Auditory Brainstem Response in Patients with a History of Kernicterus

有核黃疸既往史病人之聽性腦幹反應

洪焜隆(Kun-Kong Hung) ； 吳建明(Chien-Ming Wu)

《Acta Paediatrica Sinica》 29卷4期 (1988/08) Pp. 229-234

摘要

新生兒黃疸是新生兒時期一個重要的問題。膽紅素過高很容易引起腦部及聽神經的病變，造成核黃疸、腦性麻痺、聽力不足……等。為瞭解膽紅素的神經毒素，本文先就核黃疸病人的聽性腦幹反應提出初報。
著者選取十位過去因嚴重黃疸而引起核黃疸之孩童，施予聽性腦幹反應之檢查。檢查方法包括測量其聽覺閥（皂日能產生第五波之最小刺激強度）、腦幹電性反應的各波潛值和振幅，以及第一波到第五波之波距。將所得結果加以分析可以得到以下四種異常反應結果：第一型是完全沒有反應，表示患者之聽力極度受損；第二型是第一波潛值延長，但第一波到第五波之波距正常，屬於末梢聽覺障礙；第三型是第一波潛值正常，而第一波至第五波之波距延長，屬於腦幹受損者；第四型則各波潛值及波間距離皆延長，表示末梢與中樞功能均受損。準此，十位病人中有三例屬第一型，有三例屬於第 二型，有二例屬第三型，並有兩例屬第四型，沒有一例完全正常。這些結果顯示出膽紅素神經毒性的病變包括末梢聽神經至中樞腦幹之不同程度的傷害。

並列摘要

To understand the neurotoxicity of hyperbilirubinemia, auditory brainstem response (ABR) studies were performed retrospectively in ten known kernicteric patients to find out the posticteric changes of ABRs. The ABRs were tested to evaluate the hearing and neurologic functions, that is, hearing threshold and brainstem electric response to suprathreshold stimuli. Abnormalities of ABRs were analyzedandinterpreted as peripheral hearing loss (wave I prolongation), neurological brainstem involvement (interwave I-V prolongation or absence of later components) or both. Absence of electric waves was implicated as profound hearing loss although neurologic lesions might be masked. All the ten patients except two had elevation of hearing threshold. There were three patients with peripheral hearing loss, two patients with brainstem involvement and two patients with both lesions. The other three patients showed no elicitable ABR up to 100dB clicks. These findings demonstrate the varied involvement of peripheral hearing and central brainstem functions in the neurotoxicity of neonatal hyperbilirubinemia.

並列關鍵字

auditory brainstem response ； kernicterus ； hyperbilirubinemia ； biliru bin neurotoxicity