ABR在足月新生儿重度高胆红素血症脑损伤早期诊断中的应用价值  

Application Value of ABR in the Early Diagnosis of Severe Hyperbilirubinemia Brain Injury in Full-term Neonates

作　　者：张玉贵 周冰新 ZHANG Yugui;ZHOU Bingxin(Zhangzhou Hospital Affi liated to Fujian Medical University,Zhangzhou 363000,China)

机构地区：[1]福建医科大学附属漳州市医院,福建漳州363000

出　　处：《中国医药指南》2020年第28期13-15,共3页Guide of China Medicine

摘　　要：目的探讨听觉脑干诱发电位(ABR)在新生儿重度高胆红素血症脑损伤早期诊断中的应用价值。方法选取2013年9月至2014年6月期间于我院新生儿科住院治疗的124例重度高胆红素血症脑损伤足月新生儿为研究对象,调查患儿的临床资料及实验室检查结果,对新生儿进行ABR、颅脑磁共振成像(MRI)检查,根据ABR/颅脑MRI检查结果分为ABR组(ABR/颅脑MRI异常)和对照组(ABR/颅脑MRI正常)。以颅脑MRI检查结果是否异常作为诊断胆红素诱发的神经系统功能障碍(BIND)的金标准,对ABR检查诊断BIND进行评价分析。结果 ABR对BIND诊断的敏感度为90.91%,特异度为96.08%,阳性预测值为83.33%,阴性预测值为98.00%,误诊率(假阳性率)为3.92%,漏诊率(假阴性率)为9.09%,阳性似然比为23.191,阴性似然比为0.095。结论 ABR检查可用于足月新生儿重度高胆红素血症脑损伤的早期诊断。建议对存在高危因素的足月新生儿重度高胆红素血症脑损伤患儿及早进行ABR检查以提高BIND的早期诊断率;对于ABR初次检查结果为阴性的BIND高危患儿可给予动态监测ABR变化,并可结合颅脑MRI检查,以提高BIND的早期诊断率。Objective To study the application value of auditory brainstem response(ABR)in the early diagnosis of severe hyperbilirubinemia brain injury in full-term neonates.Method A total of 124 cases of full-term neonates with severe hyperbilirubinemia brain injury who were hospitalized in the neonatology department of our hospital from September 2013 to June 2014 were selected as the research objects.Investigate the clinical data and laboratory examination results of children,and perform ABR and cranial magnetic resonance imaging(MRI)examinations on the neonates.According to the ABR/cranial MRI examination results,they were divided into ABR group(ABR/cranial MRI abnormality)and control Group(ABR/cranial MRI is normal).Whether the brain MRI examination results were abnormal used as the gold standard for the diagnosis of bilirubin-induced neurological dysfunction(BIND),evaluate and analyze the results of ABR examination to diagnose BIND.Results The sensitivity of ABR to BIND diagnosis was 90.91%,the specifi city was 96.08%,the positive predictive value was 83.33%,the negative predictive value was 98.00%,the misdiagnosis rate(false positive rate)was 3.92%,and the missed diagnosis rate(false negative rate)was 9.09%,the positive likelihood ratio was 23.191,and the negative likelihood ratio was 0.095.Conclusion ABR examination can be used for the early diagnosis of severe hyperbilirubinemia brain damage in full-term neonates.It is recommended that full-term neonates with high-risk factors and severe hyperbilirubinemia brain injury undergo ABR examination as soon as possible to improve the early diagnosis rate of BIND;for children at high risk of BIND whose initial ABR test result is negative,dynamic monitoring of ABR changes can be performed,and brain MRI can be combined to improve the early diagnosis rate of BIND.

关 键 词：重度高胆红素血症 脑损伤 足月新生儿 听觉脑干诱发电位 诊断 

分 类 号：R722.1[医药卫生—儿科]