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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2012, Vol. 08 ›› Issue (02) : 187 -190. doi: 10.3877/cma.j.issn.1673-5250.2012.02.019

所属专题： 文献；

论著

早产儿视网膜病筛查及相关因素的临床分析
张应金1,*,*(), 黄建伟1, 黄润忠1, 梁凤潇1, 苏永棉1, 张金凤1, 廖南萍1   
  1. 1. 528300　广东顺德，暨南大学附属顺德妇幼保健院新生儿科
  • 收稿日期:2011-10-15 修回日期:2012-02-10 出版日期:2012-04-01
  • 通信作者: 张应金

Clinical Evaluation on the Screening of Retinopathy of Prematurity and Its Relevant Risk Factors

Ying-jin ZHANG1(), Jian-wei HUANG1, Run-zhong HUANG1, Feng-xiao LIANG1, Yong-mian SU1, Jin-feng ZHANG1, Nan-ping LIAO1   

  1. 1. Department of Neonatal, Maternal and Child Health Hospital of Shunde, Jinan University, Shunde 528300, Guangdong Province, China
  • Received:2011-10-15 Revised:2012-02-10 Published:2012-04-01
  • Corresponding author: Ying-jin ZHANG
  • About author:
    Corresponding author: ZHANG Ying-jin, Email:
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张应金, 黄建伟, 黄润忠, 梁凤潇, 苏永棉, 张金凤, 廖南萍. 早产儿视网膜病筛查及相关因素的临床分析[J]. 中华妇幼临床医学杂志(电子版), 2012, 08(02): 187-190.

Ying-jin ZHANG, Jian-wei HUANG, Run-zhong HUANG, Feng-xiao LIANG, Yong-mian SU, Jin-feng ZHANG, Nan-ping LIAO. Clinical Evaluation on the Screening of Retinopathy of Prematurity and Its Relevant Risk Factors[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2012, 08(02): 187-190.

目的

了解早产儿视网膜病变(ROP)的发生状况，并探讨ROP的相关危险因素。

方法

选择2009年1月至2010年12月在本院新生儿科住院的250例早产儿为研究对象，胎龄≤36孕周，出生体重≤2500 g。于生后第14天对其进行ROP筛查，记录早产儿一般临床资料。早产儿完成ROP筛查后，对其随访至周边视网膜新生血管形成或病变退化(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，得到该委员会批准，并与受试对象监护人签订临床研究知情同意书)。采用非条件logistic多元回归分析法进行ROP相关危险因素[胎龄、胎次、出生体重、性别、吸氧持续时间及浓度、机械通气治疗、是否合并新生儿窒息、呼吸暂停、呼吸窘迫综合征(RDS)并发症及是否输血等]分析。

结果

250例早产儿全部完成ROP筛查，共计检出ROP 16例(26只眼)，ROP发生率分别为6.4%(16/250，ROP患儿发病率)和5.2%(26/500，ROP眼发病率)，其中ROP 1期为12例(75.0%)，2期为3例(18.8%)，3期为1例(6.3%)。非条件logistic ROP相关危险因素分析结果显示，ROP与早产儿胎龄、吸氧持续时间及浓度、接受机械通气治疗密切相关(OR＝0.668，95%CI：－0.721～－0.088，P＝0.012；OR＝7.768，95%CI：0.608～3.492，P＝0.005; OR＝5.241，95%CI：0.191～3.121，P＝0.027；OR＝1.235，95%CI：1.109～2.872，P＝0.001)；其余因素与ROP无相关关系(P>0.05)。

结论

早产、吸氧持续时间长及浓度高、接受机械通气治疗是发生ROP的主要危险因素。对早产儿适时进行ROP筛查，可为临床防治ROP提供理论依据。

关键词: 早产儿, 早产儿视网膜病, 筛查, 危险因素, 新生儿
Objective

To investigate the screening of retinopathy of prematurity (ROP) and its related risk factors.

Methods

From January 2009 to December 2010, a total of 250 preterm newborns were recruited into this study. The gestational ages were less than 36 gestational weeks, birth weights were under 2500 g. All the cases underwent ROP screening at one week after birth, and then received regular follow-up until peripheral retinal neovascularization or lesion degradation. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Maternal and Child Health Hospital of Shunde, Jinan University. Informed consent was obtained from the parents of each participating neonate. The relationship among ROP and systemic conditions and oxygen inhalation of newborns, oxygen inhalation volume of mother during pregnancy, preeclampsia, placental abruption and other factors were analyzed, respectively.

Results

All the 250 newborns completed the retinal screening. A total of 16 newborns (26 eyes) were found ROP, and the prevalence rate of ROP were 6.4% (16/250) and 5.2%(26/500), respectively, in which 12 cases (75.0%) of grade 1, 3(18.8%) of grade 2 and 1(6.3%)of grade 3. Univariate analysis of risk factors of ROP showed gestational age, birth weight, oxygen inhalation time, oxygen inhalation concentration, mechanical ventilation were associated with ROP (P<0.05). Oxygen inhalation during pregnancy, preeclampsia, placental abruption had no correlation with ROP(P>0.05).

Conclusions

Premature birth, high concentrations of oxygen inhalation, mechanical ventilation are major risk factors of ROP. Preterm newborns should have regular screening and follow-up in order to find the lesion as soon as possible to decrease the incidence rate of blindness.

Key words: premature newborn, retinopathy of prematurity, neonatal screening, risk factor
表1 早产儿出生体重、胎龄与早产儿视网膜病变发生率的关系[n(%)]
Table 1 Relationship among birth weight, gestational age and incidence rates of ROP in preterm infants[n(%)]
影响因素 n ROP发生率
出生体重(g) ? ?
? ≤1500 83 12(14.5)
? 1500～2000 89 3 (3.4)
? ≥2000 78 1 (1.3)
胎龄(孕周) ? ?
? ≤30 26 8(30.8)
? 30～32 70 5 (7.1)
? ≥32 154 3 (1.9)
总计 250 16 (6.4)
表2 早产儿吸氧浓度及吸氧浓度相同时吸氧持续时间与ROP发生率的关系[n(%)]
Table 2 Relationship among oxygen concentration, duration of oxygen inhalation and incidence rates of ROP in preterm infants [n(%)]
影响因素 n ROP发生率
吸氧浓度(ml/L) ? ?
? ≤400 192 7 (3.6)
? >400 58 9(15.5)
吸氧持续时间(d) ? ?
? ≤3 107 3 (2.8)
? 4～6 60 5 (8.3)
? ≥7 57 8(14.0)
总计 250 16 (6.4)
表3 早产儿视网膜病的多因素logistic回归分析
Table 3 Multiple－factor logistic regression analysis of ROP
自变量 回归系数 标准差 Wald值 P OR 95%CI
Lower Upper
胎龄 －0.402 0.162 6.267 0.012 0.668 －0.721 －0.088
吸氧浓度 2.050 0.736 7.768 0.005 7.768 0.608 3.492
机械通气治疗 1.657 0.748 4.911 0.027 5.241 0.191 3.121
吸氧持续时间 1.570 0.913 5.671 0.001 2.329 1.044 3.531
出生体重 1.120 0.097 4.763 0.001 1.235 1.109 2.872
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