新生儿ABO血型不合溶血病和G6PD致高胆红素血症患儿脑干听觉诱发电位筛查及其临床意义

Screening and clinical significance of brainstem auditory evoked potential in neonates with ABO blood group incompatibility hemolytic disease of the newborn and G6PD associated with hyperbilirubinemia

摘要:

目的 探讨新生儿ABO血型不合溶血病和红细胞内葡萄糖-6-磷酸脱氢酶缺乏症（G6PD）致高胆红素血症患儿脑干听觉诱发电位筛查的临床意义。方法 选取2017年4月—2022年3月海南省人民医院收治的151例ABO血型不合溶血病和G6PD致高胆红素血症患儿为研究对象。所有患儿入院后均行脑干听觉诱发电位筛查，记录其Ⅴ波潜伏期耳间差值（ILD）。分析研究组不同病情严重程度患儿Ⅴ波ILD情况，分析影响ABO血型不合溶血病和G6PD致高胆红素血症患儿听力损伤的因素，Ⅴ波ILD诊断ABO血型不合溶血病和G6PD致高胆红素血症患儿听力情况的价值。结果 重症组脑干听觉诱发电位Ⅴ波ILD高于轻症组（P <0.05）。多因素Logistic回归分析显示：酸中毒［O^R=4.943（95% CI：2.034，12.013）］、TSB ［O^R=5.078（95% CI：2.090，12.342）］、UCB ［O^R=5.109（95% CI：2.102，12.417）］、Ⅴ波ILD ［O^R=4.614（95% CI：1.898，11.212）］是影响ABO血型不合溶血病和G6PD致高胆红素血症患儿听力的影响因素（P <0.05）。ROC曲线分析结果显示，脑干听觉诱发电位Ⅴ波ILD诊断ABO血型不合溶血病和G6PD致高胆红素血症患儿听力损伤的敏感性为73.33%（95% CI：0.538，0.870），特异性为84.30%（95% CI：0.763，0.901），AUC为0.820（95% CI：0.725，0.915）。结论 ABO血型不合溶血病和G6PD致高胆红素血症患儿病情与脑干听觉诱发电位筛查的Ⅴ波ILD有关，Ⅴ波ILD诊断患儿听力损伤效能良好。

Abstract:

Objective To investigate the clinical significance of brain stem auditory evoked potential screening in neonates with ABO blood group incompatibility hemolytic disease of the newborn and erythrocyte glucose-6-phosphate dehydrogenase deficiency(G6PD) associated with hyperbilirubinemia.Methods A total of 151 neonates with ABO blood group incompatibility hemolytic disease of the newborn and G6PD related hyperbilirubinemia who were admitted to our hospital from April 2017 to March 2022 were selected as the study group. After admission, all children were screened for brainstem auditory evoked potential, and the intraauricular latency of Ⅴ wave was recorded. The cases of Ⅴ wave ILD in children with different severity were analyzed. Factors affecting hearing impairment in neonates with ABO blood group incompatibility hemolytic disease of the newborn and G6PD associated hyperbilirubinemia were analyzed. The value of V wave ILD in the diagnosis of hearing in neonates with ABO blood group incompatibility hemolytic disease of the newborn and G6PD associated with hyperbilirubinemia was analyzed.Results The dry auditory evoked potential Ⅴ wave ILD in severe group was higher than that in mild group (P < 0.05). Logistic multifactor regression analysis showed acidosis [O^R = 4.943 (95% CI: 2.034, 12.013) ], TSB [O^R = 5.078 (95% CI: 2.090,12.342) ], UCB [O^R= 5.109 (95% CI: 2.102, 12.417) ], and V wave ILD [O^R = 4.614 (95% CI: 1.898, 11.212) ] were influencing factors affecting hearing in neonates with ABO blood group incompatibility hemolytic disease of the newborn and G6PD related hyperbilirubinemia (P < 0.05). ROC curve analysis showed that the sensitivity and specificity of BRAINstem auditory evoked potential (BRAINstem auditory evoked potential) V wave ILD for the diagnosis of hearing impairment in newborn infants with ABO hemolysis and G6PD defect related hyperbilirubinemia were 73.33% (95% CI: 0.538, 0.870) and 84.30% (95% CI: 0.763, 0.901), and AUC was 0.820 (95% CI: 0.725, 0.915).Conclusion ABO blood group incompatibility hemolytic disease of the newborn and G6PD related to hyperbilirubinemia neonates are associated with brainstem auditory evoked potential screening V wave ILD, and the diagnosis of hearing impairment in children with good efficacy.