脑干听觉诱发电位早期诊断化脓性脑膜炎听力损害的评估

应用脑干听觉诱发电位（ＢＡＥＰ）对４０例化脓性脑膜炎患儿进行检测，其中３３例为＜２岁幼婴。结果表明，１５例ＢＡＥＰ异常，１０例显示周围性听路损害，３例脑干中枢性听路损害，２例混合损害。１０例随访１年，３例完全恢复，１例部分恢复，６例仍异常。提示ＢＡＥＰ对早期诊断新生儿、幼婴化脓性脑膜炎的听力损害、判断性质、预后的监测具有重要临床价值。     

肥胖儿童血脂,脂蛋白与载脂蛋白的研究

对１２７例单纯性肥胖儿采禁食１２小时以上的静脉血，检测其血清甘油三酯，总胆固醇［ＴＣ（ＨＤＬ－ｃｈ，ＬＤＬ－ｃｈ）］，载脂蛋白（ＡＰＯＡＩ，ＡＰＯＢ）；与１２０例健康儿比较，结果ＴＣ，ＴＧ，ＬＤＬ－ｃｈ，ＡＰＯＢ浓度明显升高，ＨＤＬ－ｃｈ，ＡＰＯＡＩ两组之间差异不明显。提示肥胖儿血脂紊乱是导致动脉粥样硬化的高危因素。     

正常青春期少女及特发性中枢性性早熟女孩生长激素结合蛋白,？…

本文以４１例青春期女孩及３０例特发性中枢性性早熟（ＩＣＰＰ）女孩，观察其向身高、体重、身高增长速度，骨龄与生长激素结合蛋白（ＢＨＢＰ）、雌二醇（Ｅ２）的相关关系，结果示ＧＨＢＰ在青春各期间无显著差异，ＧＨＢＰ与身高生长速度（ＧＶ），身高标准差分（ＨｔｓＤｓ），体重指数（ＢＭＩ）呈正相关，ＧＨＢＰ与Ｅ２、年龄（ＣＡ）、骨龄（ＢＡ）无相关关系、正常青春少女与ＩＣＰＰ女孩上应青春期血清ＧＨＢＰ无明显差异     

肠道病毒特异性抗体和RNA检测对心肌炎的诊断价值

用间接酶联免疫吸附试验（ＥＬＩＳＡ）和抗体捕捉ＥＬＩＳＡ（ＭａｃＥＬＩＳＡ）分别检测６４例急性心肌炎、２０例疑似心肌炎、２０例非心肌炎和５２例正常儿血柯萨奇病毒Ｂ（ＣＶＢ）特异ＩｇＧ和ＩｇＭ。其中４９例心肌炎及２３例先天性心脏病同时用聚合酶链反应（ＰＣＲ）检测其血清中肠道病毒ＲＮＡ。结果：心肌炎组ＩｇＧ阳性３８例（５９．４％），ＩｓＭ阳性３３例（５１．６％），ＰＣＲ检测阳性２６例（５３．１％），均明显高于非心肌炎组及正常小儿组。病程早期（２周内）ＰＣＲ检测ＩｇＭ阳性率较高，二者下降较快，约６周后降至接近正常水平；ＩｇＧ则出现较晚，约２～６周达高峰，持续１０～２２周后降至接近正常水平。本研究表明：ＣＶＢ是引起心肌炎的主要病原；三种方法检测均敏感、特异；ＭａｃＥＬＩＳＡ检测特异ＩｇＭ比间接ＥＬＩＳＡ检测ＩｇＧ更有早期诊断价值。     

小儿特发性血小板减少性紫瘢T细胞亚群的观察

小儿特发性血小板减少性紫瘢Ｔ细胞亚群的观察田根全，袁文菊，程岩青海省儿童医院ＴＨＥＴ－ＣＥＬＬＳＵＢ－ＧＲＯＵＰＭＥＡＳＵＲＥＭＥＮＴＯＦＩＤＩＯＰＡＴＨＩＣＴＨＲＯＭＢＯＣＹＴＯＰＥＮＩＣＰＵＲＰＵＲＡ（ＩＴＰ）ＩＮＰＥＤＩＡＴＲＩＣＰＡＴＩＥＮＴ...     

