长潜伏期听觉诱发电位法医学应用价值的研究

发布时间：2018-02-13 19:20

本文关键词： 长潜伏期听觉诱发电位短音客观测听听阈法医学　出处：《中国医科大学》2009年硕士论文　论文类型：学位论文

【摘要】： 前言在法医学鉴定中,听力损害是以言语频率(即500Hz,1000Hz和2000Hz)纯音气导听阈均值的分贝数作为评定的依据,目前由短声(click)诱发的听觉脑干诱发电位(auditory brainstem response,ABR)是听觉诱发电位(Auditory EvokedPotentials,AEP)检查法中应用最广,技术也最为成熟的客观测听方法。但短声诱发ABR主要反映2kHz以上高频听阈情况,不能很好反映中低频率的听阈,而且只能够反应脑干以及脑干以下听觉通路的功能状况,因此单独应用ABR反应阈推测言语频率行为听阈的方法,不能够准确反映受试者不同频率听力损失的真实情况。为此,针对不同频率短音诱发的AEP与不同频率纯音主观听阈之间关系,一些学者研究发现短音诱发的短、中、长潜伏期听觉诱发电位具有较好的频率特异性,可以用于不同频率听力损失的评价。但有关应用ALR客观评定听功能障碍方面的研究目前国内外报道较少,特别是在法医学上应用尚属空白。本研究通过对45名78耳受试者纯音主观听阈、短音主观听阈和短音ALR反应阈的测试,进而研究短音ALR反应阈与纯音主观听阈之间的关系及其影响因素,旨在分析和评价ALR的法医学应用价值。试验对象与方法一、试验对象试验对象:主观检查配合的受试者45名(78耳),分为正常组、耳聋组和脑挫裂伤组。正常组20名(40耳)均为在校大学生,其中男性和女性各10名,平均年龄25.9岁,各频率(500Hz、1000Hz、2000Hz和4000Hz)的纯音气导听阈均＜25dB。耳聋组17名(22只聋耳),男性10名,女性7名,其中双耳聋5名(10只聋耳),单耳聋12名,传导性耳聋6名,感音神经性聋11名。耳聋的判定:主诉耳聋,并经纯音测听和ABR证实。耳聋范围:35dB～90dB(ABR预估值)。脑挫裂伤组8名,其中男性6名,女性2名,年龄19～55岁,各频率的纯音气导听阈均＜25dB。脑挫裂伤的诊断均由头CT和/或MRI片确认。试验方法:检查在隔音室内进行,依次测试受试者500Hz、1000Hz、2000Hz和4000Hz的纯音主观听阈、短音主观听阈和短音ALR反应阈。当测试纯音主观听阈时,采用FONMXFA—12型纯音听力计,频率范围:125Hz～8000Hz,最小输出:-10dB,最大输出:110dB。当测试短音主观听阈和短音ALR反应阈时,采用美国Nicolet Compact Four公司生产的多功能电生理记录仪做为描记系统,由TDH—39P型耳机给声,电极为银盘电极,记录电极放置在颅顶中央中点(Cz),参考电极放置在同侧耳垂内侧(A_1,A_2),接地电极放置在额极中点(Fp_z),每个电极阻抗＜5kΩ,极间电阻差＜3kΩ。描记ALR各反应波时,正常组由80dB开始,耳聋组由110dB开始,然后以每10dB为一档递减,接近反应阈时按5dB一档下降,直至反应波形消失,重复记录2次。每测定ALR一个频率休息5～10分钟。最后用X—Y记录仪记录。结果 1、典型的ALR一般包括5个波,P1、N1、P2、N2和P3。其中N1、P2波波幅最大,出现率为100%,将诱发出ALR N1、P2波的最小声强确定为短音ALR反应阈。 2、在500Hz、1000Hz、2000Hz和4000Hz四个频率上,正常组短音ALR反应阈与纯音主观听阈之差的均值和标准差分别为7.33±3.12dB、8.11±2.62dB、7.22±2.50dB、9.19±2.85dB;短音主观听阈与纯音主观听阈之差的的均值和标准差分别为3.48±2.17dB、4.33±2.36dB、4.07±1.78dB、3.96±2.21dB;短音ALR反应阈与短音主观听阈之差的均值和标准差分别为3.85±2.27dB、3.78±1.83dB、3.15±2.14dB、5.22±2.04dB。 3、在500Hz、1000Hz、2000Hz和4000Hz四个频率上,短音ALR反应阈与纯音主观听阈的回归方程分别是Y=0.87x-4.18、Y=0.91x-6.49、Y=0.6x-1.21、Y=0.99x-9.03。经t检验,P＜0.01。 4、在500Hz、1000Hz、2000Hz和4000Hz四个频率上,耳聋组短音ALR反应阈与纯音主观听阈之差的均值和标准差分别为7.00±3.08dB、8.14±2.57dB、7.37±2.79dB、9.45±3.02dB;短音主观听阈与纯音主观听阈之差的均值和标准差分别为3.56±2.58dB、4.24±2.46dB、4.18±2.01dB、4.03±2.33dB;短音ALR反应阈与短音主观听阈之差的均值和标准差分别为4.01±2.34dB、3.88±1.97dB、3.05±2.17dB、5.27±2.39dB。对耳聋组与正常组ALR反应阈与纯音主观听阈的差值进行t检验,二者无显著性差异(P＞0.05)。 5、在500Hz、1000Hz、2000Hz和4000Hz四个频率上,脑挫裂伤组短音ALR反应阈与纯音主观听阈之差的均值和标准差分别为7.21±3.21dB、8.21±2.31dB、7.02±2.91dB、9.53±3.27dB;短音主观听阈与纯音主观听阈之差的的均值和标准差分别为3.38±2.76dB、4.11±2.27dB、4.02±2.14dB、4.01±2.43dB;短音ALR反应阈与短音主观听阈之差的均值和标准差分别为3.92±2.12dB、3.96±2.07dB、3.11±2.18dB、5.47±2.22dB。对脑挫裂伤组与正常组ALR反应阈与纯音主观听阈的差值进行t检验,二者无显著性差异(P＞0.05)。对脑挫裂伤组与正常组的ALRN1、P2波潜伏期和波幅进行t检验,N1和P2均无显著性差异(P＞0.05)。 6、随着刺激声强的增高,不同频率ALRN1、P2波的潜伏期缩短,波幅增高。 7、在500Hz、1000Hz、2000Hz和4000Hz四个频率上,ALR反应阈与纯音主观听阈的差值86.25%小于10dB。因此,应用ALR反应阈预估纯音主观听阈时,保守的估计是ALR反应阈减去(0～10dB),即纯音主观听阈的预估值范围。结论 1、典型的ALR一般包括5个波,P1、N1、P2、N2和P3波。其中N1、P2波波幅最大,出现率为100%。N1、P2波的反应阈、潜伏期和波幅是ALR的主要观察指标。 2、随着刺激声强的增高,不同频率ALRN1、P2波的潜伏期缩短,波幅增高。 3、试验结果发现,在同一声强下,1000Hz和2000Hz的潜伏期较短,波幅较高。 4、ALR具有频率特异性、接近主观听阈,能够反应整个听觉通路的功能状况。对不同性质耳聋和脑挫裂伤(无听力障碍)受试者可以进行评定。 5、由于ALR属于皮层电反应,因此,为得到较好的ALR波形,受试者在测试中必须保持清醒状态。
[Abstract]:Preface
In the forensic identification, is based on the speech frequency hearing impairment (i.e. 500Hz, 1000Hz and 2000Hz) pure tone air conduction threshold average decibel as assessment basis, the short sound (click) evoked by brainstem auditory evoked potential (auditory brainstem response ABR (Auditory) is the auditory evoked potential EvokedPotentials, the AEP) wide application of check method, technology is the most mature objective audiometry method. But the short sound evoked ABR mainly reflects the above 2kHz high frequency, cannot reflect the low frequency threshold, and only able to response the brainstem and brainstem auditory pathway following functional status, therefore the single application of ABR speech frequency threshold