早产儿视网膜病变患儿血清谷氨酸水平变化的意义及其对预后的影响

目的探讨早产儿视网膜病变(ROP)患儿血清谷氨酸水平与病情严重程度之间的关系及其对预后的影响。方法选取2017年6月至2018年6月在河南省立眼科医院筛查并诊治的92例ROP患儿及同期河南省立眼科医院筛查的50例健康早产儿(对照组)进行临床对照研究,92例ROP患儿根据病变分期分为轻度ROP组和重度ROP组,依据病情进展与否分为自然消退组和病情进展组,通过测定各组儿童出生1周和出生6周血清谷氨酸水平,分析其与ROP病情严重程度的关系及其对预后评估的意义。结果重度ROP组患儿出生1周血清谷氨酸水平[(122.08±14.55)mmol/L]和出生6周血清谷氨酸水平[(107.13±13.20)mmol/L]最高,轻度ROP组患儿次之[分别为(98.60±14.48)mmol/L、(85.41±14.49)mmol/L],对照组患儿最低[分别为(68.52±7.69)mmol/L、(54.97±6.31)mmol/L],3组比较差异有统计学意义(均P<0.05);Pearson相关性分析提示出生1周和出生6周血清谷氨酸水平均与ROP病情严重程度均呈正相关(r=0.869、0.875,均P<0.05)。病情进展组患儿出生1周及出生6周血清谷氨酸水平[(107.18±17.62)mmol/L、(92.94±16.21)mmol/L]均显著高于自然消退组患儿[(131.53±10.22)mmol/L、(118.82±8.18)mmol/L],2组间比较差异均有统计学意义(均P<0.05)。出生1周和出生6周血清谷氨酸水平预测ROP病情进展患儿受试者工作特征曲线(ROC)下面积分别为0.855、0.936,根据ROC曲线结果,分别确定出生1周和出生6周血清谷氨酸水平最佳临界值分别为117.83 mmol/L(敏感性为0.909,特异性为0.728)、106.69 ng/L(敏感性为1.000,特异性为0.790)。结论出生1周和出生6周血清谷氨酸水平与ROP患儿病情严重程度呈正相关,同时出生1周和出生6周血清谷氨酸水平最佳临界值预测患儿疾病进展的敏感性和特异性均较高,对患儿预后评估具有较高的价值。

Significance of serum glutamate acid levels in children with retinopathy of prematurity and its effect on prognosis

Objective To investigate the relationship between serum glutamate levels and severity of retinopathy of prematurity(ROP)in children and its impact on the prognosis.Methods A total of 92 children with ROP who were screened and treated at Henan Provincial Eye Hospital from June 2017 to June 2018 and 50 healthy preterm infants screened at Henan Provincial Eye Hospital were selected for clinical control study.Ninety-two children with ROP were divided into the mild ROP group and the severe ROP group according to the stage of lesions,and they were divided into the progressive group and the spontaneous regression group according to whether the disease was progressive.The severity of ROP and prognosis were analyzed by measuring serum glutamate levels in 1 week and 6 weeks after birth.Results The serum glutamate concentration in the severe ROP group was the highest in the first week after birth[(122.08±14.55)mmol/L]and in the 6th week after birth[(107.13±13.20)mmol/L],followed by the mild ROP group[(98.60±14.48)mmol/L,(85.41±14.49)mmol/L]separately,and the lowest in the control group[(68.52±7.69)mmol/L,(54.97±6.31)mmol/L]separately,and there were significant differences among the 3 groups(all P<0.05).Pearson correlation analysis showed that serum glutamate concentration was positively correlated with the severity of ROP at 1 week and 6 weeks after birth(r=0.869,0.875,all P<0.05).The levels of serum glutamate at the first week after birth and at the 6th week after birth in the progressive group[(107.18±17.62)mmol/L,(92.94±16.21)mmol/L]were significantly higher than those in the spontaneous regression group[(131.53±10.22)mmol/L,(118.82±8.18)mmol/L],and there were significant differences between the 2 groups(all P<0.05).The area under the curve(AUC)values of serum glutamate concentration at 1 week after birth and 6 weeks after birth were 0.855 and 0.936,respectively,according to the receiver operating characteristic(ROC)curve,while the optimal critical values of serum glutamate concentration at 1 week and 6 weeks after birth were 117.83 mmol/L(sensitivity was 0.909,specificity was 0.728)and 106.69 ng/L(sensitivity was 1.000,specificity was 0.790),respectively.Conclusions The serum glutamate concentration was positively correlated with the severity of ROP infants in 1 week and 6 weeks after birth.The optimal threshold of serum glutamate concentration in 1 week and 6 weeks after birth was more sensitive and specific in predicting the progression of retinopathy,and had higher value in evaluating the prognosis of the infants.