听力正常的全面性发育迟缓与发育正常儿童听性脑干反应的病例对照研究

目的：探讨听力正常的全面性发育迟缓（GDD）儿童听性脑干反应（ABR）特征及不同年龄段GDD儿童ABR的变化特点，以辅助GDD的早期诊断。 方法：GDD的诊断要点是两个及以上发育指标/里程碑的落后， 2015年7月至2019年8月符合GDD诊断要点并行ABR检测的年龄1~4岁儿童，以Gesell发育诊断量表5个能区均≤75为GDD组、均>85为对照组。ABR与Gesell测试间隔不超过2周。GDD组和对照组均以3岁为界，划分出1~2岁（≧1岁但<3岁）和3~4岁（≧3岁但<5岁）两个亚组，分析比较GDD组和对照组ABR参数的差异及不同年龄段间ABR的变化特点。结果：GDD组129例（1~2岁亚组83例，3~4岁亚组46例），对照组58例（1~2岁亚组45例，3~4岁亚组13例）。①GDD组ABRⅢ、Ⅴ波潜伏期，Ⅲ~Ⅴ、Ⅰ~Ⅴ波间期较对照组延长（P<0.05）。1~2岁亚组中，GDD组ABRⅢ、Ⅴ波潜伏期，Ⅲ~Ⅴ、Ⅰ~Ⅴ波间期较对照组延长（P<0.05）；3~4岁亚组中，GDD组Ⅰ~Ⅴ波间期较对照组延长（P<0.05）；②GDD组ABRⅤ波振幅较对照组减小（P<0.05）。1~2岁亚组中，GDD组ABRⅤ波振幅较对照组减小（P<0.05）。3~4岁亚组中，GDD组ABR各波振幅较对照组均差异无统计学意义（P>0.05）；③GDD组3~4岁亚组较1~2岁亚组Ⅲ、Ⅴ波潜伏期、Ⅰ~Ⅲ、Ⅰ~Ⅴ波间期缩短（P<0.05）。对照组3~4岁亚组较1~2岁亚组各波潜伏期和振幅均差异无统计学意义（P>0.05）。结论：GDD儿童存在脑干水平的听觉处理异常，主要表现为ABRⅢ、Ⅴ波潜伏期延长和Ⅴ波振幅下降，同时伴有Ⅲ~Ⅴ、Ⅰ~Ⅴ波间期延长。年龄越小的GDD儿童，ABR异常越显著。3岁起GDD儿童ABR潜伏期和波间期逐渐向正常水平追赶，振幅基本正常。生命早期ABR测试可作为一种发育监测的手段来辅助诊断GDD，但随着年龄增长，ABR在发育监测中的价值降低。

Auditory brainstem response in global developmental delay children and typically developing children with normal hearing: A case control study

Abstract Objective:To investigate the characteristics of auditory brainstem response (ABR) in children with global developmental delay (GDD) to assist in early diagnosis of GDD. Methods:GDD refers to the delay in two or more developmental indicators or milestones. Children aged 1 to 4 years who met the GDD diagnostic criteria and received ABR test were enrolled from July 2015 to August 2019 and separated into a GDD group (the developmental quotient of each energy region in Gesell development scale ≤75) and a control group (the developmental quotient of all energy regions＞85). The interval between the test of ABR and Gesell scale should not exceed 2 weeks. The GDD group and the control group are both divided into two subgroups: 1 to 2 years old (≥ 1 year but <3 years) and 3 to 4 years old (≥ 3 years but <5 years).Compare the ABR parameters between the GDD and control group as well as the changes of the ABR parameters between the two age groups. Results:There were 129 children in the GDD group, 83 for 1 to 2 years old and 46 for 3 to 4 years old and 58 in the control group, 45 for 1 to 2 years old and 13 for 3 to 4 years old. Peak latency Ⅲ, Ⅴ and inter-peak latency Ⅲ-Ⅴ, Ⅰ-Ⅴof the GDD group was prolonged when compared with the control group (P<0.05). In the 1-2yr subgroup, peak latency Ⅲ, Ⅴ and inter-peak latency Ⅲ-Ⅴ, Ⅰ-Ⅴof the GDD group was prolonged when compared with the control group (P<0.05). In the 3 4yr subgroup, inter peak latency Ⅰ-Ⅴof the GDD group was prolonged when compared with the control group (P<0.05). WaveⅤamplitude of the GDD group was reduced when compared with the control group(P<0.05). In the 1 2yr subgroup, waveⅤamplitude of the GDD group was reduced when compared with control group (P<0.05). In the 3-4yr subgroup, there were no amplitude differences between the GDD and control group. In the GDD group, peak latency Ⅲ, Ⅴand inter-peak latency Ⅰ-Ⅲ, Ⅰ-Ⅴin the 3-4yr subgroup were reduced when compared with the 1-2yr subgroup(P<0.05) and in the control group, no age differences were found in latency and amplitude. Conclusion:GDD children showed brainstem auditory processing abnormalities with prolonged ABR peak latency Ⅲ, Ⅴ, inter-peak latency Ⅲ-Ⅴ, Ⅰ-Ⅴ and reducedⅤamplitude. The younger the GDD children were, the more obvious the ABR abnormalities were. The latency and amplitude gradually caught up to the normal level from the age of 3. Therefore, the ABR test can be used as an objective method to assist in GDD diagnosis but its role in developmental monitoring will be less important with an increase in the age.