早产儿视网膜病的筛查及其高危因素分析

Screening and risk factors analysis of retinopathy of prematurity

目的分析早产儿视网膜病（ROP）的危险因素，为合理防治ROP提供理论依据。方法回顾分析2006年7月至2008年5月，我院NICU住院的胎龄≤36周、出生体重≤2500g行ROP筛查的1675例早产儿临床资料。记录早产儿的性别、胎数、孕周、出生体重、用氧情况、患全身疾病情况及孕母情况。同时用单因素X^2检验和多因素Logistic回归分析筛选和判定早产儿ROP发生的危险因素。结果1675例早产儿中，发生ROP195例，ROP患病率为11．6％。195例ROP患儿中，达到阈值前病变Ⅰ型或阈值病变者35例，占筛查早产儿的2．1％。ROP发生的相关因素分析发现，出生体重越低、胎龄越小、氧疗时间越长，ROP患病率越高。Logistic回归分析结果表明，低出生体重、小胎龄、窒息、呼吸暂停、氧疗是ROP发生的高危因素（OR值分别为0．957、1．052、1．186、5．314、1．881）。结论低出生体重、小胎龄、窒息、呼吸暂停、氧疗是ROP发生的高危因素，建议对具有高危因素的所有早产儿均进行ROP筛查。

Objective To analyze the risk factors of retinopathy of prematurity （ROP） and provide evidence for the rational establishment of screening standard. Methods The clinical data of 1675 preterm infants at gestational age ≤36 weeks or birth weight ≤ 2500 g who were admitted to the neonatal intensive care unit and had been screened in our hospital from July 2006 to May 2008 were analyzed retrospectively by univariate analysis and Logistic regression analysis. Gender, birth count, gestational age, birth weight, oxygen therapy,and mother＇s conditions were recorded. Results ROP was detected in 195 （ 11.6% ） of 1675 infants, of whom 35 infants （2. 1% ） had type 1 or threshold ROP. The lower the birth weight, the smaller the gestational age and the longer the time of oxygen therapy were, the higher the incidence of ROP was. For the infants whose birth weight was ≤ 1200 g, 1201-1500 g, 1501-2000 g, 2001-2500 g, the incidence of ROP was 73.2%, 30. 4%, 8. 0%, and 1.1% ;for those at gestational age ≤30 weeks, 30^＋1- 32 weeks, 32^＋1-34 weeks, 34^＋1-36 weeks, the incidence of ROP was 67.6%, 16. 9%, 3.9%, and 1.0% ; for the infants underwent oxygen therapy for 0 d, -3 d, -5 d, -8 d, 〉 8 d, the incidence of ROP was 1.5%, 3.3%, 9. 6%, 23.2% and 38. 8% ;in the infants who inhaled oxygen at concentrations of 0. 40, -0.60, -0.80 and 〉 0.80, the incidence of ROP was 11.8%, 18.1%, 26. 8%, and 52. 6%, respectively. Logistic regression analysis indicated that low birth weight, small gestational age, asphyxia, apnea, oxygen therapy were the high risk factors of ROP （the odds ratio was 0. 957, 1. 052, 1. 186, 5. 314, and 1. 881 ）. Conclusions Low birth weight, small gestational age, asphyxia, apnea, and oxygen therapy were the high risk factors of ROP. It is recommended that all preterm infants with high risk factors should be screened.