Incidence and risk factors of retinopathy of prematurity and utility of the national screening criteria in a tertiary center in Iran

AIM: To determine the incidence and risk factors of retinopathy of prematurity(ROP) and the sensitivity of current screening criteria in a tertiary eye center in Tehran, Iran. METHODS: In a cross-sectional observational study, neonates weighing ≤2000 grams at birth or born <34 wk gestational age(GA) and all other infants at risk of ROP admitted to the neonatal intensive care unit(NICU) or referred to our ROP clinic were investigated. The incidence of ROP and severe ROP(i.e. patients needing treatment) were determined. The associations between risk factors and the development and severity of ROP were assessed. We also examined the sensitivity of the current national screening guideline in Iran. RESULTS: Among 207 infants, the incidence of ROP and severe ROP was 33.3% and 11.1%, respectively. Mean GA and birth weight(BW) were significantly lower in ROP vs non-ROP infants(29±2 wk vs 33±3 wk, P<0.001;1274±489 g vs 1916±550 g, P<0.001, respectively). Univariate analysis displayed significant association between ROP incidence and GA, BW, NICU admission period, blood transfusion, surfactant usage, sepsis, intraventricular hemorrhage and patent ductus arteriosus(P<0.05 for all). BW [relative risk(RR): 0.857(0.711-0.873), P<0.001], GA [RR: 0.788(0.711-0.873), P<0.001] and blood transfusion [RR: 1.888(0.995-3.583), P=0.052] were independent ROP risk factors. The sensitivity of country-specific screening guidelines was 95.7% and 100% for overall and severe ROP detection, respectively. CONCLUSION: ROP incidence is relatively high in Iran. Identifying ROP risk factors results in more accurate screening and reduces the risk of irreversible vision loss. The ROP screening criteria utilized in Iran are efficient at the present time.

One-year experience in the retinopathy of prematurity: frequency and risk factors, short-term results and follow-up

· AIM: As a result of the increase in premature births and the advances in neonatal intensive care, retinopathy of prematurity (ROP) remains one of the most important causes of childhood blindness worldwide. The main factors in the development of ROP are gestational age, birth weight and oxygen therapy. ROP continues to gain importance due to the increasing survival rates of more immature babies. · METHODS: Between January 2007 and October 2008, 203 premature infants treated at the Neonatal Intensive Care Unit (NNICU) were prospectively enrolled and the relationship between known risk factors and the occurance of ROP was studied. · RESULTS: ROP in various stages developed in 86 cases (42.4%). Statistically significant correlations were found between the development of ROP and birth weight (P < 0.0001) gestational age (P <0.0001), oxygen treatment and its duration (P <0.0001 and P =0.002), mechanical ventilation (MV) and its duration (P =0,0001 and P =0.0001), apnea(P = 0.001), intraventricular hemorrhage (IVH) (P =0.046), sepsis (P =0.0001), use of erythropoietin (EPO) (P =0.003), the number of blood transfusions and frequency (P =0.0001 and P =0.0001), surfactant application (P =0.0001), the presence of patent ductus arteriosus (PDA) (P =0.001) or bronchopu- lmonary dysplasia (BPD) (P =0.0001). No significant correlations were found between the occurance of ROP and maternal pre-eclampsia (P =0.293), multiple pregnancy (P = 0.218), or hyperbilirubinemia (P =0.494). Severity of ROP was related significantly with birth weight (P =0.0001), but no significant correlation between severity of ROP and gestational age was present. · CONCLUSION: Early description and reduction of the risk factors related with the occurance of ROP with the help of routine screening programs may warrant the prevention of visual loss, however early ophthalmic diagnosis and treatment are still mandatory to provide better visual rehabilitation. ·

Analysis of pathogenesis and risk factors associated with retinopathy of prematurity

