早产儿视网膜病变筛查和阈值期治疗的研究

Screening analysis of retinopathy of prematurity and treatment of threshold retinopathy of prematurity

目的研究早产儿视网膜病变（ROP）的发生率,评估ROP阈值期治疗效果.方法使用双目间接检眼镜对108例早产儿进行ROP筛查,将筛查结果进行统计学分析,达到阈值病变的患儿及时进行视网膜激光光凝或经巩膜、视网膜冷凝术.结果筛查108例早产儿,发现ROP 23例,发生率为21.3%.在所有ROP患儿中,ROP 1期13例,占56.5%;ROP 2期3例,占13.0%;ROP 3期7例,占30.4%.其中ROP 3期患儿均伴有附加病变,达到阈值病变标准.ROP患儿出生体重为（1.43±0.25）kg（t=4.059,P＜0.001）;孕周为（31.0±2.3）周（t=2.637,P=0.013）;吸氧时间为1～49 d,平均17 d（n=23,Z=-3.630,P＜0.001）;需要机械辅助呼吸患儿18例（x^2=12.009,P=0.001）;上述指标与非ROP患儿比较,差异均有统计学意义;而与是否多胎的差异无统计学意义（x^2=1.013,P=0.314）.Logistic回归分析：出生体重低（β=-2.542,OR=0.079,P=0.032）和使用机械辅助呼吸（β=1.341,OR=3.823,P=0.025）的患儿是发生ROP的相关高危因素.7例阈值期病变患儿中,6例进行激光光凝或冷凝治疗.术后随访2个月至2年,手术眼的结构和视功能未见异常.1例阈值期病变患儿未予治疗,于1个月后出现视网膜脱离.结论出生体重轻、孕周少、吸氧时间长、需要机械辅助呼吸的早产儿发生ROP的风险较高.对阈值期病变患儿应及时进行激光光凝或冷凝治疗.

Objective To investigate the incidence and the risk factors associated with the development of retinopathy of prematurity （ROP） by ROP screening in the premature infants and to evaluate the treatment effect of threshold ROP. Methods From March 2000 to December 2004, 108 premature infants with birth weight less than 2. 0 kg or gestational age less than 37 weeks admitted to the Neonatal Intensive Care Unit at Guangdong Provincial People＇ s Hospital were enrolled in the present study. They were examined with binocular indirect ophthalmoscope. The perinatal variables of the premature infants were analyzed to evaluate their correlation with the development of ROP. The infants with threshold ROP were treated with retinal photocoagulation or cryotherapy. Results The overall incidence of ROP was 21.3% （23 of 108）. Among 23 premature infants with ROP, 56.5% （13 of 23） were in stage 1, 13.0% （3 of 23） in stage2 and 30.4% （7 of 23） in stage 3. All infants with ROP stage 3 fulfilled the criteria of threshold ROP. As compared with non-ROP group, ROP infants had lower birth weight [ （ 1.43 ± 0.25 ） kg; t = 4.059, P 〈 0.001 ], shorter gestation age [ （ 31.0 ± 2.3 ） W; t = 2.637, P = 0.013 ], longer median time of oxygen supplementation （ 17 d; Z = - 3. 630 ,P 〈0. 001 ） and more demand of mechanical ventilation （X^2 = 12. 009, P = 0. 001 ）. Cases with multiple gestational births in ROP group were not significantly different from that in non-ROP group （ X^2 = 1. 013, P = 0. 314）. Multivariate logistic regression analysis showed that low birth weight （X^2 = - 2. 542, OR = 0. 079, P = 0. 032） and mechanical ventilation （ β = 1. 341 ,OR = 3. 823 ,P = 0. 025 ） were significantly associated with the development of ROP. In a total of seven cases with threshold ROP, six cases were treated with retinal laser photocoagulation or transscleral cryotherapy timely. After followed up for two months to two years, all treated eyes had normal pupil response to the light. The optic disk, macula and posterior retina appeared normal. No abnormal retinal vessels and proliferative vitreoretinopathy were found. One premature infant with threshold ROP, not treated by laser photocoagulation or transseleral eryotherapy, developed retinal detachment in both eyes. Conclusions Premature infants with low birth weigh, shorter gestational age, longer history of oxygen supplemental and the using of mechanical ventilation have more chance of developing ROP. The analysis of risk factors will be helpful in understanding and prediction of development of ROP. ROP screening and timely treatment for threshold ROP are very important for preventing the development of advanced ROP in premature infants. （Chin J Ophthalmol , 2006,42 ： 496-500）