对心前区不适为主诉的72例小儿ECG和DCG的观察和随访

观察心前区不适小儿常规和动态心电图（ＥＣＧ,ＤＣＧ）的变化及与心肌炎的关系。７２例患儿分为两组：Ａ组（３４例）同时伴ＥＣＧ改变,Ｂ组（３８例）ＥＣＧ无异常变化。结果示Ａ组心肌酶谱导常率６７．７％）明显高于Ｂ组（１８．４％）;Ａ组病前１～３周患上道感染例数（占８８％）明显多于Ｂ组（占２１％）,Ｐ〈０．０１,抗心肌抗体阳性影增大也发生在Ａ组;Ａ组ＤＣＧ心律失常检 高于ＥＣＧ,提示Ａ组患心肌可能大。Ｂ组     

碱性成纤维细胞生长因子对新生大鼠缺氧缺血性脑损伤的保护作用

目的 探讨碱性成纤维细胞生长因子（ ｂＦＧＦ）对新生大鼠缺氧缺血性脑损伤( ＨＩＢＤ）的保护作用。方法 将 ３２只 ７日龄Ｗｉｓｔａｒ大鼠分为４组：假手术组、ＨＩＢＤ组、 ｂＦＧＦ治疗组（分大剂量组１７．５ μｇ／ｋｇ和小剂量组１０ μｇ／ｋｇ）,每组 ８只。后３组动物制成 ＨＩＢＤ模型,给予治疗组大鼠连续 ７ ｄ腹腔注射 ｂＦＧＦ, ＨＩＢＤ组腹腔注射等体积生理盐水作为对照。全部大鼠于术后１４ ｄ处死,对脑纹状体、皮质的光镜下结构、乙酰胆碱酯酶（ＡｃｈＥ）、酸性磷酸酶（ＡＣＰ）活性变化进行观察和比较。结果 新生大鼠 ＨＩＢＤ后皮质、纹状体有选择性神经元坏死及胶质细胞增生, ｂＦＧＦ治疗组上述病变明显减轻; ＨＩＢＤ后纹状体、皮质神经元 ＡｃｈＥ活性明显下降(－～＋）, ｂＦＧＦ组 ＡｃｈＥ活性（＋～＋＋）较ＨＩＢＤ组恢复快; ＨＩＢＤ后纹状体神经元 ＡＣＰ活性明显增高（＋＋＋）, ｂＦＧＦ组 ＡＣＰ活性（＋＋）变化程度小于ＨＩＢＤ组。但大、小剂量ｂＦＧＦ治疗组未见明显差异。结论 ｂＦＧＦ能通过影响受损神经元的酶物质代谢而加快ＨＩＢＤ新生大鼠神经元的修复。     

2367例新生儿听力筛查初步报告

目的　筛查新生儿听力障碍。方法　采用诱发畸变耳声发射（ＤＰＯＡＥ）对２ ３６７ 例新生儿进行听力筛查，连续监测异常者，最后由脑干听觉诱发电位（ＡＢＲ） 确诊。结果　５ 例听觉障碍，其中单耳聋２ 例，双耳聋３ 例。中度听觉障碍２例，重度听觉障碍３ 例。结论　ＤＰＯＡＥ测试是适合于新生儿听力筛查可靠、有效、快速、简便的好方法。     

小儿血液病骨髓活检的临床意义

小儿血液病骨髓活检的临床意义屠立明，沈亦逵，王若洁广东省人民医院儿科ＣＬＩＮＩＣＳＩＧＮＩＦＩＣＡＮＣＥＯＦＢＯＮＥＭＡＲＲＯＷＢＩＯＰＳＹＩＮＣＨＬＬＤＲＥＮＨＥＭＡＴＯＬＯＧＩＣＤＩＳＥＡＳＥＳ￥ＴｕＬｉｍｉｎｇ，ｅｔａｌ．（ＧｕａｎｇｄｏｎｇＰ...     

