早产儿视网膜病变的筛查与高危因素

目的探讨早产儿视网膜病变(ROP)的发生及其危险因素。方法对2003年5月1日~2004年11月30日北京协和医院172例胎龄小于37周,或胎龄大于37周、但出生体重低于2500g的早产儿定期检查眼底。根据ROP国际分期标准进行诊断、分期。同期住院的20例正常足月新生儿作为对照组。结果172例早产儿中,放弃治疗或死亡12例,检查并随访完全160例。早产儿ROP的患病率为19·4%,对照组新生儿未发生ROP。出生体重≤2000g组的ROP患病率(28·4%)显著高于出生体重>2000g组(8·3%)(χ2=10·217,P=0·001)。孕周≤32周组的ROP患病率(42·5%)显著高于孕周>32周组(11·7%)(χ2=18·258,P=0·000)。胎龄(OR=0·959,P=0·036)和出生体重(OR=0·999,P=0·026)与ROP的发生相关性最高;输血(OR=0·076,P=0·029)和Apgar评分(OR=23·62,P=0·012)与ROP的发生具有负相关性。未发现吸氧方式、表面活性物质、多巴胺和出生前地塞米松的使用、输血和母亲病情与ROP的发生具有相关性。结论早产儿ROP的患病率高于正常足月新生儿。孕周越短、出生体重越低,ROP患病率越高。应定期检查早产儿眼底,早期发现ROP。

Prevalence and risk factors of retinopathy of prematurity

OBJECTIVE: To investigate the prevalence and the risk factors of retinopathy of prematurity (ROP). METHODS: Totally 172 premature infants who were less than 37 weeks postconceptional age, or more than 37 weeks but weighing < 2 500 g at birth, and born at PUMC hospital from May 1, 2003 to November 30, 2004, were enrolled in this study. Their fundus were routinely checked. Diagnosis and staging of ROP were performed according to the international guidelines. Another 20 mature infants were selected as the control group. RESULTS: Twelve infants quitted the treatment or died. The remaining 160 infants completed the follow up. The prevalence of ROP in the premature group was 19.4%, while no ROP was found in the control group. The prevalence of ROP in subgroup with body weight < or = 2 000 g (28.4%) was significantly higher than in subgroup with body weight > 2 000 g (8.3%, chi2 = 10.217, P = 0.001) at birth. The prevalence of ROP in subgroup with postconceptional age < or = 32 weeks (42.5%) was significantly higher than in subgroup with postconceptional age > 32 weeks (11.7%, chi2 = 18.258, P = 0.000). The postconceptional age (OR = 0.959, P = 0.036) and body weight (OR = 0.999, P = 0.026) were the most important risk factors of ROP. Furthermore, blood transfusion ( OR = 0.076, P = 0.029) and Apgar score ( OR = 23.62, P = 0.012) were inversely correlated with ROP. Correlation was not found between ROP prevalence and oxygen inhalation mode, surface active substance, administration of dopamine and dexamethasone, and mother conditions. CONCLUSIONS: The prevalence of ROP is higher in premature infants than in mature infants. Shorter postconceptional age and lower body weight may result in higher ROP incidence. Routine screening of fundus in premature infants may be helpful for the early detection of ROP.