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目的探讨脑干听觉诱发电位(BAEP)对儿童结核性脑膜炎(TBM)预后的评估价值。方法对2007年1月-2010年8月本科初治的48例TBM患儿进行BAEP检测。男28例,女20例;年龄1～13岁。测量Ⅰ、Ⅲ、Ⅴ波潜伏期和波幅,Ⅰ～Ⅲ、Ⅲ～Ⅴ、Ⅰ～Ⅴ波峰间期。BAEP结果分级采用Hall分级标准。TBM患儿入院当天行改良Glasgow评分。出院后随访3个月,比较不同BAEP级别TBM患儿的预后不良率;比较BAEP和Glasgow评分对TBM患儿预后评估的价值。结果 BAEP 1级18例中预后不良1例,2级22例中预后不良6例,3级6例中预后不良4例,4级2例均预后不良;BAEP中1级、2级、3级和4级的预后不良率分别为5.6%、27.3%、66.7%和100.0%,差异有统计学意义(P<0.01)。BAEP分级与不良预后发生率呈正相关(r=0.56,P<0.05)。BAEP对TBM患儿的预后评估:真阴性38例,假阴性2例,真阳性7例,假阳性1例;Glasgow评分对TBM患儿的预后评估:真阴性31例,假阴性5例,真阳性4例,假阳性8例;BAEP对TBM患儿预后评估的敏感性、特异性、准确率和错误率分别为77.8%、97.4%、93.6%和6.3%;Glasgow评分对TBM患儿预后评估的敏感性、特异性、准确率和错误率分别为44.4%、79.5%、72.9%和27.1%,2种评估方法比较差异有统计学意义(Pa<0.05,0.01)。结论 BAEP可反映TBM患儿的脑损伤程度,有助于评估预后;BAEP对TBM患儿的预后评估价值优于Glasgow评分。
Objective To evaluate the prognostic value of brainstem auditory evoked potential (BAEP) in children with tuberculous meningitis (TBM). Methods BAEP was performed on 48 TBM children admitted to our department from January 2007 to August 2010. 28 males and 20 females; aged 1 to 13 years old. The latency and amplitude of Ⅰ, Ⅲ and Ⅴ waves were measured, and the interphase Ⅰ ~ Ⅲ, Ⅲ ~ Ⅴ and Ⅰ ~ Ⅴ were measured. The BAEP results were graded using the Hall classification criteria. Patients with TBM underwent modified Glasgow scores on the day of admission. The patients were followed up for 3 months after discharge. The poor prognosis of children with different BAEP grade TBM was compared. The prognostic value of BAEP and Glasgow scores in children with TBM was compared. Results In the 18 patients with BAEP grade 1, the prognosis was poor in 1 case, 2 cases in 22 cases with poor prognosis in 6 cases, 3 cases in 6 cases with poor prognosis in 4 cases and 4 cases in 2 cases with poor prognosis. In BAEP, grades 1, 2 and 3 And grade 4 were 5.6%, 27.3%, 66.7% and 100.0% respectively, the difference was statistically significant (P <0.01). There was a positive correlation between BAEP classification and adverse prognosis (r = 0.56, P <0.05). The prognosis of children with TBM evaluated by BAEP was as follows: 38 cases of true negative, 2 cases of false negative, 7 cases of true positive and 1 case of false positive; Glasgow score prognosis of children with TBM: 31 cases of true negative, 5 cases of false negative 4 cases were positive and 8 cases were false positive.The sensitivity, specificity, accuracy and error rate of BAEP in prognosis of children with TBM were 77.8%, 97.4%, 93.6% and 6.3% respectively. The prognosis of children with TBM The sensitivity, specificity, accuracy and error rates were 44.4%, 79.5%, 72.9% and 27.1%, respectively. There was significant difference between the two evaluation methods (Pa 0.05, 0.01). Conclusion BAEP can reflect the degree of brain injury in children with TBM, which is helpful to evaluate the prognosis. BAEP is superior to Glasgow in the prognosis of children with TBM.