早产儿视网膜病年度筛查报告

Annual report of retinopathy of prematurity screening

目的调查温州医学院附属育英儿童医院早产儿视网膜病变(ROP)的发生率及其发病高危因素,初步对2004年我国卫生部制定的ROP筛查标准进行评价。方法对2007年1月1日-12月31日入住该院新生儿科并符合筛查标准的254例早产儿进行ROP筛查,即出生体重<2000g的早产儿,在婴儿出生后4～6周或矫正胎龄32周开始进行检查,随诊至周边视网膜血管化。再分别按英国推荐的ROP筛查标准(体重≤1500g或孕周≤31周)和美国推荐的ROP筛查标准(体重≤1500g或孕周≤28周)对筛查结果进行比较。结果在接受筛查的254例早产儿中,发生ROP24例,发生率为9.4%。其中Ⅰ期病变18例,Ⅱ期病变4例,Ⅲ期病变2例,2例需激光治疗,无失明病例。若按美国推荐的ROP筛选标准统计,将遗漏21例,其中包括2例需要激光光凝治疗;若按英国推荐的标准筛选,将遗漏8例,其中1例同样需要激光光凝治疗。本研究将出生体重在1500～2000g的早产儿再细分为4组进行比较,发现发生ROP的患儿基本集中在出生体重1501～1600g组,与其余3组间两两比较差异均有统计学意义(P均<0.01),而在这组筛查患儿中出生体重在1601～2000g的患儿数远远多于1501～1600g患儿例数(165/30)。ROP相关因素的Logistic回归分析结果表明,孕周、出生体重、吸氧时间、机械通气、呼吸窘迫综合征、输血是发生ROP的高危因素。结论出生体重≤1600g的早产儿为ROP筛查标准更符合本地区的实际情况;对于出生体重>1600g的早产儿,根据患儿全身疾病情况有选择的进行筛查可减少漏诊率。孕周、出生体重、吸氧时间、机械通气、呼吸窘迫综合征、输血是发生ROP的高危因素。有必要根据更多的流行病学结果,制定出符合我国国情的ROP筛选标准。

Objectives To investigate the incidence and risk factors of retinopathy of prematurity（ROP）in Yu-ying Children’s Hospital of Wenzhou Medical College,and to provide preliminary data for evaluating the appropriateness of the ROP screening criteria set by Ministry of Health in 2004. Methods Records of 254 premature infants who had undergone ROP screening when hospitalized in the NICU of Yuying Children’s Hospital of Wenzhou Medical College between Jan. 1 and Dec. 31,2007 were analyzed. Screening criteria included preterm infants with low birth weight（LBW）of 2000 g or less. The first examination was done at 4 to 6 weeks chronologic age or 32 weeks post conceptual age. They were followed up until vascularization in the peripheral retina had been detected. The results were analyzed and comparisons between criteria of British,American and Chinese were done. Results In the 254 infants,24（9.4%）had developed ROP. Among them,18 with stageⅠROP,4 with had stage Ⅱ ROP,and 2 had stage Ⅲ ROP. Two infants needed laser therapy and there was none with visual loss. There would be 21 cases of ROP missed（including 2 cases of ROP needed laser therapy）if the screening was done in according to American guidelines（BW ≤ 1 500 g or GA ≤ 28 weeks）. There would be 8 cases of ROP missed（including one case of ROP needed laser therapy）if the screening was done in according to British guidelines（BW ≤ 1 500 g or GA ≤ 31 weeks）. Premature infants with birth weight over 1 500 g were further divided into four groups. The analysis revealed that most of the premature infants had birth weight over 1 601 g （165/ 195）. The birth weights of infants with ROP were between 1 501 g to 1 600 g,the differences were significant when the comparisons were done among others （P 〈 0.01）. Logistic regression analysis indicated that low birth weight,low gestation age,long-term oxygen therapy,mechanical ventilation,respiratory distress syndrome （RDS）,and blood transfusion were the high risk factors of ROP. Conclusions Birth weight ≤ 1 600 g is more practical for ROP screening in China. ROP screening should also be done for the premature infants with birth weight 〉 1 600 g but with unstable clinical course. Further epidemiological data are needed to modify the guideline accordingly.