 ears,there were 2cases of single ear and 43 cases of both ears）,including 11 cases of mild- moderate group（22ears,24.44%,11/45）and34cases with severe-extreme group（66ears,75.56%,34/45）.There were 16neonates（32ears）met the criterion of auditory neuropathy（12.31%,16/130）.The difference of the peak concentrations of serum total bilirubin among the three groups was statistically significant（F=16.525,P=16.525）.And positive correlation was observed between ABR threshold and peak serum total bilirubin concentration（r=0.584,P〈0.001）.Conclusion The major feature of the neonate with severe hyperbilirubinemia need to be exchanged transfusion was extremely severe sensorineural hearing loss in both ears;and the higher probability of serious hearing loss with the higher peak concentrations of serum total bilirubin.

关 键 词：新生儿 高胆红素血症 感音神经性听力损失 

分 类 号：R764.5[医药卫生—耳鼻咽喉科]