聚合酶链反应诊断病毒性心肌炎

用聚合酶链反应（ＰＣＲ）检测３０例小儿病毒性心肌炎血清肠道病毒（ＥＶ）ＲＮＡ，６例阳性。检出率２０％，并对阳性病例作临床分析。用ＥＬＩＳＡ法混合反应对照检测柯萨奇Ｂ组病毒（ＣＢＶ）ＩｇＭ、ＩｇＧ，阳性率分别为７７％和３０％。认为ＰＣＲ对ＥＶ感染早期检出率高，对病原学诊断有意义。     

新生儿高胆红素血症脑干听觉诱发电位的临床意义

通过脑干听觉诱发电位(BAEP)的检测，研究血清胆红素水平对新生儿听力的影响。对240例(480耳)高胆红素血症患儿进行了BAEP检测，并以240例正常新生儿作为对照组，随访监测异常患儿。高胆患儿中BAEP异常16l例(253耳)，总异常耳数率52．7％。同时发现高胆红素血症程度越重，BAEP异常改变越严重。随访114例BAEP异常患儿，14例仍有中、重度异常，其中脑瘫2例。研究提示，BAEP是简便易行、无创性、客观性好的检测方法，能及早发现听力异常并进行干预。     

新生儿重度高胆红素血症伴听力损伤预后相关因素研究

目的探讨影响重度高胆红素血症新生儿听力损伤预后情况的相关因素。方法选择2008年11月至2009年10月本院新生儿科收治的重度高胆红素血症患儿,进行脑干听觉诱发电位（BAEP）的检测,对异常者分别于生后1个月、3个月、6个月、1岁时复查BAEP,直至BAEP恢复正常或年龄至1岁。按照随访时BAEP能否恢复正常分为随访正常组和随访异常组。对随访异常的影响因素进行单因素分析,并对单因素分析有统计学意义的因素纳入Logistic回归模型进行多因素分析。结果 967例重度高胆红素血症患儿中BAEP异常168例,其中150例按时进行随访的患儿纳入本研究。至随访结束,94.2%的轻度听力损伤者、85.5%的中度听力损伤者和19.2%的重度听力损伤者恢复正常。单因素分析结果显示,酸中毒、B/A比值、黄疸持续时间、BAEP异常程度、胆红素脑病临床表现是随访异常的影响因素。多因素Logistic回归分析结果显示,BAEP重度异常（OR=9.291）和胆红素脑病临床表现（OR=9.176）是听力损伤的重度高胆红素血症患儿随访异常的危险因素。结论新生儿重度高胆红素血症伴轻中度BAEP异常者1年内大多可恢复正常,但当存在BAEP重度异常和胆红素脑病临床表现时,1年内听力持续异常的可能性大,需要给予更加积极的神经康复治疗。     

Hearing screening of high-risk newborns with brainstem auditory evoked potentials: a follow-up study

Numerous techniques have been used in attempts to find a reliable and efficient screening method for determining auditory function in the newborn. The brainstem auditory evoked potential (BAEP) is the latest method advocated for that purpose. The BAEP was evaluated as a hearing screening test in 168 high-risk newborns between 35 and 45 weeks of conceptual age. Follow-up data were obtained after 1 year (mean 17.3 months) on 134 of the infants (80%). Normal hearing was defined as a reproducible response in both ears to a 25 dB normal hearing level (nHL) click stimulus; 21 infants (12.5%) failed the initial screening test. Follow-up on 19/21 infants revealed 18 infants with normal hearing and one infant with an 80 dB nHL bilateral hearing loss substantiated. One infant with an abnormal screening test died before retesting, and the other infant was lost to follow-up but had only a unilaterally abnormal BAEP. None of the infants with a normal BAEP screening study had evidence of hearing loss on retesting. Sensitivity of the BAEP was 100%, specificity was 86%, predictive value of a positive test was 5.26%, and the predictive value of a negative test was 100%. The incidence of significant hearing loss in our population was between 0.75% (1/134 infants) confirmed, and 2.24% (3/134 infants) including infants who failed screening but were lost to follow-up. The BAEP is a sensitive procedure for the early identification of hearing-impaired newborns. However, the yield of significant hearing abnormalities was less than predicted in other studies using BAEP for newborn hearing screening.     