speculation behavior the threshold, can not accurately reflect the real situation of the subjects of different frequency hearing loss. Therefore, according to the different frequency tone PIP evoked AEP and different subjective relationship between the frequency of pure tone threshold, a Some scholars found that Tone Pip evoked short and long latency auditory evoked potentials with good frequency specific, can be used for the evaluation of different frequency hearing loss. But the application of ALR to study the function of objective evaluation at home and abroad is rarely reported, especially in the application of forensic medicine is still blank.
This study of 45 ears of 78 subjects pure tone thresholds, short and short subjective threshold ALR threshold test, and study the relationship between the factors of short ALR thresholds and pure tone thresholds and their influence to forensic analysis and evaluation of ALR applications.
Test object and method
First, the test object
Participants: Participants' subjective examination combined with 45 (78 ears), were divided into normal group, deafness group and cerebral contusion group. 20 normal subjects (40 ears) were college students, male and female each 10, the average age of 25.9 years, the frequency of (500Hz, 1000Hz, 2000Hz 4000Hz) and pure tone air conduction threshold < 25dB. deafness group 17 (22 ears), 10 males and 7 females, including 5 double deafness (10 ears), 12 single deafness, 6 conductive deafness, sensorineural deafness decision: 11. Complained of deafness, and by pure tone audiometry and ABR deafness confirmed. Range: 35dB ~ 90dB (ABR estimate). Cerebral contusion Group 8, male 6, female 2, age 19~55 years, diagnosis of various frequency pure tone air conduction hearing thresholds were less than 25dB. in brain contusion were from CT and / or MRI confirmed.
Test method: check in indoor noise, followed by test subjects 500Hz, 1000Hz, 2000Hz and 4000Hz of the pure tone thresholds, short and short subjective threshold ALR threshold. When the test of pure tone thresholds, using FONMXFA - 12 type audiometer, frequency range: 125Hz ~ 8000Hz, the minimum output: -10dB, maximum output: 110dB. when the test is short and short sound subjective threshold ALR threshold, using the United States Nicolet Compact Four company production of multifunctional electric physiological recorder for recording system by TDH - type 39P headset to sound, as the silver electrode electrode and recording electrode placed on the parietal central point (Cz), reference electrode placement in the ipsilateral medial lobe (A_1, A_2), the ground electrode placed at the midpoint of the frontal pole (Fp_z), each electrode impedance < 5K, resistance difference between 3K. ALR wave tracings of the reaction, the normal group started by 80dB, the deaf group started by 110dB, then every 10 DB decreased for the first gear. When it approached the reaction threshold, it fell down according to the first gear of 5dB, until the reaction waveform disappeared, repeated 2 times. Every ALR frequency was measured for 5~10 minutes. Finally, it was recorded by X Y recorder.
Result
1, the typical ALR generally includes 5 wave, P1, N1, P2, N2 and P3. in N1, P2 wave amplitude is maximum, the occurrence rate of 100%, will be induced by ALR N1, P2 wave minimum sound intensity to determine the short ALR threshold.
In 2, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequencies, normal group mean and standard short ALR thresholds and pure tone thresholds of the difference between the difference was 7.33 + 3.12dB, 8.11 + 2.62dB, 7.22 + 2.50dB, 9.19 + 2.85dB; s subjective threshold and pure tone thresholds of the difference between the mean value and the standard deviation was 3.48 + 2.17dB, 4.33 + 2.36dB, 4.07 + 1.78dB, 3.96 + 2.21dB; the mean and standard short ALR thresholds and short subjective hearing threshold difference difference were 3.85 + 2.27dB, 3.78 + 1.83dB, 3.15 + 2.14dB, 5.22 + 2.04dB.