Retinopathy of prematurity(ROP)is a disease associated with the vasculogenesis of the developing retina and in particular,in preterm newborns.The long term visual outcome of this disease includes increased risk of blindness and visual disabilities.The increasing prevalence of ROP,the leading cause of blindness in infants,necessitates the implementation of preventive measures to halt this trend,and this,most certainly,calls for the thorough understanding of the pathogenesis and various risk factors associated with the disease.Risk factors for ROP are among the main targets for improving health outcomes.Angiogenic factors including VEGF and IGF-1,maternal factors,oxidative stress and others(erythropoietin and inflammatory cytokines)are among the few of the most important risk factors that need to be addressed.A growing body of evidence suggests that subjects with ROP who have prenatal or postnatal risk factors are at increased risk of more severe ROP.These consistent observations have given rise to hopes of identifying the potential new risk factors and coming up with more efficient prevention and therapeutic strategies.However,studies focusing on incidence rates of ROP over time have painted an inconsistent picture.Individual studies have unequivocally demonstrated an association with the aforementioned risk factors,whereas epidemiological data however,is at best inconclusive.We have tried to integrate the studies,past and present,to identify the pathogenesis and novel risk factors.

A predictive score for retinopathy of prematurity by using clinical risk factors and serum insulin-like growth factor-1 levels

AIM：To detect the impact of insulin-like growth factor-1（IGF-1）and other risk factors for the early prediction of retinopathy of prematurity（ROP）and to establish a scoring system for ROP prediction by using clinical criteria and serum IGF-1 levels.METHODS：The study was conducted with 127 preterm infants.IGF-1 levels in the 1st day of life,1st,2nd,3rd and4th week of life was analyzed.The score was established after logistic regression analysis,considering the impact of each variable on the occurrences of any stage ROP.A validation cohort containing 107 preterm infants was included in the study and the predictive ability of ROP score was calculated.RESULTS：Birth weights（BW）,gestational weeks（GW）and the prevalence of breast milk consumption were lower,respiratory distress syndrome（RDS）,bronchopulmonarydysplasia（BPD）and necrotizing enterocolitis（NEC）were more frequent,the duration of mechanical ventilation and oxygen supplementation was longer in patients with ROP（P〈0.05）.Initial serum IGF-1 levels tended to be lower in newborns who developed ROP.Logistic regression analysis revealed that low BW（〈1250 g）,presence of intraventricular hemorrhage（IVH）and formula feeding increased the risk of ROP.Afterwards,the scoring system was validated on 107 infants.The negative predictive values of a score less than 4 were 84.3%,74.7%and 79.8%while positive predictive values were 76.3%,65.5%and71.6%respectively.CONCLUSION：In addition to BW〈1250 g and IVH,formula consumption was detected as a risk factor for the development of ROP.Breastfeeding is important for prevention of ROP in preterm infants.

Postnatal weight gain in very low birth weight infants in Beijing and the risk of retinopathy of prematurity

AIMTo analyze the low weight gain (WG) from birth to 4 and 6wk of life to predict the development of retinopathy of prematurity (ROP) among very low birth weight (VLBW) preterm babies.METHODSThree hundred and three newborns with VLBW were analyzed. Body weight measurements were recorded weekly. In all patients, the proportion of the WG was defined as the preterm weight measured at the 4th and 6th weeks of life minus the birth weight (BW) divided by the BW. Other risk factors for ROP were also analyzed.RESULTSMean gestational age and mean BW of the whole cohort were 29.56±1.44wk and 1270.58±176.18g respectively. WG proportion at 4wk postnatal age (18.89%±13.58%) were significantly lower in infants with ROP (P=0.003). WG proportion at 6wk was not different between ROP and no ROP group (42.48%±20.36% vs 46.43%±15.65% P=0.118). When all the other risk factors significant for ROP were included in the logistic regression poor WG did not arise as an independent risk factor. Area under the ROC curve was 0.591 (95%CI: 0.515-0.666; P=0.016). For ROP, the best discriminative cutoff of 18.06% of the proportional WG at the 4th week over the BW, sensitivity and specificity values were 67.3% and 50.0% respectively.CONCLUSIONLow WG proportion in the first 4wk of life is maybe an additional predictor of ROP in very low BW infants. Preterm babies with low BW and low WG proportion should be followed closely for ROP.

