瞬态耳声发射联合自动听性脑干反应对高胆红素血症足月新生儿听力损伤的筛查价值  

Value of TEOAE combined with AABRin screening of hearing impairment in full-term neonates with hyperbilirubinemia

作　　者：李丽娟 罗家胜 杨引通 秦燕 常换换 LI Lijuan;LUO Jiasheng;YANG Yintong;QIN Yan;CHANG Huanhuan(Department of Otolaryngology Head and Neck Surgery,Xi’an People’s Hospital,Xi’an 710004,China;Department of Otorhinolaryngology Head and Neck Surgery,Xi’an Children’s Hospital,Xi’an 710003,China)

机构地区：[1]西安市人民医院西安市第四医院耳鼻咽喉头颈外科,陕西西安710004 [2]西安市儿童医院耳鼻咽喉头颈外科,陕西西安710003

出　　处：《陕西医学杂志》2025年第3期358-363,共6页Shaanxi Medical Journal

基　　金：西安市卫生和计划生育委员会卫生科研人才项目(J201802030)。

摘　　要：目的:探讨瞬态耳声发射(TEOAE)联合自动听性脑干反应(AABR)对高胆红素血症足月新生儿听力损伤的筛查价值。方法:选取高胆红素血症足月新生儿296例(592耳)为研究对象,根据血清总胆红素(TSB)水平分为重度组(TSB≥342μmol/L,199例,398耳)、极重度组(TSB≥427μmol/L,88例,176耳)和危险组(TSB≥510μmol/L,9例,18耳),均于出生后7 d内行TEOAE和AABR听力初筛,42 d后行听力复筛,3个月后行诊断型ABR检测确诊听力,并对听力结果进行统计学分析。结果:三组TEOAE、AABR及两项联合测试听力初筛、复筛未通过率及诊断型ABR异常率比较差异有统计学意义(均P<0.05)。经组间两两比较后发现危险组上述指标明显高于重度组和极重度组(均P<0.05)。经诊断型ABR检测,听力受损147耳(24.83%)。对于听力受损疾病,复筛听力时两项联合测试的敏感度、准确率和Kappa值高于单独TEOAE或AABR,同时漏诊率较低。结论:危险高胆红素血症是足月新生儿听力损伤的高危因素。TEOAE联合AABR对高胆红素血症足月新生儿听力损伤具有良好的筛查价值。Objective:To explore the value of combined transient otoacoustic emission(TEOAE)combined with automatic auditory brainstem response(AABR)in the screening of hearing impairment in full-term neonates with hyperbilirubinemia.Methods:A total of 296 full-term neonates(592 ears)with hyperbilirubinemia were enrolled as subjects.According to the serum total bilirubin(TSB)level,they were divided into severe group(TSB≥342μmol/L,199 cases,398 ears),extremely severe group(TSB≥427μmol/L,88 cases,176 ears)and fatal group(TSB≥510μmol/L,9 cases,18 ears).All of them underwent TEOAE and AABRhearing screening within 7 days after birth,followed by hearing re-screening after 42 days,and diagnostic ABRtest after 3 months to confirm hearing.The hearing results were statistically analyzed.Results:In all three groups,the failure pass rates of TEOAE,AABR,and the combination of both tests showed statistically significant differences in initial screening,re-screening,and diagnostic ABRabnormality rates(all P<0.05).After pairwise comparison between groups,it was found that above differences in the fatal group were significantly higher than those in the severe group and the extremely severe group(all P<0.017).A total of 147 ears(24.83%)with hearing impairment were identified by diagnostic ABR.For hearing impairment diseases,the sensitivity,accuracy,and Kappa value of the combined test during re-screening were higher than those of TEOAE or AABRalone,with a lower rate of missed diagnoses.Conclusion:The fatal hyperbilirubinemia is a higher risk factor for neonatal hearing impairment.TEOAE combined with AABRhas a good screening value for hearing impairment in full-term neonates with hyperbilirubinemia.

关 键 词：高胆红素血症 听力损伤 听力筛查 瞬态耳声发射 自动听性脑干反应 足月新生儿 

分 类 号：R722.1[医药卫生—儿科]