严重早产儿视网膜病变危险因素分析

Analysis of risk factors of severe retinopathy of prematurity

目的分析严重早产儿视网膜病变(ROP)的危险因素,为合理制定ROP筛查标准提供参考依据。方法回顾性分析2002年12月至2004年4月期间我院眼科就诊的168例孕龄<37周的早产儿临床资料。记录其性别、胎数(BC)、孕龄(GA)、出生体重(BW)、氧疗时间以及双眼充分散瞳后双目间接检眼镜检查所见的视网膜血管发育情况。按ROP国际分类法(ICROP)记录检查结果,1、2、3期为轻度ROP,阈值病变、4期和5期为严重ROP。应用多元Logistic回归分析分析ROP与性别、BC、GA、BW、氧疗时间等因素之间的关系。结果168例早产儿336只眼中,严重ROP47例91只眼,分别占患儿例数和眼数的28.0%、27.1%。其中,阈值病变20只眼,占6.0%;4期病变11只眼,占3.3%。4期病变中,4A期2只眼,占0.6%;4B期9只眼,占2.7%。5期60只眼,占17.8%。各因素中,GA、BW和氧疗时间对严重ROP的发生有影响(P值分别为0.000、0.000和0.015,α=0.05),性别和BC与ROP无关(P值分别为0.640和0.084,α=0.05)。亚变量统计分析显示,当GA≤30周或BW≤1500g或氧疗时间>4d时早产儿患严重ROP的危险性显著增加。结论严重ROP的发生受GA、BW和氧疗时间的影响,而与性别和BC无关。GA≤30周或BW≤1500g或氧疗时间>4d的早产儿患严重ROP的危险性显著增加,建议重点对此类早产儿进行筛查。

Objective To analyze the risk factors of severe retinopathy of prematurity （ROP） and provide consultable evidence for the rational establishment of screening standard. Methods The clinical data of 168 premature infants （gestational age less than 37 weeks） who was diagnosed in our department from Dec 2002 to Apr 2004 was analyzed retrospectively. Gender, birth count （BC）, gestational age （GA）, birth weight （BW）, duration of oxygen therapy and vascularization development of posterior and peripheral retina examined by binocular indirect ophthalmoscope after mydriasis were recorded. The results were recorded by the international classification of ROP （ICROP）, and stage 1, 2 and 3 were mild ROP while threshold disease, stage 4 and 5 were severe ROP, Logistic regression was applied to analyze the relationship of ROP and gender, BC, GA, BW, and oxygen therapy. Results Severe ROP was found in 91 eyes （27.1% ） of 47 infants （28. 0% ） in a36 eyes of 168 premature infants, including threshold disease in 20 eyes （6.0%） and disease at stage 4 in 11 eyes （3.3%） in which the diseases at stage 4A was found in 2 eyes （0.6%） and stage 4Bin 9eyes （2.7%）. There were 60 eyes （17.8%） at stage 5. In all of the factors, GA, BW and oxygen therapy were found to have a significant impact on severe ROP （P= 0.000, 0.000 and 0.015,a=0. 05） while gender and BC were not （P=0. 640 and 0.084, a=0.05）. Statistic analysis of subgroup showed that the risk of severe ROP in premature infants would increase significantly when GA≤30 weeks, BW≤1500 g or oxygen therapy〉4 days. Conclusions Severe ROP relates to GA, BW and oxygen therapy instead of gender and BC. The risk of occurrence of severe ROP in premature infants increases significantly when GA≤30 weeks, BW≤1500 g or oxygen therapy〉4 days, so it is recommended to screen such premature infants carefully.