早产儿视网膜病变141例自然退行与进展的影响因素分析

Analysis of influencing factors of natural degeneration and progression of retinopathy of prematurity

目的通过分析早产儿视网膜病变(retinopathy of prematurity,ROP)自然退行和进展的影响因素,了解ROP的发展规律,以期对ROP病儿的临床及筛查工作有一定指导作用。方法收集2018年9月至2021年4月在徐州医科大学附属医院就诊并进行眼底筛查的病儿472例。收集确定有眼底病变的141例病儿的临床资料,退行组107例,需干预治疗的进展组34例,分析早产儿视网膜病变自然退行与进展的影响因素。结果退行组和进展组平均胎龄分别为(31.61±2.29)周、(29.76±1.82)周,经独立样本的t检验,差异有统计学意义(P<0.05),两组出生体质量的中位数分别为1.58(1.25,1.82)kg、1.26(1.03,1.48)kg,无创通气时间为8.50(6.00,18.75)d、20.00(10.75,32.25)d,两组合并支气管肺发育不良(bronchopulmonary dysplasia,BPD)的占比分别为40.2%(43/107),79.4%(27/34),败血症59.8%(64/107)、82.4%(28/34)、贫血59.8%(64/107),82.4%(28/34)、输血34.6%(37/107)、61.8%(21/34),经非参数两独立样本检验,差异有统计学意义(均P<0.01);多因素logistics回归分析显示,胎龄(β=-0.32,P=0.004,OR<1)是ROP进展的独立危险因素。结论低出生体质量、胎龄小、无创通气时间长,合并支气管肺发育不良、败血症、贫血、输血的病儿ROP进展至需干预治疗的风险较高,提示对于胎龄小、低出生体质量的早产儿加强筛查管理,对于ROP病儿应防治BPD、贫血、严格把控输血指征用氧指征;胎龄是ROP进展的独立危险因素,应加强母孕期的检查与护理,延长孕周。

Objective To analyze the influencing factors of natural degeneration and progression of retinopathy of prematurity(ROP),and to understand the law of development of ROP,so as to provide some guidance for the clinical and screening work of children with ROP.Methods Four hundred and seventy-two children with fundus screening in The Affiliated Hospital of Xu Medical College from September,2018 to April,2021 were collected.The clinical data of 141 children confirmed with fundus lesions were collected,including 107 children in the degenerative group and 34 children in the progressive group requiring intervention,to analyze the influencing factors of natural degeneration and progression of retinopathy of prematurity.Results The mean gestational age of the regressive group and the progressive group was(31.61±2.29)weeks and(29.76±1.82)weeks,respectively.The t test of independent samples showed statistically significant differences(P<0.05).The median birth weight of the two groups were[1.58(1.25,1.82)]kg and[1.26(1.03,1.48)]kg,non-invasive ventilation time was[8.50(6.00,18.75)]d and[20.00(10.75,32.25)]d.The ratio of the two combinations with bronchopulmonary dysplasia was 40.2%(43/107)and 79.4%(27/34),sepsis was 59.8%(64/107),82.4%(28/34),anemia was 59.8%(64/107),82.4%(28/34),blood transfusion was 34.6%(37/107),61.8%(21/34),the difference was statistically significant after two independent samples test(all P<0.01).Multivariate logistic regression analysis showed that gestational age(β=−0.32,P=0.004,OR<1)was an independent risk factor for ROP progression.Conclusion Children with low birth weight,small gestational age,long duration of noninvasive ventilation,the combination of bronchial pulmonary dysplasia,sepsis,anemia,blood transfusion have a higher risk of ROP progression to intervention therapy,suggesting that preterm infants with small gestational age and low birth weight should be strengthen the screening and management,ROP children should be prevent BPD and anemia,and strictly control the blood transfusion indication of oxygen indications;gestational age is an independent risk factor for the progression of ROP,so maternal examination and nursing during pregnancy should be strengthened to prolong the gestational age.