脑干听觉诱发电位在儿科临床应用的价值

本文对１２４０例患儿ＢＡＥＰ资料进行了分析,正常５１８例,异常７２２例。其中新生儿,乳幼儿４８６例;轻－重度异常占７４．５％双侧极重度异常占２５．５％。ＢＡＥＰ异常最高的疾患为听力障碍,听力障碍危险因素,语言障碍,脑干肿瘤智力障碍和脑性瘫痪。     

Outcomes of neonatal screening for hearing loss by otoacoustic emission.

AIM: To assess universal neonatal screening for bilateral hearing impairments averaging 40 dBHL or worse in the better ear, using transient evoked otoacoustic emission screening (TEOAE) testing. METHODS: A three year cohort (14,353 infants born from January 1992 to 1995) was screened and subsequently followed up by hearing surveillance methods, including a distraction test screen from 7 months of age. The entire cohort was used to evaluate the outcome of the screen. A subcohort of 8172 district residents was used to evaluate the continuing worth of the distraction test programme. RESULTS: Nineteen infants (1.3/1000) with a targeted hearing impairment failed the neonatal TEOAE test. Six profoundly deaf infants identified by the TEOAE screen, were fitted with hearing aids at a median age of 16 weeks. One remained without an aid. Of 12 infants with a moderate impairment, only seven accepted hearing aid fitting and the median age of being fitted with an aid increased to 42 weeks. By the time of the analysis 22 children with a targeted hearing impairment (1.5/1000) had been identified from the cohort. Of the three missed neonatally, one was cared for elsewhere, another had a progressive loss, and the third had central deafness. Twenty children were ascertained with a congenital peripheral deafness. Of these, eight (40%) had risk factors identifiable neonatally. Only the child with central deafness was missed by TEOAE screening and subsequently identified by behavioural tests in infancy. The TEOAE screen outperformed the distraction test in terms of processes and yield and was 25% less expensive. CONCLUSIONS: The analysis confirmed the worth within the district of the TEOAE hearing screen. It will thus be continued as a universal neonatal screen with the distraction test being retained as a selective screen in the latter half of infancy.     

Sensory evoked potentials in infants with Down syndrome

Aim: To investigate the sensory functions of the peripheral to central pathways in infants with Down syndrome (DS) by sensory evoked potentials. Methods: Fifty-five infants, 30 DS infants and 25 controls, were examined by multimodal evoked potentials, including brainstem auditory evoked potentials (BAEP), visual evoked potentials (VEP) and short-latency somatosensory evoked potentials (SSEP). Results: No obvious difference was found in the peak latencies between the two groups for BAEP. Nine children with DS showed abnormal BAEP; six had hearing loss and three had prolonged wave I latencies. For VEP, the peak latencies of P₂ and N₂ were significantly longer and the amplitudes were smaller in the DS group than in the control group. Of the 30 infants with DS, five had significantly prolonged P₂ latencies and two had lower amplitudes. In SSEP, the mean latencies of N₂₀ and the interpeak latencies of N₁₃-N₂₀ of the infants with DS showed apparent prolongation compared to the controls. Seven of 30 (23.3%) DS patients had prolonged N₂₀ latencies.

Conclusion: Our results indicate that various sensory deficits occur in patients with DS during the first year of life.     

新生儿高胆红素血症听觉诱发电位检测的临床意义

目的　 通过对新生儿高胆红素血症患儿进行脑干听觉诱发电位 (BAEP)检测 ,评估高胆红素血症在未发生核黄疸时对脑损害及听力的影响。 方法 　对新生儿高胆红素血症患儿入院后进行脑干听觉诱发电位的测定。 结果 　 49例高胆红素血症患儿中异常BAEP发生率为 3 7%( 18/ 49例 ) ,表现为各波潜伏期 (PL)及波间潜伏期 (IPL)的延长和听阈值的增高 ,听阈值随胆红素浓度的增高而增高 ,经治疗后黄疸消退 ,脑干听觉诱发电位大部分恢复正常。 结论 　高胆红素血症对新生儿可造成听力损害 ,BAEP是检测高胆红素血症患儿听力筛查的重要手段之一     

