早产儿视网膜病变的筛查策略探讨

Discussion of screening strategy of retinopathy of prematurity

目的:根据早产儿出生体重和出生胎龄为指标,探讨早产儿视网膜病变的临床筛查标准和初次筛查时间。方法:收集2008年2月～2011年2月厦门市妇幼保健院NICU病区1 148例早产儿,使用双目间接眼底镜进行眼底检查,收集相关临床资料进行统计分析。结果:出生体重≤1 000 g、1 001～1 250 g、1 251～1 500 g、1 501～1 750 g、1 751～2 000 g、>2 000 g各组间阈值ROP发生率比较有统计学差异(χ2=201.54,P<0.001),其OR值为1.00、0.45、0.24、0.07、0.02、0.003,出生体重﹥1 500 g时阈值ROP发病率显著降低;ROC曲线示在出生体重为1 532.5g面积最大;出生胎龄﹤28周、28～30周、30～32周、32～34周、≥34周各组间阈值ROP发生率差异有统计学意义(χ2=213.14,P<0.001),其OR值为1.00、0.68、0.29、0.07、0.02,出生胎龄>32周时阈值ROP发病率明显降低;ROC曲线显示在出生胎龄32.07周面积最大;出现阈值ROP时的矫正胎龄﹤35周的8例早产儿,出生后周龄均在4～6周。结论:出生体重≤1 500 g和出生胎龄≤32周是ROP筛查指标;初次筛查时间在矫正胎龄≥35w或出生后4～6周。

Objective：To explore the clinical screening criteria and screening time for the first time according to birth weight and birth gestational age of premature infants.Methods：A total of 1 148 premature infants from NICU of the hospital from February 2008 to February 2011 were collected,bilateral indirect ophthalmoscope was used for fundus examination,related clinical data were collected for statistical analysis.Results：There was statistically significant difference in the incidence of threshold retinopathy of prematurity（ROP） among the infants with birth weight ≤1 000 g,1 001-1 250 g,1 251-1 500 g,1 501-1 750 g,1 751-2 000 g,and 2 000 g（χ2=201.54,P0.001）,the OR values were 1.00,0.45,0.24,0.07,0.02,and 0.003,respectively;the incidence of threshold ROP in infants with birth weight1 500 g decreased significantly.The area under ROC curve was the largest in the infants with birth weight=1 532.5 g;there was statistically significant difference in the incidence of threshold ROP among the infants with birth gestational age28,28-30,30-32,32-34,and ≥34 weeks（χ2=213.14,P0.001）,the OR values were 1.00,0.68,0.29,0.07,and 0.02,respectively;the incidence of threshold ROP in infants with birth gestational age32 weeks decreased significantly ROC curve showed that the area was the largest in the infants with birth gestational age=32.07 weeks;the gestational weeks of 8 premature infants with threshold ROP whose correct gestational weeks was less than 35 weeks were 4-6 weeks.Conclusion：Birth weight≤1 500 g and birth gestational weeks≤32 weeks are screening indexes of ROP;the screening time for the first time was correct gestational weeks≥35 weeks or at 4-6 weeks after birth.