Retinopathy of prematurity: Past, present and future

Retinopathy of prematurity(ROP) is a vasoproliferative disorder of the retina occurring principally in new born preterm infants. It is an avoidable cause of childhood blindness. With the increase in the survival of preterm babies, ROP has become the leading cause of preventable childhood blindness throughout the world. A simple screening test done within a few weeks after birth by an ophthalmologist can avoid this preventable blindness. Although screening guidelines and protocols are strictly followed in the developed nations, it lacks in developing economies like India and China, which have the highest number of preterm deliveries in the world. The burden of this blindness in these countries is set to increase tremendously in the future, if corrective steps are not taken immediately. ROP first emerged in 1940 s and 1950 s, when it was called retrolental fibroplasia. Several epidemics of this disease were and are still occurring in different regions of the world and since then a lot of research has been done on this disease. However, till date very few comprehensive review articles covering all the aspects of ROP are published. This review highlights the past, present and future strategies in managing this disease. It would help the pediatricians to update their current knowledge on ROP.

The neuroprotective effects of oxygen therapy in Alzheimer’s disease:a narrative review

Alzheimer’s disease(AD)is a degenerative neurological disease that primarily affects the elderly.Drug therapy is the main strategy for AD treatment,but current treatments suffer from poor efficacy and a number of side effects.Non-drug therapy is attracting more attention and may be a better strategy for treatment of AD.Hypoxia is one of the important factors that contribute to the pathogenesis of AD.Multiple cellular processes synergistically promote hypoxia,including aging,hypertension,diabetes,hypoxia/obstructive sleep apnea,obesity,and traumatic brain injury.Increasing evidence has shown that hypoxia may affect multiple pathological aspects of AD,such as amyloid-beta metabolism,tau phosphorylation,autophagy,neuroinflammation,oxidative stress,endoplasmic reticulum stress,and mitochondrial and synaptic dysfunction.Treatments targeting hypoxia may delay or mitigate the progression of AD.Numerous studies have shown that oxygen therapy could improve the risk factors and clinical symptoms of AD.Increasing evidence also suggests that oxygen therapy may improve many pathological aspects of AD including amyloid-beta metabolism,tau phosphorylation,neuroinflammation,neuronal apoptosis,oxidative stress,neurotrophic factors,mitochondrial function,cerebral blood volume,and protein synthesis.In this review,we summarized the effects of oxygen therapy on AD pathogenesis and the mechanisms underlying these alterations.We expect that this review can benefit future clinical applications and therapy strategies on oxygen therapy for AD.

Expression and function of Delta-like ligand 4 in a rat model of retinopathy of prematurity

The Delta-like ligand 4/Notch signaling pathway was shown to participate in the process of retinal development and angiogenesis. However, the function of the Delta-like ligand 4/Notch signaling pathway in retinopathy of prematurity requires further study. Retinopathy of prematurity was induced in 5-day-old Sprague-Dawley rats exposed to hyperoxia for 7 days, and then returned to room air. Reverse transcription-PCR and western blot revealed that Delta-like ligand 4 levels decreased at postnatal day 12 and increased at postnatal day 17 in retinopathy of prematurity rats. Flat-mounted adenosine diphosphatase stained retina and hematoxylin-eosin stained retinal tissue slices showed that the clock hour scores and the nuclei counts in retinopathy of prematurity rats were significantly different compared to normal control rats. After retinopathy of prematurity rats were intravitreally injected with Delta-like ligand 4 monoclonal antibody to inhibit the Delta-like ligand 4/Notch signaling pathway, there was a significant increase in the severity of retinal neovascularization （clock hours） in the intravitreally injected eyes. The nuclei count was highly correlated with the clock hour score. These results suggest that Delta-like ligand 4/Notch signaling plays an essential role in the process of physiological and pathological angiogenesis in the retina.

