急进性后部型早产儿视网膜病的危险因素分析

Risk factors of aggressive posterior retinopathy of prematurity:a retrospective,longitudinal study

目的分析急进性后部型早产儿视网膜病(AP-ROP)的危险因素。方法采用回顾性病例对照研究方法 ,纳入2012年3月至2014年9月在广东省妇幼保健院住院的55例AP-ROP先证者和110例普通ROP患儿,两者按1∶2进行配比,匹配条件:普通ROP患儿、入院时间最接近,收集、整理资料。结果胎龄<32周(χ~2=8.584),出生体质量<1 250 g(χ~2=3.960),吸氧(χ~2=7.015),吸氧≥14 d(χ~2=22.273),机械通气(χ~2=10.104),机械通气≥14 d(χ~2=12.579),使用PS(χ~2=10.942),新生儿贫血(χ~2=8.462),输血≥2次(χ~2=41.734),RDS(χ~2=11.733),新生儿肺炎(χ~2=25.536),呼吸暂停(χ~2=23.468),BPD(χ~2=8.319),颅内出血(χ~2=6.478),代谢性酸中毒(χ~2=8.317),视网膜出血(χ~2=10.188)与AP-ROP显著相关(P<0.05)。在单因素分析基础上运用条件Logistic回归分析,输血≥2次(OR:14.956)和呼吸暂停(OR:7.590)是AP-ROP的独立危险因素。结论 AP-ROP的发生与出生胎龄小、出生体重低、氧疗及相关并发症(如呼吸窘迫综合征、视网膜出血等)有关,输血和呼吸暂停是AP-ROP的独立危险因素。

Objective To analyze the risk factors of aggressive posterior retinopathy of prematurity(AP-ROP).Methods A retrospective case-control study was applied.Questionnaire was designed through literature research to collect data of AP-ROP and ordinary ROP(except for AP-ROP)from March,2012 to September,2014 in the department of neonatology in Guangdong Women and Children′s Hospital.Based on the ratio of 1∶2,the two groups were selected with the matching conditions:the closest date of admission in hospital,ordinary ROP children,collection and analysis of the data.Results Univariate analysis:gestational age(P<0.05),birth weight(P<0.05),oxygen therapy days(P<0.05),days of mechanical ventilation(P<0.05),gestational age<32 w(P<0.05),birth weight<1 250 g(P<0.05),oxygen(P<0.05),oxygen≥14 d(P<0.05),mechanical ventilation(P<0.05),mechanical ventilation≥14 d(P<0.05),PS(P<0.05),neonatal anemia(P<0.05),blood transfusion≥2 times(P<0.05),RDS(P<0.05),neonatal pneumonia(P<0.05),apnea(P<0.05),BPD(P<0.05),intracranial hemorrhage(P<0.05),metabolic acidosis(P<0.05),and retinal hemorrhage(P<0.05)were related to AP-ROP.Multivariate analysis with conditional logistic regression analysis indicated that blood transfusion≥2 times(OR:14.956,95%CI:4.328~51.684)and apnea(OR:7.590,95%CI:2.507~22.978)were regarded as the independent risk factors for AP-ROP.Conclusions AP-ROP is associated with low gestational age,low birth weight,oxygen therapy and related complications including RDS and retinal hemorrhage.Blood transfusion and apnea are important independent risk factors of AP-ROP.