婴儿听性脑干反应与胎儿期低水平铅暴露的相关分析

背景虽然许多研究提出了听脑干反应在检查新生儿和婴幼儿听觉通路及判断脑干功能中具有重要价值.但孕期低水平铅暴露与婴儿是否有听脑干反应的结果异常的关系尚缺乏足够的证据.目的通过听脑干反应检查观察孕期低水平铅暴露对婴儿期听力发育的影响.设计随机、双盲对照研究.单位南京医科大学第二附属医院儿童保健研究中心,耳鼻喉科.对象1999-04/12在南京医科大学第二附属医院产科住院分娩的237名产妇及所生240婴儿,除外高危妊娠.根据产母自愿的原则,纳入215例产母、婴儿出生后在儿童保健研究中心随访检查,配对资料完整的54例6月龄婴儿.方法检查6月龄婴儿的听性脑干反应(auditorybrainstem response,ARB),检测母产时血铅、脐血铅及婴儿血铅水平,进行两者间相关分析.主要观察指标①脐血铅水平与母产时血铅水平相关性.②婴儿ABR的各波潜伏期及左、右耳潜伏期比较.③ABR的各波间期及左、右耳波间期比较.结果6月龄婴儿左耳ABRⅠ,Ⅲ,Ⅴ波潜伏期[(1.97±0.49),(5.22±0.51),(6.05±0.54)ms]明显长于右耳[(1.85±0.53),(5.09±0.60),(5.91±0.47)ms](t=3.07,2.68,2.56,P＜0.05～0.01);脐血铅水平与右耳的Ⅰ,Ⅲ,Ⅴ波潜伏期明显相关(r=0.624,0.592,0.602,P＜0.05).结论胎儿期低水平的铅暴露可能对婴儿期的听觉神经发育产生不良影响;右耳较左耳对铅的伤害可能更为敏感.

Relation between auditory brainstem response and low-level lead exposure during period of fetus in infants

BACKGROUND: Though many researches suggested that auditory brainstem response(ABR) has important values in examining auditory pathway and appraising brainstem effects, but there is still no research on the changes of ABR in infants with low-level lead exposure during the period of fetus.OBJECTIVE: To explore the effect of low-level lead exposure during pregnancy on the auditory developmental level of infants through examination of auditory brainstem response.DESIGN: Double blinded randomized controlled trial.SETTINGS: Research Center of Children' s Health Care and Department of Otorhinolaryngology of the Second Affiliated Hospital of Nanjing Medical University.PARTICIPANTS: During April to December in 1999, 237 parturient and 240 babies as potential study subjects were interviewed at the Department of Obstetrics in the Second Affiliated Hospital of Nanjing Medical University,while those with high risk pregnancy were excluded. On the basis of voluntary, totally 215 parturient and babies after birth were followed up in the Research Center of Children' s Health Care, and other 54 6-months-old infants, which were followed up, and with completely paired data were enrolled.INTERVENTIONS: ABR of the 6-months-old infants were examined. Blood lead level of parturient, umbilical cord and infants were also determined. The relationship between ABR and the lead level was analyzed.peak intervals of each wave of ABR and those of left and right ears.RESULTS: For the 6-month-old infants, the mean latencies of waves I,Ⅲ and Ⅴ in the left ear were(1.97±0.49), (5.22±0.51) and (6.05 ± 0.54) ms respectively, which were significantly longer than those in the right ear [(1.85±0.53), (5.09±0.60), (5.91±0.47) ms]( t = 3.07, 2.68, 2.56, P ＜ 0.05 ). There were significant positive relations of the blood lead level of umbilical cord with the latencies of waves Ⅰ, Ⅲ and Ⅴ in the right ear ( r =0. 624, 0. 592, 0. 602, P ＜ 0. 05).CONCLUSION: Low-level lead exposure during the period of fetus may have harmful effect on the auditory nervous development of early infant.Furthermore, right ear may be more sensitive to lead poisoning than left ear.