早产儿视网膜病变的彩色多普勒超声诊断与临床眼科随访对比分析

Comparative study on retinopathy of prematurity by color Doppler flow imaging diagnosis and clinical ophthalmology

目的研究彩色多普勒血流成像(CDFI)检查技术在早产儿视网膜病变(ROP)的诊断和随访中所具有的临床价值。方法选择2008年3月至2009年2月我科收治的胎龄小于37周或出生体质量小于2000g的早产儿、低体质量儿为研究对象,在生后4～6周采用RetCam数字视网膜照相机及间接眼底镜等眼科检查进行ROP筛查,共检查49例,98只眼,同时行双眼彩色多普勒超声检查,并将两者对照分析。结果眼科检查确诊ROP患眼41只,包括Ⅰ期8只,Ⅱ期19只,Ⅲ期6只,瘢痕期8只,未发现Ⅳ、Ⅴ期的患儿。CDFI与眼科检查对照特异性为85.5%,敏感度为76.7%。其中Ⅱ、Ⅲ期表现为:眼底视网膜中央动脉(CRA)的血流信号异常丰富,血管细小分支增多,走行迂曲,收缩期峰值流速(VS)测值无明显改变,舒张期流速(Vd)减低,血流阻力指数(RI)增高,在眼底正中视乳头区域可见强回声短条状结构突向玻璃体内,Ⅰ期ROP的8只眼CDFI未发现明显特征性改变。结论Ⅰ期ROP的CDFI表现不典型,而Ⅱ～Ⅲ期患儿眼底视网膜血管病变CDFI具有特征性的图像表现,CDFI对于ROP高危人群的常规初筛有较好的临床实用价值。

Objective To investigate the clinical value of color Doppler flow imaging（CDFI） in the diagnosis and clinical follow-up of retinopathy of prematurity（ROP）.Methods From March 2008 to February 2009,98 eyes of 49 premature infants（gestational age≤37 weeks,or birth weight≤2 000 g） underwent ROP screening by RetCam digital retinal camera and indirect ophthalmoscopy in the fourth to sixth postnatal week.At the same time,they were also examined by 8-14 MHz CDFI.Results Determined by RetCam digital retinal camera and indirect ophthalmoscopy,ROP was found in 41 eyes, including 8 eyes at stage Ⅰ , 19 eyes at stage Ⅱ , 6 eyes at stage Ⅲ, 8 eyes at scarring stage and no eye at stage Ⅳ and Ⅴ. Compared with ophthahnologic examination, the specificity of CDFI for ROP diagnosis was 85.5%, and the sensitivity was 76.7%. Detected by CDFI, typical changes were not found in the infants with ROP at stage Ⅰ. In the infants with ROP at stage Ⅱ and Ⅲ, abundant blood flow signals were found in the central retinal artery （CRA）. Increased amounts of the small vessels and irregular circuitousness were also observed. There was no obvious change in the systolic velocity （Vs ） of CRA. The diastolic velocity （Vj） was decreased and the resistance index （RI） was increased. A strong zonal echo protruded into the vitreum. Small blood flow signals which came from CRA by tracing toward their distal end were found in the same position using CDFI. Conclusions Detected by CDFI, the sonographic features of infants with ROP at stage I are not typical, but those of infants with ROP at stage Ⅱ and Ⅲ are specific. CDFI is valuable in clinical ROP screening of high risk group.