Fibrovascular proliferation of retinopathy of prematurity in zone Ⅱ after initial ranibizumab treatment

This study was designed to explore the prevalence of fibrovascular proliferation not regressed in zone Ⅱ stage 3 retinopathy of prematurity(ROP)after initial intravitreal ranibizumab(IVR)injections and to explore the possible influence factors.Fifty-seven patients(108 eyes)with ROP who underwent intravitreal injection of ranibizumab between January 2013 and July 2014 participated in the retrospective study.Based on regress of fibrovascular tissue or not after initial injections of ranibizumab,eligible eyes were divided into two groups.Data was collected and analyzed with SPSS 16.0.In the study,108 eyes of 57 patients(18 females,39 males)underwent initial intravitreal injection.The mean birth weight was 1,440.0±357.7 g and the mean gestational age was 30.5±2.0 weeks.Eight of 57(14.0%)patients showed unfavorable fibrovascular proliferation after initial ranibizumab treatment within 2 weeks.Among them,11 eyes were controlled by further laser treatment and 3 eyes underwent vitrectomy.The difference of occurrence rate in hemorrhage between the two groups was significant(P<0.030),and the unfavorable group required more laser treatment(P<0.001).The incidence of unfavorable fibrovascular proliferation was relatively high,and intraocular hemorrhage was possibly associated with the progress in zone Ⅱ stage 3 ROP after initial IVR injection.

Laser therapy versus intravitreal injection of anti-VEGF agents in monotherapy of ROP:a Meta-analysis

AIM:To compare the efficacy and safety between laser therapy and anti-vascular endothelial growth factor(VEGF)agents intravitreal injection monotherapy in type-1 retinopathy of prematurity(ROP)and aggressive posterior retinopathy of prematurity(APROP).METHODS:A systematic literature search was performed in PubMed,Cochrane Library,and Embase for original comparable studies.We included studies that compare laser therapy and intravitreal injections of anti-VEGF agents monotherapy in ROP regardless of languages and publication types.RESULTS:Complication incidence was significantly higher in laser therapy group(OR:0.38;95%CI:0.19-0.75;P=0.005).Spherical equivalent(SE)was higher in laser therapy[weighted mean difference(WMD):2.40,95%CI:0.88-3.93;P=0.002].The time between treatment and retreatment was longer in laser therapy group(WMD:8.45,95%CI:5.35-11.55;P<0.00001).Recurrence incidence(OR:0.97;95%CI:0.45-2.09;P=0.93)and retreatment incidence(OR:1.24;95%CI:0.56-2.73;P=0.59)were similar in two approaches.Subgroup analysis between type-1 ROP and APROP was not significant except SE reported in the included studies(P<0.0001).CONCLUSION:This Meta-analysis outcome indicates anti-VEGF agents are as effective as laser treatment,and safer than laser in type-1 ROP and APROP.The degree of myopia in APROP is higher than type-1 ROP.More randomized controlled trials in large sample size should be conducted in the future.

血常规指标与早产儿视网膜病变发病率及严重程度的相关性

目的分析血常规指标与早产儿视网膜病变发病率(retinopathy of prematurity,Rop)及严重程度的相关性,为临床防治及减轻ROP严重程度提供依据。方法回顾性系列病例研究(Retrospective case study),选取自2018年9月至2023年9月到昆明市儿童医院进行眼底检查的早产儿648例,男371例,女277例,分为无ROP组和ROP组包括阈值前ROP、阈值ROP及急进型后极部ROP(A-ROP),收集患儿胎龄、出生体重、血常规各参数,采用卡方检验检测性别组间差异,单因素方差分析胎龄、出生体重的组间差异,采用秩和检验检测血常规各项数据组间差异,及Logistic回归分析确立相关独立危险因素,并通过绘制受试者工作特征(ROC)曲线,评估LMR及NLR对ROP的早期预测价值。结果性别在组间比较差异无统计学意义(P>0.05),BW、GA在4组间比较中差异具有统计学意义(P<0.05)。3组ROP相较于无ROP组患儿WBC、N、M、HB、NLR比值均明显降低,LMR比值明显增高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析提示BW、GA、HB、NLR、N、M、LMR是发生ROP的独立危险因素(P<0.05)。ROC曲线显示,LMR的曲线下面积为0.651,LMR对ROP具有一定早期预测价值。结论BW、GA、HB、NLR、N、M、LMR是ROP的独立危险因素,LMR对ROP具有一定早期预测价值。

