新生儿急性胆红素脑病早期诊断探讨  

Early diagnosis of acute bilirubin encephalopathy in the newborn

作　　者：蒙丹华[1] 潘新年[1] 赵丹[1] 李燕[1] 韦秋芬[1] 闭宏娟[1] 沈开颜[1] 许靖[1] 甘金梅[1] 梁英福[1] 

机构地区：[1]广西壮族自治区妇幼保健院新生儿科,南宁530003

出　　处：《中华新生儿科杂志（中英文）》2017年第5期346-350,共5页Chinese Journal of Neonatology

基　　金：吴阶平医学基金临床科研专项资助基金课题（320.6750.14171）;广西医疗卫生适宜技术研究与开发课题（S201405-03）

摘　　要：目的 探讨振幅整合脑电图（amplitude integrated electroencephalogram,aEEG）、脑干听觉诱发电位（brainstem auditory evoked potential,BAEP）、头颅磁共振成像（magnetic resonance imaging,MRI）与急性胆红素脑病临床诊断的相关性及敏感度.方法 回顾性选取2014年1月至2015年12月我院新生儿科收治、胎龄≥35周的中、高危高胆红素血症新生儿为研究对象,根据急性胆红素脑病诊断标准,分为急性胆红素脑病组和非急性胆红素脑病组,收集相关临床资料,分析aEEG、BAEP、头颅MRI结果与急性胆红素脑病临床诊断的相关性,并应用受试者工作特征曲线评价血清胆红素峰值、aEEG、BAEP、头颅MRI在急性胆红素脑病早期诊断中的价值.结果 纳入研究的高胆红素血症患儿共152例,其中急性胆红素脑病组33例,非急性胆红素脑病组119例.（1） aEEG、头颅MRI异常与急性胆红素脑病临床诊断成正相关,但关系不密切（aEEG：r=0.487,P＜0.001;MRI：r =0.220,P=0.018）,BAEP异常与急性胆红素脑病临床诊断成正相关且关系密切（r=0.593,P＜0.001）.（2）aEEG异常与BAEP异常、头颅MRI异常在急性胆红素脑病的诊断中成正相关,但关系不密切（BAEP：r=0.424,P＜0.001;MRI：r =0.307,P＜0.001）.（3）血清总胆红素峰值、BAEP、aEEG、头颅MRI异常预测高胆红素血症患儿发生急性胆红素脑病的受试者工作特征曲线下面积分别为0.899、0.767、0.738、0.590.结论 aEEG、BAEP、头颅MRI在急性胆红素脑病诊断中具一定相关性和互补性,aEEG对急性胆红素脑病的预测具有较高敏感度,有助于急性胆红素脑病的早期诊断.Objective To investigate the diagnostic correlation and sensitivity of amplitude integrated electroencephalogram （aEEG）,brainstem auditory evoked potential （BAEP） and cranial magnetic resonance imaging （MRI） for acute bilirubin encephalopathy （ABE） in the newborn.Method Term and near-term neonates （gestational age ≥ 35 weeks） with hyperbilirubinemia （the level of bilirubin over than 95th percentile） of high and intermediate risk group admitted in the neonatal ward of Guangxi Maternal and Child Health Care Hospital from Jan 2014 to Dec 2015 were recruited retrospectively.The infants were assigned to ABE group and non-ABE group according to the diagnostic criteria of ABE.The clinical data of the newborns were collected and the diagnostic correlation between clinical diagnosis and aEEG,BAEP and cranial MRI were analyzed.The receiver operating characteristic （ROC） curve was adopted to assess the diagnostic efficiency of the peak level of serum bilirubin,aEEG,BAEP and cranial MRI on the early diagnosis of ABE.Result A total of 152 newborns with hyperbilirubinemia were recruited,including 33 cases in the ABE group and 119 cases in non-ABE group.（1） The results of aEEG and MRI were marginally positively correlated with clinical diagnosis of ABE （aEEG：r =0.487,P 〈 0.001;MRI：r =0.220,P=0.018）,while the results of BAEP were closely related to the clinical diagnosis of ABE （r =0.593,P 〈 0.001）;（2） The results of BAEP and MRI on the diagnosis of ABE were positively correlated with those of aEEG （BAEP：r =0.424,P 〈 0.001;MRI：r =0.307,P 〈 0.001）.（3） The area under the ROC curves for predicting the onset of ABE were 0.899 for the peak level of serum bilirubin,0.767 for BAEP,0.738 for aEEG and 0.590 for MRI.Conclusion There was the correlation on the diagnosis of ABE among the methods of aEEG,BAEP and MRI.The combined diagnosis of the three methods could play a complementary role.The aEEG contributed to the early diagnosis of ABE with high sensitivity.

关 键 词：胆红素脑病 早期诊断 诱发电位 听觉 脑干 振幅整合脑电图 磁共振成像 

分 类 号：R722.1[医药卫生—儿科]