多胎与单胎早产儿视网膜病变的发病率及危险因素的比较

Incidence and risk factors of retinopathy of prematurity among the multiple and single gestation births

目的比较并分析多胎与单胎早产儿视网膜病变的发病情况及相关的危险因素。方法收集2013年9月至2015年12月我院新生儿科住院的早产儿652例,根据出生胎儿数量分为多胎组(二胎及以上,52例)与单胎组(600例),使用RetCamⅢ数字视网膜照相机和视频双目间接检眼镜进行早产儿视网膜病变筛查并分析相关危险因素。各组之间发病率的比较采用卡方检验。结果多胎与单胎早产儿视网膜病变发病率分别为32.69%和20.83%,多胎发病率高于单胎(P=0.047)。随着孕周的增加,多胎组与单胎组早产儿视网膜病变发病率均降低;≤30周的早产儿,多胎组早产儿视网膜病变发病率高于单胎组(P=0.040);>30周的早产儿,两组早产儿视网膜病变发病率差异无统计学意义(均为P>0.05)。随着出生体质量的增加,两组早产儿视网膜病变发病率均降低,多胎组和单胎组相比,不同出生体质量的早产儿视网膜病变发病率差异无统计学意义(均为P>0.05)。两组中吸氧>5 d的早产儿视网膜病变发病率均高于吸氧≤5 d者(P=0.025、0.001);吸氧≤5 d不同胎别的早产儿视网膜病变发病率差异无统计学意义;吸氧>5 d的多胎组早产儿视网膜病变发病率高于单胎组(P=0.020)。多因素分析发现,多胎和小孕周是早产儿视网膜病变的危险因素。结论孕周越小、出生体质量越低、吸氧时间越长(>5 d)早产儿视网膜病变的发病率越高。多胎的早产儿视网膜病变总体发病率高于单胎。孕周越小、吸氧时间越长的多胎早产儿视网膜病变发病率高于单胎。不同出生体质量的早产儿视网膜病变发病率与胎别无关。

Objective To analyze the incidence and the risk factors of retinopathy of prematurity （ROP） among the multiple and single gestations births.Methods A prospective control study was applied to the research.The preterm infants were selected that from September 2013 to December 2015 in neonatology department of our hospital.They were divided into multiple gestations group （52 cases） and single birth infants group （600 cases）.RetCam Ⅲ retina camera and binocular indirect ophthalmoscope video were used to screening the ocular fundus.The cure rate of the two groups was compared with chi-square test.Results The incidence of ROP in multiple gestations group （32.69%） was higher than single birth infants group （20.83%） （P=0.047）.There was significant difference about the multiple and single gestations births in ≤30 weeks （P=0.040）,and there was no statistically significant difference in 〉30 weeks （all P〉0.05）.With the increase of birth weight,the ROP detection rate of two groupa was reduced.There was no statistically significant difference about different birth weight among the two groups （all P〉0.05）.The oxygen usage of 〉5 days ROP detection rate was higher than 5 days or less in the two groups （P=0.025,0.001）.There was no significant difference in ROP detection rate between two groups with ≤5 d oxygen usage.There was significant difference about the multiple and single gestations births in oxygen usage of 〉5 days （P=0.020）.Multivariate analysis found that multiple gestations and small gestational age were risk factors for ROP.Conclusion The smaller gestational age,the lower birth weight,and the longer oxygen therapy with the preterm infants,the higher the incidence of ROP.The number of different gestational is also the influences factors of ROP.Multiple gestations overall incidence of ROP is higher than the single birth infants.The smaller the gestational age and the longer oxygen usage,multiple gestations incidence of ROP is higher than single gestation in different births.However,there is no relationship in different birth weight among the multiple and single gestations.