听性脑干反应和耳声发射在足月新生儿高胆红素血症听力筛查中的应用

摘要

目的 探讨听性脑干反应(ABR)和畸变产物耳声发射(DPOAE)应用于高胆红素血症新生儿听力筛查中的差异和意义.方法 对197例诊断为高胆红素血症的新生儿同时进行ABR和DPOAE检查,异常者于生后3-4个月进行随访.结果 197例患儿临床上无明显胆红素脑病表现,ABR和DPOAE的总异常率分别为76.65%和14.47%;血清胆红素水平越高,ABR异常率越高(P<0.01),而DPOAE异常率与黄疸程度无明显相关性;DPOAE异常者多并存潜在的围生期其他导致听力损伤的高危因素.重度ABR异常者在生后3～4个月复查时仍有40.7%无改善.结论 临床上无明显胆红素脑病表现的高胆红素血症新生儿ABR异常率高,对此类患儿进行听力检查应先ABR后DPOAE或者两者同时进行以避免漏诊.%Objective To systematically evaluate the efficacy of C-reactive protein ( CRP) in differentiating bacterial from nonbacterial community-acquired pneumonia in children. Methods According to the requirements of Cochrane systematic review, a thorough literature search relevant to CRP and pneumonia was performed among PubMed, Medline, EMBASE and China Biology Medicine disc et al from 1990 to 2010 in any language. Results Seven placebo-controlled literatures and 1 165 children were included. The primary outcome measure was the odds ratio of patients with bacterial or mixed etiology pneumonia and serum CRP concentrations exceeding 30 - 60 mg/L. The value of the weighted sensitivity was 47% (42% - 51%) , the specificity was 65% (61% - 68%) , the positive likelihood ratio was 1.50 (1.20 - 1.88), the negative likelihood ratio was 0.75 (0.60 - 0.92), and the summary receiver operating characteristic (SROC) area under the curve (AUC) was 0.64. Conclusions C-reactive protein can be regarded as a valuable marker in differentiating bacterial from nonbacterial pneumonia. However, more high-quality, large-sized and multi-center studies are still required to evaluate its clinical value.