广州市番禺区早产儿视网膜筛查及结果分析

The screening and results analysis of premature retinopathy in the secondary hospital of Guangzhou city

目的 了解广州市番禺区早产儿视网膜发育特点及眼底病变发生情况,探讨适合基层医院早产儿视网膜筛查的方法及标准,并为早产儿视网膜筛查多中心研究提供流行病学资料.方法 采用前瞻性研究方法.对2010年1月至2011年12月在番禺区妇幼保健院使用带视频录像的双目间接眼底镜对番禺区1270例早产儿进行眼底检查,观察视网膜病变的发生情况,并将其结果与国内三级医院报道的结果进行比较分析.结果 在收集的1270例早产低体重儿中,依据广州市的筛查标准,发现早产儿视网膜病变（ROP）者14例;按照卫生部的筛查标准进行筛查,发现ROP者13例,有1例ROP患者遗漏.其中,ROPⅢ区Ⅰ期者7例,Ⅲ区Ⅱ期者3例,Ⅲ区Ⅲ期者2例,Ⅱ区Ⅲ期者2例,未发现Ⅳ期及Ⅴ期病变.达到阈值病变需要治疗的2例.12例随访病变消退,2例行激光治疗后病变消退.结论 由于各地区、各医疗机构ROP筛查对象不同,各自报道的发病率亦不同.目前尚难评估我国ROP的流行病学特点,要做到真正的流行病学研究,需要各级医院统一筛查对象及筛查工具,统一人才培训,所有数据统一分析.因此,应重视二级及以下医院早产儿视网膜筛查工作的开展.

Objective To investigate the characteristics of the retinal development of premature infants in the secondary hospitals in China.To explore a suitable ROP screening method and standard for hospitals of basic level in China in order to provide epidemiological data for multicenter study on ROP screening.Methods This prospective study enrolled 1270 premature infants for ROP screening.The procedures were examined by using a computer-assisted imaging system of binocular indirect ophthalmoscope.The development of retina was observed and the fundus lesions were recorded and compared with other basic level hospitals in China.Results According to the screening criteria of Guangzhou city,14 cases had ROP.If according to the screening standard set by the ministry of health,13 cases had ROP.Among them,7 cases was in Ⅲ area Ⅰ period; 3 cases was in Ⅲ area Ⅱ period,2 cases was in Ⅲ area Ⅲ period,2 cases was in Ⅱ area Ⅲ period.No cases were found in stage Ⅳ and Ⅴ lesions.Two cases with threshold lesions needed treatment.Conclusions The screening standard set by the ministry of health in China works well for ROP screening in the Panyu district at present.Due to different objective of ROP screening in various areas and various medical institutions,the incidence is also variable.It is difficult to assess the epidemiological characteristics of ROP.Therefore,we should focus ROP screening work on the secondary and even lower hospitals.