超低出生体重儿早产儿视网膜病变发病情况及危险因素分析

Incidence and risk factors of retinopathy of prematurity in extremely low birth weight infants

目的了解超低出生体重儿早产儿视网膜病变（ROP）发病情况，探讨其相关危险因素。方法回顾分析ROP筛查的出生体重不足1000g早产儿共145例。其中，男性93例，女性52例；平均胎龄（28．5±2．0）周，平均出生体重（923．0±85．0）g。统计时，诊断以随访过程中出现的最重ROP病情为录入标准，双眼非对称病例以发病严重侧为录入标准。以是否发生ROP将患儿分为ROP组和非ROP组，ROP组患儿再分为轻症组和重症组。轻症组包括1、2期ROP，未达阈值的3期ROP，以及以上各期ROP发生的瘢痕病变；重症组包括阈值前1型、阈值、急进性后部型以及4、5期ROP。将胎龄〉28周或≤28周、出生体重〈750g或≥750g、胎数单胎或多胎、分娩方式顺产或剖宫产、性别男或女作为危险因素，运用SPSS13．0进行统计学分析。结果145例出生体重不足1000g的早产儿中，96例发生不同程度的ROP，占66．21％。其中，重症患儿59例，重症ROP发生率为40．69％。ROP组和非ROP组胎龄（χ2=15．021，P=0．000）、胎数（χ^2=4．744，P=0．029）、分娩方式（χ^2=11．848，P=0．001）间差异有统计学意义（P〈0．05）；轻症组和重症组胎龄间差异有统计学意义（χ^2=7．588，P=0．006）。Logistic回归分析显示，仅胎龄与ROP的发生相关[Exp（B）=0．32807，P=0．005197]。结论超低出生体重儿具有ROP发生率以及重症率高的特点。胎龄≤28周、顺产、多胎是ROP发病危险因素。

Objective To investigate the incidence of retinopathy of prematurity （ROP） in extremely low birth weight infants and to explore their risk factors. Methods ROP screening was carried out in Shenzhen Eye Hospital from July 2006 to October 2011. One hundred and forty-five infants with a birth weight less than 1000 grams were respectively analyzed. There were 93 males and 52 females. Their average gestational age was （28.5±2. 0） weeks and average birth weight was （923.0±85.0） grams. The more advanced ROP stages during the follow up or between the 2 eyes of bilateral patients were recorded and analyzed in this study. All infants were first divided into ROP group or non ROP group. All the ROP cases were further divided into mild ROP group and severe ROP group. Mild group included infants with stage 1, stage 2 and non-threshold stage 3 ROP. Severe group included infants with pre threshold type 1, threshold, aggressive posterior ROP and stage 4/5 ROP. Gestational age （less than or equal to 28 weeks or more than 28 weeks）, birth weight （less than 750 grams or more than or equal to 750 grams）, fetus number in one birth （single or multiple fetus）, mode of delivery （normal or cesarean section delivery） and gender were analyzed as risk {actors according to reference. SPSS 13.0 was used to do the statistical analysis. Results 96/145 infants developed ROP with an incidence of 66.21%. There were 59 （40.69%） severe ROP infants who underwent laser coagulation, bevacizumab intravitreal iniection or vitreoretinal surgery. The difference of gestational age, fetus number in one birth, mode of delivery between ROP group and non-ROP group was statistically significant （P〈0.05）. The difference of gestational age between mild ROP group and severe ROP group was statistically significant （χ^2= 7. 588,P=0. 006）. Logistic regression analysis showed that only gestational age related to ROP oecurence [Exp（B）=0.328 07, P=0.005 197]. Conclusions Theincidence of ROP and severe ROP are very high in extremely low birth weigh infants. ROP risk factors are various and mainly include gestational age less than or equal to 28 weeks, multiple fetus and normal delivery.