老年急性脑卒中患者经鼻高流量氧疗后呼吸困难信念现状及相关影响因素分析

目的 探讨老年急性脑卒中(CVA)患者经鼻高流量氧疗后(HFNC)呼吸困难信念现状及影响因素。方法 回顾性选取2022年1月-2023年1月首都医科大学附属北京天坛医院收治的136例老年CVA经HFNC患者作为研究对象,采用呼吸困难信念问卷(BBQ)进行呼吸困难信念评分,得分率=分值/满分×100%,将得分率<满分的60%设为低呼吸困难信念组,得分率≥满分的60%设为高呼吸困难信念组。比较2组文化程度、性别、领悟社会支持量表(PSSS)、住院时间、日常生活活动能力(ADL)、 24项自我效能感量表(SEES)差异,并通过二元Logistic回归分析高呼吸困难信念的影响因素。结果 研究共纳入136例老年CVA经HFNC患者,其中低呼吸困难信念组87例,高呼吸困难信念组49例;低呼吸困难信念组年龄、肺部感染控制、昏迷、吞咽功能、咳嗽反射、 SEES评分、 PSSS评分、 ADL、是否规律体育锻炼、 HFNC设置温度、发病后救治时间评估值与高呼吸困难信念组差异均有统计学意义(P<0.05);二元Logistic分析结果显示,年龄>75岁(OR=1.719,P=0.004)、吞咽功能越差(OR=1.735,P=0.006)、咳嗽反射越差(OR=1.898,P=0.0004)、 SEES评分低(OR=1.785,P=0.002)、 PSSS评分低(OR=1.599,P=0.006)、不规律体育锻炼(OR=1.634,P=0.003)、 HFNC设置温度≥37℃(OR=1.621,P=0.006)均为影响老年CVA患者HFNC后呼吸困难信念的独立危险因素(P<0.05);构建老年CVA患者HFNC后高呼吸困难信念的风险预测模型,以模型新生成概率值为依据,绘制预测模型ROC曲线,得到AUC=0.769 0(95%CI为0.681~0.759)>0.75;Hosmer-Lemeshow检验评价模型校准能力(χ^(2)=3.543,P=0.896>0.05)。结论 老年CVA患者经HFNC后呼吸困难信念总体处于较低水平,临床工作者应早期识别患者经HFNC后呼吸困难的动机,纠正他们对呼吸困难的灾害性认识,制定针对性干预措施,促进患者心理调适和疾病康复。

小于32周早产儿视网膜病变的临床资料及血象分析

目的探讨相关临床资料及血象对小于32周早产儿视网膜病(ROP)的影响。方法回顾性分析资料完整的2021年06月—2024年01月新生儿科收治的小于32周的早产儿,包括极早产儿组(胎龄28~31+6周)327例及超早产儿组(胎龄<28周)50例;收集两组早产儿的ROP组和非ROP组住院资料及所有血常规结果,通过单因素和多因素分析探讨ROP发生的高危因素;以受试者工作特征曲线(ROC)确定临界值,曲线下面积(AUC)评估危险因素的预测价值。结果极早产儿ROP检出率为12.5%(41/327),其中需手术比例为1.22%(4/327);超早产儿ROP的检出率为76.0%(38/50),其中需手术比例为20.0%(10/50)。极早产儿ROP组与非ROP组在胎龄、出生体重、有创机械通气时间、吸氧总时长、BPD、败血症、NEC、PNAC、ICH及住院期间血红蛋白最低值、白细胞平均值、嗜酸性粒细胞平均值、单核细胞平均值等差异有统计学意义(P<0.05);超早产儿ROP组与非ROP组在出生体重、吸氧总时长、BPD方面差异有统计学意义(P<0.05),全血计数资料差异均无统计学意义。经多因素Logistic回归分析结果显示,有创通气时间、NEC、ICH、血红蛋白最低值、嗜酸性粒细胞平均值是极早产儿组ROP发生的独立危险因素;超早产儿组未发现ROP独立危险因素。通过ROC曲线,有创机械通气对应的诊断临界值为5.5 d,提示极早产儿有创机械通气时间超过5.5 d,发生ROP的风险将增加;嗜酸性粒细胞对应的诊断临界值为0.245×10^(9)/L,提示极早产儿有嗜酸性粒细胞超过0.245×10^(9)/L,发生ROP的风险将增加;两者AUC在0.5~0.7,提示预测ROP效能较低。结论有创通气时间长、发生NEC、颅内出血、贫血程度越重、嗜酸性粒细胞升高是极早产儿ROP发生的独立危险因素;有创通气超过5.5 d或者嗜酸性粒细胞超过0.245×10^(9)/L的极早产儿,应高度重视发生ROP的风险;超早产儿ROP发生率及手术率高,可能因病情变化复杂,需要更多样本资料,去发现独立危险因素。

