CAJ | 학술논문

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1000 Hz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。
목적：탐토수환혈치료적중도고담홍소혈증환인적은력변화특점，료해신생인혈청총담홍소봉치농도여은력손실적상관성。방법대130례학진위중도고담홍소혈증수환혈치료적신생인진행은성뇌간반응（ABR）、기변산물이성발사（DPOAE）화1000 Hz성도항검사，은력이상자우3월령시복사。이3월령시적은력정황장130례분위은력정상조、경도－중도은력손실조、중도－겁중도은력손실조，비교삼조혈청총담홍소봉치농도여은력손실적상관성。결과①3월령시은력정상85례（65．38％，85／130）；은력이상45례（34．62％，45／130）（88이，쌍이43례，단이2례），기중경도－중도조11례22이（24．44％，11／45）、중도－겁중도조34례66이（75．56％，34／45）。②3월령시16례32이（12．31％，16／130）제시와후은신경병변。③은력정상조、경도－중도은력손실조、중도－겁중도은력손실조혈청총담홍소봉치농도분별위470．80±107．90、493．60±106．79、626．40±187．18μmol／L ，삼조간차이유통계학의의（F＝16．525，P＝0．000）；ABR반응역화혈청총담홍소봉치농도지간정정상관（r＝0．584，P＜0．001），즉수혈청총담홍소봉치봉치농도증가，ABR반응역축점증고。결론수환혈치료적중도고담홍소혈증환인주요표현위쌍측겁중도감음신경성은력손실，부분환인표현위와후은신경병변；신생인혈청총담홍소봉치농도월고，발생중도이상은력손실적풍험월대。
Objective To study the change of audiological characteristics of neonate with severe hyperbilirubi‐nemia need to be exchanged transfusion ,and to explore the correlation between the peak concentrations of serum to‐tal 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 ser‐um 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 2 cases of single ear and 43 cases of both ears) ,including 11 cases of mild - moderate group (22 ears ,24 .44% ,11/45) and 34 cases with severe - extreme group (66 ears ,75 .56% ,34/45) .There were 16 neonates (32 ears) met the crite‐rion of auditory neuropathy (12 .31% ,16/130) .The difference of the peak concentrations of serum total bilirubin a‐mong 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 ma‐jor feature of the neonate with severe hyperbilirubinemia need to be exchanged transfusion was extremely severe sen‐sorineural hearing loss in both ears ;and the higher probability of serious hearing loss with the higher peak concen‐trations of serum total bilirubin .