93例先天性白内障高危影响因素分析

Analysis of high risk factors of congenital cataract in 93 cases

目的通过对93例先天性白内障病例的分析,了解导致先天性白内障的高危影响因素,为儿童先天性白内障的预防和早期诊治提供临床依据。方法本研究采用病例对照研究设计,选择2016年1月—2019年2月在本保健中心先天性白内障筛查门诊收集的93例先天性白内障阳性患儿(病例组)及随机选取的同期筛查的正常儿童372名(对照组)作为研究对象,比较两组在一级亲属遗传史、母亲孕期既往史、婴儿个人史等方面的差异,采用多因素Logistic回归分析提取主要危险因素。结果病例组平均胎龄[(36.79±3.32)w]与对照组[(37.79±2.25)w]相比较,经t检验后差异有统计学意义(t=-3.45,P<0.05);病例组平均出生体重为(3058.92±382.34)g,明显低于对照组的(3235.83±579.72)g,差异有统计学意义(t=-2.79,P<0.05)。两组经单因素卡方检验分析后显示:一级亲属遗传史(χ^(2)=8.119,P<0.05)、母亲孕期感染(χ^(2)=5.130,P<0.05)、早产(χ^(2)=4.598,P<0.05)、低出生体重(χ^(2)=16.728,P<0.05)、出生后1分钟Apgar评分低于4分(χ^(2)=3.883,P<0.05)与先天性白内障的发生密切相关。多因素Logistic回归分析结果表明,婴儿一级亲属遗传史(OR=4.244,P<0.05)、母亲孕期感染(OR=2.177,P<0.05)、早产(OR=2.369,P<0.05)、低出生体重(OR=4.279,P<0.05)是先天性白内障的主要危险因素。结论婴儿有一级亲属遗传史、母亲孕期感染、胎龄越小,出生体重越低,先天性白内障的发生率越高。对高危新生儿进行早期眼科筛查,先天性白内障患者尽早手术干预可有效降低剥夺性弱视引起的盲与低视力的发生。

Objective To understand the risk factors and provide the clinical basis for early diagnose and treatment of congenital cataract in children via the retrospective analysis of 93 congenital cataract medical records.Methods A case-control study was conducted.93 infants with congenital cataract diagnosed between January 2016 and February 2019(case group),and 372 normal children(control group)were selected as study subjects.Patient's data were collected from department of ophthalmology,Women and Children Health Centre of Tianjin city.The chi-square was used to compare the differences of genetic history of first-degree relatives,past history during pregnancy and infants personal history between observation group and control group.Logistic regression analysis was used to extract the main risk factors.Results The mean gestational age in case group was(36.79±3.32)weeks,ad that of control group was(37.79±2.25)weeks,according to the results of t-test,the difference between the two groups were statistically significant(t=-3.45,P<0.05).The average birth weight in case group was(3058.92±382.34)g,which is significantly lower than(3235.83±579.72)g in control group(t=-2.79,P<0.05).After comparison between the two group by chi-square test,genetic history of first-degree relatives(χ^(2)=8.119,P<0.05),infection during pregnancy(χ^(2)=5.130,P<0.05),preterm birth(χ^(2)=4.598,P<0.05),low birth weight(χ^(2)=16.728,P<0.05),Apger score less than 4 one minute after birth(χ^(2)=3.883,P<0.05)were closely related to the congenital cataract.Multi-factor Logistic regression analysis revealed that genetic history of first-degree relatives(OR=4.244,P<0.05),infection during pregnancy(OR=2.177,P<0.05),preterm birth(OR=2.369,P<0.05)and low birth weight(OR=4.279,P<0.05)were the main risks for congenital cataracts.Conclusions Infants have genetic history of first-degree relatives,mothers infected during pregnancy,the younger the gestational age,the lower the weight,the higher the probability of congenital cataract.Early eye screening of newborns and early surgical intervention on patients with congenital cataract could effectively reduce the incidence of blindness and low vision caused by deprivation of amblyopia.