筛查标准在早产儿视网膜病变中的应用

Applying screening criteria for retinopathy of prematurity in preterm infants

目的正确认识早产儿视网膜病变（简称ROP）的筛查标准；评价筛查标准在早产儿视网膜病变防治中的实用性、可行性、有效性；探讨建立完善的早产儿视网膜病变筛查体系，提高筛查水平。方法回顾性研究。收集2005年1月1日至2010年12月31日期间住院治疗并新生儿医师请会诊的672例早产儿。参照中华医学会制定的早产儿视网膜病变防治指南进行筛查。在早产儿生后4～6周，由有经验的眼科医师应用双目间接眼底镜对其进行定期眼底筛查。每两周行1～2次早产儿的眼底筛查，根据患儿筛查情况结果，决定进行下一步的工作。结果（1）在所筛查的672例早产儿中首检为正常视网膜者605例，发生ROP67例，占9．97％，其中ROPⅠ期38只眼，ROPⅡ期60只眼，ROPⅢ期4只眼，ROPⅡ期伴plus病变（3区）16只眼，ROPⅢ期伴plus病变（2区）10只眼，ROPⅣ期2只眼，AP—ROP（进展性后部ROP）2只眼；阈值前病变20只眼，阈值病变14只眼。（2）其中接受眼底激光治疗26只眼，行玻璃体切割手术6只眼（ROP发展至Ⅳ期）；其中死亡5例10只眼。（3）67例ROP患儿Ⅲ生体重均低于2500g；出生体重≤1000g、1001—1500g、1501～2000g、≤2500g的早产儿ROP的比例分别为56．76％、12．83％、5．10％、3．42％。（4）孕周小于32W，发生ROP55例，占82．09％；孕周小于34W，发生ROP64例，占95．52％。结论早产、低出生体重是ROP发生的高危因素；对于全身疾病严重的患儿需适当放宽筛查标准。根据不同地域，制定不同的筛查标准。孕周小于34周或出生体重小于2000g的早产儿进行ROP筛查的标准是可行的，值得推广应用。

Objective To describe retinopathy of prematurity （ROP） of preterm infants in Xiamen and evaluate the efficacy of applying current screening guidelines. Methods Retrospective data on preterm infants were collected who were referred by their neonatologist for ROP screening at Xiamen First Hospital between January 2005 and December 2010 according to the Screening criteria of our country. Additionally, older preterm infants considered at risk for ROP by the neonatal intensive care unite were screened. Initial examinations begin 4-6 weeks after birth or at 32 weeks postconception. Routine ophthalmologic examinations used by the indirect ophthalmoscopy and the scleral depression. All infants were followed-up until a stable retinal situation was reached. Results Retinopathy of prematurity was detected in 9.97% of 672 neonates who had eye examinations. Including 38 eyes suffered from stage Ⅰ, 60 eyes suffered from stage Ⅱ, 4 eyes suffered from stage Ⅲ, 16 eyes suffered from stage Ⅲ with plus disease （zone 3）, 10 eyes suffered from stage Ⅲwith plus disease （zone 2）, 2 eyes suffered from stage Ⅳ, 2 eyes suffered from stage of AP-ROP. Favorable outcome was observed in 26 infants who had undergone photocoagulation; 3 infants developed retinal detachment with plus disease and performed vitretectomy. Four infants died. The occurrence rate of ROP in the infants with the birth weight ≤1000g, 1001-1500g, 1501-2000g,≤2500g was 56.76%, 12.83%, 5.10%, 3.42%, respectively; the occurrence rate of ROP in the infants with the gestationalage~≤32 weeks, ≤34weeks was 82.09%, 95.52%. Conclusions The criteria for ROP screening programs should be designed according to local conditions. In our country, screening all premature babies with a gestational age less than 34 weeks or a birth weight less than 2000g appears to be ap- propriate.