新生儿视网膜出血严重程度的相关因素调查及检测孕妇血小板数量及平均体积的临床预测价值

Investigation on the related factors of neonatal retinal hemorrhage severity and clinical prediction value of platelet count and mean volume in pregnant women

目的探讨新生儿视网膜出血严重程度的相关因素以及检测孕妇血小板计数(PLT)及平均血小板体积(MPV)的临床预测价值。方法选取2018年6月至2019年10月期间在我院产科分娩的360例足月新生儿,出生1周后采用广角数码儿童视网膜成像系统行眼底检查。根据出血情况分为正常组、Ⅰ度出血组、Ⅱ度出血组、Ⅲ度出血组。收集产妇、新生儿一般资料,采用多因素Logistic回归分析出血严重程度的相关因素,并观察血小板数量及平均体积对新生儿视网膜出血的临床预测。结果360例足月新生儿中正常组、Ⅰ度出血组、Ⅱ度出血组、Ⅲ度出血组分别为250例(69.4%)、46例(12.78%)、35例(9.72%)、29例(8.06%)。Logistic回归分析显示窒息(95%Cl=0.969~6.930,P=0.014)、生产方式(95%Cl=0.437~0.979,P=0.006)、血小板数量(95%Cl=1.189~3.823,P=0.000)及平均体积(95%Cl=1.026~3.814,P=0.008)是新生儿视网膜出血的危险因素。Spearman相关性分析显示血小板数量与视网膜出血程度正相关(r=0.658,P=0.000),平均体积水平与与视网膜出血程度负相关(r=-0.779,P=0.000)。出血新生儿的血小板数量显著低于正常组,而平均体积显著高于正常组(P<0.05)。血小板数量以及平均体积水平预测新生儿视网膜出血程度的ROC曲线下面积分别为0.884、0.911,截断值为0.603、0.688,灵敏度为67.75%、71.46%,特异度为92.57%、97.29%。结论窒息、产道分娩以及血小板参数均是影响新生儿视网膜出血严重程度的危险因素,其中血小板数量及平均体积与血严重程度具有显著相关性,可有效预测出血风险。

Objective To study the related factors of neonatal retinal hemorrhage severity and the clinical prediction value of platelet count and mean volume in pregnant women.Methods A total of 360 full-term newborns born in our hospital from June 2018 to October 2019 were selected,and all received fundus examination by wide-angle digital retinal imaging system.According to the conditions of bleeding,they were divided into the normal group,first degree hemorrhage group,second degree hemorrhage group and third degree hemorrhage group.General data of the parturients and newborns were collected,and the related factors of retinal hemorrhage severity were analyzed by multiple logistic regression.The role of the number of platelets and the average volume in the clinical prediction of neonatus retinal hemorrhage was investigated.Results Among the 360 full-term neonates,there were 250 cases(69.4%),46 cases(12.78%),35 cases(9.72%)and 29 cases(8.06%)in the normal group,the first degree hemorrhage group,the second degree hemorrhage group and the third degree hemorrhage group,respectively.Logistic regression analysis showed that asphyxia(95%Cl=0.969~6.930,P=0.014),mode of delivery(95%Cl=0.437~0.979,P=0.006)platelet count(95%Cl=1.189~3.823,P=0.000)and mean volume(95%Cl=1.026~3.814,P=0.008)were risk factors of neonatal retinal hemorrhage.Spearman correlation analysis showed that platelet count was positively correlated with the degree of retinal hemorrhage(r=0.658,P=0.000),and the average volume level was negatively correlated with the degree of retinal hemorrhage(r=-0.779,P=0.000).The platelet count of bleeding neonates was significantly lower than that of the normal group,and the average volume was significantly higher than that of the normal group(P<0.05).he area under the ROC curve for predicting the degree of retinal hemorrhage in neonates was 0.884 and 0.911,the cut-off value was 0.603 and 0.688,the sensitivity was 67.75%and 71.46%,the specificity was 92.57%and 97.29%,respectively.Conclusions Asphyxia,vaginal delivery and platelet parameters are all risk factors affecting the severity of retinal hemorrhage in neonates.The number and average volume of platelets are significantly correlated with the severity of bleeding,which can effectively predict the risk of hemorrhage.