西藏高海拔地区早产儿视网膜病变现状及预测研究

Study on current status and prediction of retinopathy of prematurity in high altitude areas of Tibet

目的 探讨西藏高海拔地区(海拔>3 600 m)早产儿视网膜病变(retinopathy of prematurity,ROP)的发生现状、影响因素及其对ROP的预测价值。方法 选取2020年5月1日至2022年5月1日拉萨市人民医院新生儿科住院藏族早产儿131例,采用第三代广角数码儿童视网膜成像系统(RetCam Ⅲ)进行ROP筛查。采用多因素logistic回归方程分析早产儿发生ROP的影响因素。结果 131例早产儿中男74例、女57例;胎龄32(30,34)周,体质量(1 634.3±378.7)g。33例(66眼)发生ROP,ROP检出率为25.2%。多因素回归分析结果显示,支气管肺发育不良(bronchopulmonary dysplasia,BPD)(OR=4.637,95%CI:1.132~19.003,P=0.042)和有创机械通气时间越长(OR=1.226,95%CI:1.033~1.454,P=0.038)的早产儿更容易发生ROP。ROC曲线结果显示,BPD、有创机械通气时间和两者联合预测ROP的AUC分别为0.686(95%CI:0.571~0.801,P=0.001)、0.688(95%CI:0.573~0.802,P=0.001)和0.728(95%CI:0.615~0.842,P=0.000),灵敏度分别为0.485、0.273和0.576,特异度分别为0.888、0.969和0.867。结论 西藏高海拔地区ROP检出率较高,建议关注BPD、有创机械通气时间较长的早产儿ROP的发生情况。

Objective To explore the current status,influencing factors and their predictive value of retinopathy of prematurity(ROP) in high altitude areas of Tibet(altitude above 3 600 m).Methods A total of 131 Tibetan premature infants hospitalized in the Neonatal Department of Lhasa People's Hospital from May 1st,2020 to May 1st,2022 were selected,the third-generation wide-angle digital children's retinal imaging system(RetCam Ⅲ) was used to screen ROP.Multivariate logistic regression equation was used to analyze the influencing factors of ROP.Results Among the 131 premature infants,74 were males and 57 were females.The gestational age was 32(30,34) weeks and the body mass was(1 634.3 ± 378.7) g.ROP occurred in 33 newborns(66 eyes),and the detection rate of ROP was 25.2%.Multivariate regression analysis showed that premature infants with bronchopulmonary dysplasia(BPD)(OR = 4.637,95%CI:1.132-19.003,P = 0.042),or who received invasive mechanical ventilation for a longer period of time(OR = 1.226,95%CI:1.033-1.454,P = 0.038) were more likely to develop ROP.The ROC curve showed that the AUC of ROP predicted by BPD,invasive mechanical ventilation time and their combination were 0.686(95%CI:0.571-0.801,P = 0.001),0.688(95%CI:0.573-0.802,P =0.001) and 0.728(95%CI:0.615-0.842,P = 0.000),respectively,the sensitivity was 0.485,0.273 and 0.576,and the specificity was 0.888,0.969 and 0.867,respectively.Conclusions The detection rate of ROP in high altitude areas of Tibet is high.It is suggested to pay attention to the occurrence of ROP with BPD and longer invasive mechanical ventilation.