In 3, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequencies, regression equation of short ALR thresholds and pure tone thresholds were Y=0.87x-4.18, Y=0.91x-6.49, Y=0.6x-1.21, Y=0.99x-9.03. by t test, P < 0.01.
In 4, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequency, mean and standard deafness group short ALR thresholds and pure tone thresholds of the difference between the difference was 7 + 3.08dB, 8.14 + 2.57dB, 7.37 + 2.79dB, 9.45 + 3.02dB; the mean and standard short subjective threshold and pure tone thresholds of the difference between the difference were 3.56 + 2.58dB, 4.24 + 2.46dB, 4.18 + 2.01dB, 4.03 + 2.33dB; the mean and standard short ALR thresholds and short subjective hearing threshold difference difference were 4.01 + 2.34dB, 3.88 + 1.97dB, 3.05 + 2.17dB, 5.27 + 2.39dB. difference of deafness group and the normal group ALR thresholds and pure tone thresholds the T test, there was no significant difference between the two (P > 0.05).
In 5, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequency, mean and standard of group short ALR thresholds and pure tone thresholds of the difference between the difference of cerebral contusion were 7.21 + 3.21dB, 8.21 + 2.31dB, 7.02 + 2.91dB, 9.53 + 3.27dB; s subjective threshold and pure tone thresholds of the mean and standard deviation the difference was 3.38 + 2.76dB, 4.11 + 2.27dB, 4.02 + 2.14dB, 4.01 + 2.43dB; the mean and standard short ALR thresholds and short subjective hearing threshold difference difference were 3.92 + 2.12dB, 3.96 + 2.07dB, 3.11 + 2.18dB, 5.47 + 2.22dB. difference on cerebral contusion group and the normal group ALR reaction threshold and pure subjective threshold for t testing, there was no significant difference between the two (P > 0.05). The cerebral contusion group and normal group ALRN1, the latency and amplitude of P2 were analyzed by t test, there were no significant differences between N1 and P2 (P > 0.05).
6, with the increase of the intensity of the stimulus, the latency of the P2 wave was shortened and the amplitude of the wave increased at different frequencies of ALRN1.
In 7, 500Hz, 1000Hz, 2000Hz and 4000Hz four frequency, 86.25% ALR difference thresholds and pure tone thresholds of less than 10dB.. Therefore, application of ALR threshold prediction of pure tone thresholds, a conservative estimate is subtracted from the ALR threshold (0 ~ 10dB), the pure subjective threshold pre valuation range.
conclusion
1, the typical ALR generally includes 5 waves, P1, N1, P2, N2 and P3 waves. N1, P2 wave amplitude is the largest, the rate of occurrence is 100%.N1, the threshold, latency and amplitude of P2 wave are the main indicators of ALR.
2, with the increase of the intensity of the stimulus, the latency of the P2 wave was shortened and the amplitude of the wave increased at different frequencies of ALRN1.
3, the experimental results show that, under the same sound intensity, the latency of 1000Hz and 2000Hz is shorter and the amplitude of wave is higher.
4, ALR has the frequency specificity, close to the subjective threshold, can reflect the functional status. The auditory pathway for different deafness and cerebral contusion (without hearing impairment) subjects can be assessed.
5, since ALR is a cortical electrical response, in order to get a better ALR waveform, the subjects must remain awake in the test.

【学位授予单位】：中国医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：D919.4

【参考文献】