Early development of brainstem auditory evoked potentials in Down's syndrome

Early development of brainstem auditory pathway was studied in 14 children with Down's syndrome (age range from 1 month to 3 years). The brainstem auditory evoked potentials (BAEP) during infancy was characterized by elevated threshold and poorly differentiated wave I. All children within 2 years had elevated threshold in one or both ears, suggesting a high incidence of peripheral hearing deficits. Follow-up tests showed that as age increased up to 3 years the elevated threshold gradually decreased and the differentiation of wave I improved. The I-V interpeak interval was slightly shorter and the amplitude of wave V was smaller than the normal controls, which existed continuously during follow-up studies. Our findings suggest that the development of peripheral hearing is delayed, although persistent hearing deficits cannot be excluded, and the functioning and development of the brainstem auditory pathway may also be abnormal in Down's syndrome children.     

Brainstem size and function at term age in relation to later neurosensory disability in high-risk, preterm infants

The aim of this study was to measure brainstem size on magnetic resonance imaging (MRI) scans of high-risk, preterm infants, to assess brainstem function by brainstem auditory-evoked potentials (BAEP) and to determine the predictive value of these measures for the neurosensory outcome. A total of 51 preterm infants (gestational age <34 wk, birthweight <1500 g) underwent examinations at term age; neuromotor outcome and hearing were followed up until a corrected age of 18 mo. Fourteen (27%) infants had neurosensory disability. Those with a later neurosensory disability had a significantly smaller brain stem than those with a normal outcome. The preterm infants had significantly longer peak latency (L) V and interpeak latency (IPL) III–V than the full-term control infants. Most of the preterm infants with severe cerebral palsy or hearing loss had abnormal BAEP. Sensitivity of morphometric dimensions for predicting neurosensory disability was only 20–31%, but specificity was 97–100%. Abnormal L I and IPL III–V in BAEP predicted disability with a sensitivity of 93% and a specificity of 57–59%.
Conclusion: We conclude that adverse events during the perinatal period may lead to morpho-functional changes in the brain stem in high-risk, preterm infants, and it seems that functional changes are accurate in predicting neurosensory disability in such patients.     

Brainstem acoustic evoked potentials in children with developmental disabilities--a useful tool for differential diagnosis

In a retrospective study brainstem acoustic evoked potentials (BAEP) were evaluated in 222 children with psychomotor retardation or dysmorphic signs. Registrations were done, when no clear response to acoustic stimuli of medium intensity (60-80 dBA) could be obtained during clinical examination. Only 118 children (53%) had normal BAEP. 50 patients (22%) suffered from hearing impairment. 39 children (17%) showed disturbances of neuronal conduction. In 15 cases (7%) a combination of both conditions occurred. The mean age of our children with hearing impairment was 33.1 months, no case having been diagnosed before. In 57% the impairment was of the conductive type with an amount of less than 40 dB nHL This type was predominant in children with skeletal dysplasias (43%), chromosomal aberrations (43%) and malformation syndromes (40%). Severe hearing deficits of the sensorineural type with more than 69 dB nHL were found in children with malformation syndromes (28%), perinatal injuries (23%) and cns malformations (16%). As far as reference data were available, the hearing impairment in the BAEP was confirmed in 92% by our pedaudiologists. As a consequence hearing aids were first prescribed in 10 children, their medium age being 33.6 months. In 18 cases grommets were inserted. 9 children required paracentesis and 4 adenotomy. Disturbances of neuronal conduction with increased interpeak latencies and deformed potentials were predominantly found in the group of children with neurometabolic diseases (67%) and cns malformations (32%). Early diagnosis of hearing impairment in children with psychomotor retardation remains a problem as it is in the general population. More attention in clinical examination and appropriate screening is necessary. BAEP provide a powerful tool for hearing screening and additional information for differential diagnosis especially in children with neurometabolic diseases.