血液指标对早产儿视网膜病变影响的研究进展

早产儿视网膜病变(ROP)是发生在早产儿的血管异常增生性视网膜病变,可导致视网膜脱离和失明。随着新生儿医学的进步,低出生体质量儿及低胎龄儿存活率的提高,ROP发病率越来越高,因此,研究ROP的发病机制及影响因素具有重要的临床意义。既往文献对ROP的危险因素研究较多,如胎龄、吸氧、分娩方式、新生儿支气管肺的发育不良、表面活性剂的使用等。目前,早产、低出生体质量、出生后高浓度吸氧是国内外普遍公认的ROP独立危险因素。近些年来,越来越多的学者发现患儿的血液指标异常可能与ROP发生发展有关,本文就血小板、血红蛋白、血糖、炎症细胞及血脂对ROP的影响进行综述,为ROP危险因素的识别和预防提供参考。

经皮穿刺股静脉-动脉体外膜肺氧合患者发生下肢并发症的危险因素

目的分析经皮穿刺股静脉-动脉体外膜肺氧合(venoarterial extracorporeal membrane oxygenation,VA-ECMO)患者发生下肢并发症的危险因素。方法收集2020年1月至2022年12月在郑州大学第一附属医院因循环衰竭行VA-ECMO治疗的304例患者临床资料。根据患者临床事件分为下肢并发症组和无下肢并发症组,比较两组临床资料的差异,采用Logistic多因素回归分析探讨患者发生下肢并发症的危险因素。结果经过纳排标准筛选后,共有209例患者纳入本研究。下肢并发症发生率27.8%(n=58),下肢并发症组主动脉球囊反搏(intra-aortic balloon pump,IABP)治疗、机械通气、ECMO运行后4 h及24 h乳酸、24 h ECMO流量、ECMO操作并发症、神经系统并发症、高胆红素血症、急性肾功能不全进行连续肾脏替代治疗(continuous renal replacement therapy,CRRT)、感染并发症及病死率与无下肢并发症组相比差异有统计学意义(P<0.05)。Logistic多因素回归分析显示,IABP治疗和ECMO后24 h乳酸是VA-ECMO患者发生下肢并发症的独立危险因素。通过Generalized Additive Models分析得出拟合曲线显示,ECMO后24 h乳酸越高,下肢并发症发生率越高。结论IABP治疗和ECMO后24 h乳酸是VA-ECMO患者发生下肢并发症的独立危险因素。在VA-ECMO患者的治疗过程中,应密切关注这些因素,以便早期预防和干预下肢并发症的发生。

早产儿视网膜病危险因素研究进展

早产儿视网膜病(retinopathy of prematurity,ROP)是早产儿的严重并发症之一,严重者可致视网膜脱离甚至失明。ROP病因复杂,多种因素参与及影响了ROP的发生与进展,对其相关危险因素进行研究,有助于ROP的预防及治疗,对提高我国人口质量有重要意义。目前大量研究显示胎龄小、出生体重低、氧疗、机械通气、贫血、输血、早产儿感染、妊娠期并发症等均是ROP发生的危险因素,本文对这些可能影响ROP发生的相关危险因素进行综述。以期达到对危险因素的早期综合干预,提高ROP的整体防治水平,减少ROP的远期并发症。

