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目的观察铅中毒对学龄儿童听觉神经系统的损害。方法对100例无神经系统阳性体征的铅中毒儿童进行听性脑干反应、纯音测听及畸变产物耳声发射检测,并将其分为补钙组和未补钙组,观察治疗前后的听性脑干反应、纯音测听及畸变产物耳声发射的变化,同时与50例年龄性别相匹配的血铅正常儿童进行对比分析。结果治疗前铅中毒组和正常组听性脑干反应比较:铅中毒组Ⅴ波潜伏期较正常组延长,差异有统计学意义(T=3·21,P<0·01),Ⅰ、Ⅲ波潜伏期较正常组延长,但差异无统计学意义(前者T=2·06,P>0·05,后者T=1·64,P>0·05)。铅中毒组Ⅲ~Ⅴ、Ⅰ~Ⅴ波间期较对照组延长,差异有统计学意义(前者T=7·30,P<0·01,后者T=3·14,P<0·01),Ⅰ~Ⅲ波间期较对照组延长,但差异无统计学意义(T=0·91,P>0·05)。铅中毒组Ⅰ、Ⅲ、Ⅴ波波幅均低于正常组,差异有统计学意义(Ⅰ波:T=3·20,P<0·01,Ⅲ波:T=3·31,P<0·01,Ⅴ波:T=3·41,P<0·01)。补钙组、未补钙组及血铅正常组治疗半年前后比较:3组听性脑干反应各指标在治疗前后均无统计学意义(P>0·05)。纯音测听及畸变产物耳声发射检测前后差异均无统计学意义(P值均>0·05)。结论铅中毒可以引起神经系统的亚临床损害,补钙对治疗后ABR无显著改变,ABR对于早期发现铅中毒对神经系统损害有一定的价值。
Objective To observe the damage of lead poisoning to auditory nervous system in school-age children. Methods 100 cases of children with lead poisoning without nervous system positive signs were measured by auditory brainstem response, pure tone audiometry and distortion product otoacoustic emission. The patients were divided into calcium group and non-calcium group. Sexual brainstem response, pure tone audiometry and distortion product otoacoustic emissions changes, at the same time with 50 age-matched gender-matched children with normal blood lead for comparative analysis. Results Compared with normal control group, the brainstem responses of lead poisoning group and normal group before treatment were higher than that of normal group (P <0.01), the latency of Ⅴ wave of lead poisoning group was longer than that of normal group (T = 3.21, P <0.01) The latency was longer than the normal group, but the difference was not statistically significant (former T = 2.06, P> 0.05, latter T = 1.64, P> 0.05). Lead poisoning group Ⅲ ~ Ⅴ, Ⅰ ~ Ⅴ wave interval than the control group, the difference was statistically significant (the former T = 7.30, P <0.01, the latter T = 3.14, P <0.01 ). The wave interval of Ⅰ ~ Ⅲ was longer than that of the control group, but the difference was not statistically significant (T = 0.91, P> 0.05). The wave amplitudes of Ⅰ, Ⅲ and Ⅴ in lead poisoning group were lower than those in normal group (Ⅰ wave: T = 3.20, P <0.01, Ⅲ wave: T = 3.31, P < 01, Ⅴ wave: T = 3.41, P <0.01). Calcium group, non-calcium group and blood lead group before and after treatment six months before and after treatment: three groups of auditory brainstem response in each index before and after treatment were not statistically significant (P> 0.05). There was no significant difference between pure tone audiometry and distortion product otoacoustic emissions (P> 0.05). Conclusion Lead poisoning can cause subclinical damage to the nervous system. Calcium supplementation has no significant effect on ABR after treatment. ABR has some value in the early detection of lead poisoning on nervous system damage.