阈值期和高危阈值前早产儿视网膜病变临床特点分析

Clinical characteristics of high-risk prethreshold and threshold retinopathy of prematurity

目的分析阈值期和高危阈值前早产儿视网膜病变(retinopathy of prematurity,ROP)的临床特点。方法回顾分析2011年1月至2012年12月在北京军区总医院住院治疗确诊的阈值期和高危阈值前ROP患儿106例,分析其出生胎龄、出生体质量、病变程度和病变部位特点。结果 106例阈值期和高危阈值前ROP患儿出生胎龄(28.70±1.89)周。44.34%患儿出生胎龄≤28周,其中2例出生胎龄为24周,2例出生胎龄为25周,84.91%≤30周。出生体质量(1 190.00±282.33)g,86.27%患儿出生体质量<1 500 g,20.59%<1 000 g,3例患儿出生体质量超过2 000 g。1期病变2.83%,2期21.70%,3期73.58%,4期1.89%,没有5期病变的患儿。33.96%为Ⅰ区病变,66.04%为Ⅱ区病变。Ⅰ区病变患儿的出生胎龄(28.94±1.57)周和出生体质量(1224.31±196.04)g,与Ⅱ区病变患儿[(28.51±2.03)周;1 168.54±321.32)g]无显著性差异(P>0.05),治疗时矫正胎龄Ⅰ区病变为(35.09±1.28)周,与Ⅱ区病变(38.43±6.32)周有显著性差异(P=0.000)。结论我国仍有较大、较成熟早产儿进展为阈值期或高危阈值前ROP的情况,目前指南适合我国国情。Ⅰ区病变进展至阈值期或高危阈值前发生较早,应注意及早筛查,缩短筛查间隔,及时治疗。

Objective To observe the clinical characteristics of high-risk prethreshold and threshold retinopathy of prematurity（ ROP）. Methods There were 106 premature infants diagnosed with high-risk prethreshold or threshold ROP in our hospital from January 2011 to December 2012. The clinical characteristics such as gestational ages,birth weights,disease stages and disease zones were summarized.Results The gestational ages of the ROP infants were 28. 70 ± 1. 89 weeks,and there were 44. 34% infants≤28 weeks,2 infants 24 weeks,2 infants 25 weeks,and 84. 91% infants ≤30 weeks. The diseased infants had birth weights of 1 190. 00 ± 282. 33 g,and included 86. 27% infants less than 1 500 g,20. 59% infants less than 1 000 g,and 3 infants more than 2 000 g. There were 2. 83% infants in stage Ⅰ,21. 70% in stageⅡ,73. 58% in stage Ⅲ,1. 89% in stage Ⅳ,and zero in stage V. Among the ROP infants,33. 96%diseased in zone Ⅰ and 66. 04% diseased in zone Ⅱ. The gestational ages and birth weights of the infants with ROP in zone I were 28. 94 ± 1. 57 weeks and 1 224. 31 ± 196. 04 g,respectively,while those of the infants with ROP in zone Ⅱ were 28. 51 ± 2. 03 weeks and 1 168. 54 ± 321. 32 g,respectively,and there was no significant difference（ P 〉 0. 05）. The correct gestational ages suitable for treating ROP in zone Ⅰ and ROP in zone Ⅱ were 35. 09 ± 1. 28 weeks and 38. 43 ± 6. 32 weeks,respectively,and there was significant difference（ P = 0. 000）. Conclusion In China,there are still more larger and more mature infants progressed to high-risk prethreshold and threshold ROP,and the present guidelines are suitable for our country’s conditions. The infants with ROP in zone I were always earlier progressed to high-risk prethreshold and threshold ROP,so early screening and frequent screening should be done to support timely treatment.