深圳地区早产儿视网膜病变10年发病情况分析

目的 观察深圳地区近10年早产儿视网膜病变（ROP）发病状况和变化趋势。方法 2004年1月至2013年6月对在深圳市人民医院、深圳市妇幼保健院等新生儿重症监护病房住院或早产儿出院后至深圳市眼科医院ROP专科门诊检查且符合筛查标准的9100名早产儿进行了ROP筛查。首次检查在出生后4～6周开始。接受筛查的早产儿中，男性5401名，女性3699名；出生体重520～2990 g，平均出生体重（1710±410） g。其中，＜1000 g者206名；1000～1499 g者2473名；1500～1999 g者4038名；≥2000 g者2383名。出生胎龄24～36周，平均出生胎龄（31.57±1.99）周。其中，＜28周者208名；28～32周者3608名；33～34周者3553名；＞34周者1731名。采用双目间接检眼镜配合巩膜压迫器和（或）广角数码视网膜成像系统进行眼底检查。按照国际ROP分类法的规定和ROP早期治疗研究标准记录检查结果。双眼病变不对称时，记录病变严重眼；所有接受治疗的病例统一定义为重症ROP。回顾分析近10年ROP总体发病率、重症率，以及第一、二阶段即2004年至2008年和2009年至2013年6月ROP发病率、重症率的变化情况。结果 9100名早产儿中，发生不同程度ROP 1137例，发病率12.49%；重症ROP 454例，占筛查人数的4.99%。出生体重＜1000、1000～1499、1500～1999、≥2000 g者，ROP发病率分别为62.62%、28.40%、11.34%、3.63%；重症率分别占筛查人数的34.95%、12.21%、3.73%、0.49%。出生胎龄＜28、28～32、33～34、＞34周者，ROP发病率分别为67.31%、25.27%、7.22%、3.87%；重症率分别占筛查人数的37.02%、10.71%、1.79%、0.68%。第二阶段ROP发病率、重症率与第一阶段比较，ROP发病率、重症率分别从14.64%、6.52%降至11.47%、4.26%，差异有统计学意义（χ²=26.96、26.61，P＜0.05）。出生体重＜1000 g的患儿，第二阶段ROP发病率、重症率明显低于第一阶段，差异有统计学意义（χ²=13.676、5.271，P＜0.05）。出生胎龄＜28周的患儿，第一阶段ROP发病率与第二阶段ROP发病率比较，差异无统计学意义（χ²=0.843，P＞0.05）；第二阶段重症率较第一阶段明显下降，差异有统计学意义（χ²=4.757，P＜0.05）。结论 2004年至2013年深圳地区ROP发病率和重症率逐年下降。

The incidence of retinopathy of prematurity in Shenzhen during the past ten years

Objective To retrospectively analyze incidence and trends of retinopathy of prematurity (ROP) from 2004 to 2013 in Shenzhen. Methods  A total of 9100 preterm children (5401 males, 3699 females) were screened for ROP in Shenzhen from January 2004 to June 2013 using binocular ophthalmoscope or RetCam Ⅱ. First examination was performed from 4-6 weeks after birth. The birth weight was 520 -2990 g with an average of (1710±410) g.The gestational age were 24-36 weeks with an average of (31.57±1.99) weeks. The gestational age of 208 children were ＜28 weeks, 3608 children were 28 -32 weeks, 3553 children was 33-34 weeks, 1731 children was ＞34 weeks. The ocular findings were recorded according to the International Classification of ROP and The Early Treatment for ROP. Only the more aggressive eye of bilateral asymmetrical cases was counted for statistical purpose, and the cases required surgeries were defined as severe cases. The 10 years period was divided into first phase (2004-2008) and second phase (2009-2013). The incidence of ROP and severe ROP of these two phases was compared and statistics was analyzed. Results In the past 10 years, the overall incidence of ROP and sever ROP in Shenzhen was 12.49% and 4.99% in this screen. The children were divided into 4 groups according to the birth weight, the ROP incidences of birth weight ＜1000 g, 1000 -1499 g, 1500 -1999 g and ≥2000 g were 62.62%, 28.40%, 11.34% and 3.63% respectively. The severe ROP incidences were 34.95%, 12.21%, 3.73% and 0.49% respectively in these birth weight groups. The children were divided into 4 groups according to gestational weeks, the ROP incidences of gestational age ＜28 weeks , 28 -32 weeks, 33-34 weeks and ＞34 weeks were 67.31%, 25.27%, 7.22% and 3.87% respectively. Severe ROP incidences were 37.02%, 10.71%, 1.79% and 0.68% in these gestational age groups respectively. ROP and severe ROP incidences were decreased from 14.64% at first phase to 11.47% at second phase, and from 6.52% at first phase to 4.26% second phase respectively, the differences were statistical significant (χ²=26.96, 26.61; P＜0.05 ). ROP and severe ROP incidence in ＜1000 g birth weight group at second phase were much less than the first phase (χ²=13.676, 5.271; P＜0.05). In ＜28 weeks gestational age group, the ROP incidence was the same in first phase and second phase (χ²=0.843, P＞0.05), but the severe ROP incidence at second phase was much less the first phase (χ²=4.757，P＜0.05). Conclusion From 2004 to 2013, the incidences of ROP and severe ROP have decreased significantly in Shenzhen.