广东省三家医院早产儿视网膜病变发生特点及转归分析

Development and progress of retinopathy of prematurity in three hospitals in Guangdong province

目的观察并分析广东省3家医院早产儿视网膜病变（ROP）的发生发展特点及治疗后转归情况。方法前瞻性研究。采用双目间接检眼镜对出生或收治于广东省3家妇幼保健院的出生体重〈2000g早产儿和低体重儿638例进行ROP筛查。排除未完成随访的52例，共586例1172只眼纳入研究。首次眼底筛查时间为出生后4．0～6．0周或矫正胎龄32．0周。对阈值期前1型病变考虑激光光凝治疗，阈值期病变48h内首选激光治疗。所有患儿均随访至周围视网膜完全血管化，ROP病变自然退行或治疗后病变退行且治疗后至少1个月。观察并分析ROP发生率，ROP发生时患儿矫正胎龄、出生日龄，ROP治疗时患儿矫正胎龄、出生日龄，ROP病变进展天数以及随访期间治疗眼的预后情况。对ROP患儿胎龄与其ROP发生、治疗时出生日龄之间行Spearman相关性分析。结果1172只眼中，发生ROP者118只眼，占10．07％；视网膜完全血管化1054只眼，占89．93％。发生ROP者胎龄中位数30．2周，矫正胎龄中位数36．4周；发生ROP时出生日龄中位数40．5d。共60只眼需进行ROP治疗。其胎龄中位数29．3周，矫正胎龄中位数37．5周；需治疗时的出生日龄中位数59．5d。相关性分析发现，胎龄与ROP发生、需治疗时出生日龄均呈负相关（R=-0．65，～0．80；P=0．000）。ROP1期进展至2期、2期进展至3期、3期进展至需治疗的3个阶段，其病情进展天数中位数分别为14．0、10．5、3．0d。随着病变加重，病情进展时间缩短，并呈非正态分布。各进展阶段病情进展天数中位数比较，差异有统计学意义（H=30．69，P=0．000）。治疗眼治疗后追光、注视反应正常，视盘、黄斑、视网膜结构正常，无视网膜血管行径异常，亦未发现玻璃体、视网膜增生病变形成。结论广东省3家医院ROP发生时间在矫正胎龄36．4周左有，ROP治疗时间在矫正胎龄37．5周左右。随着ROP病变加重，其病情进展时间缩短。治疗眼预后良好。

Objective To overview the characteristic in development and progress of retinopathy of prematurity （ROP）. Method Six hundred and thirty eight premature birth infants with birth weight less than 2000 grams born or hospitalized in three hospitals in Guangdong province were examined by indirect ophthalmoscopy as part of ROP screening. 1172 eyes in 586 infants are included. Follow up has not been completed in 52 infants. The first time of screening was 4 to 6 weeks after birth or 32 weeks corrected for gestational age. Threshold and pre threshold （type I） disease was treated by laser photo coagulation within 48 hours. All infants were followed until complete vascularization, natural regress or for more than 1 month after effective therapy. Data regarding incidence of ROP, corrected gestational age and days after birth of ROP onset, corrected gestational age and days after birth of getting treatment, progress pace and prognosis were collected and analyzed by Spearman statistical analyses. Results In 1172 eyes, ROP developed in 118 eyes （10.07%）. In 1054 eyes （89.93%） were completed vascularized. Sixty eyes received laser treatment. In ROP infants, the median gestational age was 29.3 weeks and the median corrected gestational age and days after birth when ROP develops were 36.4 weeks and 59.5 days respectively. There was a negative correlation between gestational age and ROP development and treatment timing （R=-0.65,-0.80;P=0. 000）. The median interval days from stage 1 to stage 2, from stage 2 to stage 3, and stage 3 to getting treatment were 14.0, 10. 5 and 3.0 clays respectively. The interval showed a non-normal distribution and there is statistical difference （H=30.69,P=0.000）. During the follow-up after treatment, the ocular fixation and following reactions were normal. The structure of optic disc, the maeula lutea and retina were normal. Conclusions Timing of ROP development is about 36.4 weeks corrected for gestational age and 37.5 weeks when treated. The interval is shorter when ROP progresses. The prognosis is good for the treatment of aular.