浙江地区早产儿视网膜病筛查1225例分析

目的 了解早产儿ROP发病状况,探索早产儿ROP筛查的临床策略.方法 按照"早产儿治疗痒和视网膜病变防治指南"中的ROP筛查标准用间接眼底镜对浙江两家医院新生儿监护室(NICU)住院的早产儿进行ROP筛查.结果 2005年3月至2008年11月间共筛查1225例住院早产儿,发生ROP132例(10.8%),高风险阈前ROP12例(0.98%),阈值ROP4例(0.3%);其中未吸氧的早产儿65例,发生低风险阈前ROP1例(1.5%);两者差异有极显著性意义(x2=5.115,P＜0.01).有与无ROP组出生体重或胎龄的比较,差异均有极显著意义(分别F=26.39,19.73,P＜0.001);与出生体重或胎龄呈负相关(r=-0.145,-0.126,P＜0.000).不同出生体重或胎龄的早产儿发生ROP的比较,差异亦有极显著意义(x2=39.53,31.40,P＜0.001);体重≤1000 g的早产儿发生ROP是体重＞1000 g的3倍多,胎龄≤28周的早产儿发生ROP是＞28周的2.5倍.性别和多胎与ROP无明显相关性,差异无统计学意义(x2=0.279,3.449,P＞0.05).高风险阈前和阈值ROP与患儿反复呼吸暂停、多次窒息抢救及当地用氧抢救史相关(r=0.54,0.57,0.57,P＜0.05).阈值ROP患儿均有氧依赖、反复呼吸暂停及窒息.结论 ROP的发生与出生体重和胎龄负相关,体重≤1000 g或胎龄≤28周的有吸氧史的早产儿在筛查中要予以特别关注;通过筛查,ROP及时发现并在阈值期得到治疗,减少了盲童.

Analysis on the result of retinopathy of prematurity screening in 1225 premature infants

Objective To investigate the factors involved in the development of retinopathy of prematurity (ROP), and to provide the preliminary data for the evaluation of current criteria for ROP screening. Method Premature infants with birth body weight (BBW) ≤2000 g or gestational age (GA) ≤34 weeks in the two hospitals in Zhejiang between March 2005 and November 2008 were recruited and examined by indirect ophthalmoscopy. The records were analyzed. Result One thousand two hundred and twenty-five premature infants were included. Of them, 713 were male and 512 female. There were 179 twins and 21 triplets in the premature infants. The incidence of ROP was 10.8% ( 132 in 1225 patients). There were 12 cases (0.98%) to the point of prethreshold ROP. 4 cases (0.3%) developed threshold ROP.Only one case developed prethreshold ROP of low risk among 65 cases without history of oxygen treatment ( 1.5% ). The percentage has significant difference compared to that of cases with history of oxygen ( x2 =5.115, P < 0.01 ). Between ROP and Non-ROP groups, there was significant difference in BBW( F = 26.39,P < 0.001 ), gestational age ( F = 19.73, P < 0.001 ), but there was no significant difference in sex ( x2 =0.279, P > 0.05 ) or twins and triplets ( x2 = 3. 449, P > 0.05 ). The incidence of ROP among premature infants with BBW≤1000 g was more than three times of that with BBW > 1000 g, and the incidence of ROP among premature infants with GA ≤ 28 weeks was about 2.5 times of that with GA > 28 weeks. Logistic regression analysis indicated that less BBW or shorter GA or undulation of blood oxygen concentration was a significant risk factor involved in the development of ROP ( r = 0.57, P < 0.05 ). All ROP patients were cured. Conclusion Less BBW, shorter GA and undulation of blood oxygen concentration are the important risk factors for the development of ROP. Premature infants with BBW≤1000 g or GA≤28 weeks, who had oxygen history, should be given very special attention in the ROP screening. The current criteria for ROP screening should be narrowed. In general, the ROP screening has lowered the incidence of blindness among children by investigating and treating ROP timely.