山东大学耳鼻喉眼学报 ›› 2019, Vol. 33 ›› Issue (3): 31-35.doi: 10.6040/j.issn.1673-3770.1.2018.044

• 研究进展 • 上一篇    下一篇

胆红素所致听觉系统神经损害的新机制

张玲,叶海波,时海波()   

  1. 上海交通大学附属第六人民医院耳鼻咽喉头颈外科，上海交通大学耳鼻咽喉科研究所，上海东方耳鼻咽喉科研究所，上海 200233
  • 收稿日期:2018-12-03 修回日期:2019-05-09 出版日期:2019-05-20 发布日期:2019-08-07
  • 通讯作者: 时海波 E-mail:haibo99@hotmail.com
  • 作者简介:时海波，医学博士，主任医师，教授，博士生导师。现任上海交通大学附属第六人民医院耳鼻咽喉头颈外科常务副主任，教研室主任。主要学术任职：中华医学会耳鼻咽喉头颈外科学分会青年委员会副主任委员，上海市医学会耳鼻咽喉头颈外科专科分会委员兼耳科学组副组长，中国中西医结合学会耳鼻咽喉科专业委员会眩晕专家委员会副主任委员，上海市声学学会生理学组主任委员。1995年毕业于南京医科大学临床医学系眼耳鼻喉专业，在第一附属医院（江苏省人民医院）耳鼻咽喉科工作，2003年获南京医科大学耳鼻咽喉科学硕士学位。2006年获日本九州大学医学博士学位。长期从事耳鼻咽喉科学的医、教、研工作，曾赴美国HEI进修耳科专业。致力于耳科疾病诊治，尤其是耳显微外科手术以及耳聋、耳鸣、耳源性眩晕等临床诊治及研究。先后主持国家自然科学基金面上项目4项、上海市科学技术委员会基础研究重点项目2项、教育部留学回国人员科研启动基金项目1项、校局级课题3项，作为学术骨干参与973课题2项。发表SCI收录论文50余篇，其中第一作者或通信作者35篇，主审及参编著作5部。2013年入选上海市卫生和计划生育委员会“新百人计划”，2015年入选上海市教育委员会高峰高原学科建设计划，2017年入选上海领军人才。荣获上海市科技进步奖一等奖、上海医学科技进步奖二等奖各1项。
  • 基金资助:
    国家自然科学基金面上项目(81870722);上海领军人才(2017062);上海交通大学“科技创新专项资金”多学科交叉项目 培养（医工）重点项目(YG2016ZD02)

A new mechanism of bilirubin-induced auditory nervous system injury

Ling ZHANG,Haibo YE,Haibo SHI()   

  1. Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People's Hospital
  • Received:2018-12-03 Revised:2019-05-09 Online:2019-05-20 Published:2019-08-07
  • Contact: Haibo SHI E-mail:haibo99@hotmail.com

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摘要：

严重高胆红素血症（黄疸）可导致特定神经系统的功能损害，具有神经核团选择性、新生儿期易感性等临床特征。听觉神经系统对胆红素毒性高度敏感，临床表现为最早出现的、或者是惟一显症的急性功能损害，或者是隐匿的、成年期显症的听神经病谱系障碍。临床及基础领域的零散研究表明，兴奋毒性是胆红素诱发神经功能障碍的主要途径，但听觉障碍特征及损害机制均未明确。听觉环路电信号的产生及传导，有赖于神经元动作电位的节律形成，以及电信号在神经纤维的同步化传导。适度兴奋性是维系正常听觉的基础，但“癫痫样”过度兴奋将导致细胞能量代谢紊乱，细胞内Ca2+增多，最终导致细胞凋亡或坏死。探索胆红素所致听觉神经毒性机制的研究，不仅有助于揭示听觉环路病理生理特征，也有助于揭示胆红素脑病的发生机制及拮抗措施。

关键词: 胆红素, 听觉系统, 神经元, 兴奋毒性

Abstract:

Severe hyperbilirubinemia (jaundice) may lead to functional damage of a specific nervous system, presenting clinical characteristics such as nucleus selectivity and neonatal susceptibility. The auditory nervous system is extremely sensitive to bilirubin toxicity. The clinical manifestations comprise of acute functional impairment, which might be the first or only manifestation, or hidden and adult onset auditory neuropathy spectrum disorder. Scattered clinical and basic studies have shown that excitotoxicity is the main pathway of bilirubin-induced neurological dysfunction. However, the characteristics and mechanism of hearing impairment are still unknown. The generation and transmission of electrical signals in an auditory circuit depend on both the rhythmic firing of action potential of neurons and the synchronous transmission among nerve fibers. Moderate excitability is the basis of maintaining normal hearing, but “epilepsy-like” overexcitation may lead to an impairment of cell energy metabolism, increase in intracellular Ca2+, and eventual cell apoptosis or necrosis. Exploring the mechanism of bilirubin-induced auditory neurotoxicity is not only helpful in revealing the pathophysiological characteristics of auditory circuits, but also in shedding light on the pathogenesis and antagonistic measures of bilirubin encephalopathy.

Key words: Bilirubin, Auditory system, Neuron, Excitotoxicity

中图分类号: 

  • R764
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