中国大陆早产儿视网膜病变临床特点和眼底病变的多中心调查

目的通过多中心筛查反映中国大陆早产儿视网膜病变(ROP)的发生率及相关流行病学特征。方法 2010年6月1日至2012年6月1日ROP调查协作组在中国大陆7个行政区域首先邀请有能力行ROP筛查的医院,从新生儿生后第4周或纠正胎龄32周行初次眼底检查,使用统一型号的间接眼底镜和电子眼底镜,依据ROP分期决定随访方案,经复旦大学附属眼耳鼻喉科医院培训、考核认证的ROP筛查医生,参照ROP国际分类法诊断和分期。结果中国7个行政区共22家医院6 091例出生体重2 000 g或胎龄34周的早产儿或因重大疾病进行了氧疗(≥5 d)的新生儿中,ROP924例,发生率为15.2%。轻度ROP(1和2期)92.3%(853/924),重度ROP(3期及以上)7.7%(71/924),急进型ROP患儿7例。行激光或手术治疗69例,均为ROP 3期以上病例。924例ROP患儿胎龄28~36+5(30.2±2.2)周,出生体重624~3 400(1 364±344)g。呈现出生体重越低和出生胎龄越小ROP发生率逐渐增高趋势,出生体重越低和出生胎龄越小轻度ROP的发生率未见逐渐增高的趋势。ROP 4~5期仅出现在出生胎龄30周和出生体重1 250 g的新生儿。妇幼保健院较儿童专科医院和综合性医院儿科ROP发生率低,但重度ROP发生率高。结论中国大陆ROP发生率为15.2%,出生胎龄30周ROP发生率为46.9%,出生体重1 500 g ROP发生率为30.6%。

Multicenter survey on the clinical features and fundus lesions of retinopathy in premature infants in mainland China

Objective To reflect the incidence and epidemiological characteristics of retinopathy of premature (ROP) infants in China by multi-center screening. Methods Hospitals having the qualification to perform ROP screening in China were invited to participate in the multicenter survey on clinical features and fundus lesions of retinopathy of premature infants since June 1st 2010 to June 1st 2012. Neonates aged over 4 weeks or with corrected gestational age over 32 weeks were initially taken ROP screening by fundus examination using indirect ophthalmoscopy or fundus mirror. The follow-up schedule was decided according to the International Classification of ROP (ICROP). Results A total of 6 091 patients from 22 hospitals in 7 administrative regions in China were enrolled, including neonates with birth weight below 2 000 g or gestational age younger than 34 weeks or taking oxigen therapy for more than 5 days. The incidence of ROP was 15.2% (924/6 091). 92.3%(853/924) neonates with ROP were classified as stage 1 or 2, and 7.7% (71/924) neonates were diagnosed as severe ROP (stage 3 or above). Sixty-nine patients, all classified as stage 3 or above, received the laser therapy.The average birth age of ROP group was (30.2±2.2) (28-36+5) weeks. The average birth weight of ROP group was (1 364±344), ranged from 624 g to 3 400 g. The less the birth weight and birth gestational age the higher the incidence rate of severe ROP, however, the incidence of mild ROP did not follow this trend. Stages 4 and 5 of ROP appeared only in those infants whose birth weight less than 1 250 g or birth gestational age younger than 30 weeks .The overall incidence was lower in the maternal and children's care centers than in the children's hospitals and general hospitals. Conclusion The overall incidence of ROP in the whole country was 15.2%, and the incidence was higher in premature infants with gestational age less than 30 weeks and birth weight less than 1 500 g (46.9% and 30.6%, respectively).