GPER抑制星形胶质细胞活性减少OIR小鼠视网膜新生血管生成的机制研究

目的探究在氧诱导下的新生小鼠视网膜缺血模型(oxygen-induced retinopathy,OIR)中,G蛋白偶联雌激素受体(G proteincoupled estrogen receptor,GPER)减少OIR小鼠视网膜新生血管生成的机制。方法42只新生小鼠采用随机数字表法分为4组:常氧对照组(n=11)、OIR组(n=11)、G-1(GPER激动剂)组(n=10)和溶剂对照组(n=10)。出生后17 d(P17)时,眼球冰冻切片免疫荧光染色观察常氧对照组小鼠GPER在视网膜分布情况。G-1组和溶剂对照组在P12~P15时分别腹腔注射给予G-1[50μg/(kg·d)]或玉米油溶剂,P17时视网膜铺片免疫荧光染色观察视网膜血管标志物(IB4)、星形胶质细胞标志物胶质纤维酸性蛋白(glia fibrilary acidic protein,GFAP)表达,蛋白免疫印迹法定量检测视网膜血管内皮生长因子A(vascular endothelial growth factor A,VEGFA)、GFAP、炎症因子TNF-α、IGF-1、IL1-β蛋白表达情况。结果GPER存在于小鼠视网膜全层,在视网膜神经节细胞层与星形胶质细胞标志物GFAP共染。与常氧对照组相比,OIR组小鼠视网膜出现新生血管与无血管区,且GPER、VEGFA和GFAP表达增多,差异具有统计学意义(P<0.05);与溶剂对照组相比,G-1组视网膜新生血管生成减少,VEGFA、GFAP、TNF-α、IGF-1、IL1-β蛋白表达下降,差异具有统计学意义(P<0.05)。结论GPER能抑制星形胶质细胞活性,减少VEGFA、炎症因子释放,减少OIR小鼠视网膜新生血管生成。

早产儿视网膜病变的筛查结果分析

目的：总结早产儿视网膜病变（retinopathy of prematurity，ROP）发生发展特点及相关危险因素，探讨其合理的筛查标准和治疗模式。方法：对胎龄≤35wk，体质量≤2500g的1626例早产儿进行ROP筛查，并对其临床特点进行总结。结果：发现ROP173例（10．64％）；出生体质量≤1000g组，1001～1500g组，1501～2000g组，2001～2500g组患病百分比有显著性差异（分别为89．64％，29．71％，7．82％，1．29％，P〈0．05）；出生胎龄≤30wk组，30wk〈出生胎龄≤32wk组，32wk〈出生胎龄≤35wk组间ROP患病百分比有显著性差异（分别为31．11％，12．24％，4．04％，P〈0．05）；单生子与多生子患病率有显著性差异（分别为6．99％，34．12％，P〈0．05）；少数全身病情严重者可在32wk前发生ROP；患儿行冷凝术36例，手术效果满意。结论：体质量〈1500g，胎龄〈31wk，多生子中发病率高；及早行冷冻术病情榨制满意。

早产儿视网膜病变发生率和危险因素的临床研究

目的:调查早产儿视网膜病变(ROP)的发生率及危险因素。方法:研究对象是2006年7月至2008年12月在广东省人民医院新生儿重症监护病区住院治疗的早产儿,记录筛查出的视网膜病变的相关数据,包括可能的危险因素和眼部检查结果,进行统计分析。结果:在183例早产儿中,有42例发生了ROP,发生率23%。统计分析显示不同性别间ROP发生率差异不具有统计学意义(P>0.05);不同出生体重组间ROP发生率差异有显著性(P<0.05);不同孕周组间ROP发生率差异有显著性(P<0.05)。经卡方检验显示氧疗、呼吸暂停、肺炎与ROP有显著的关系(P<0.05)。结论:ROP的发生率较高,出生体重、孕周、氧疗、呼吸暂停、肺炎和ROP有显著关系。

早产儿视网膜病变激光光凝治疗效果及预后影响因素分析

目的:观察激光光凝术治疗阈值前Ⅰ型和阈值期早产儿视网膜病变(ROP)的临床效果,分析光凝术后病变进展的影响因素。方法:回顾分析激光光凝治疗ROP患者46例89眼,其中阈值前Ⅰ型57眼,阈值期32眼。采用810nm激光对周边视网膜无血管区进行光凝治疗。根据光凝术后结果分为病变消退组和进展组。随访视网膜解剖结构和ROP病变的变化,分析ROP病变部位、病变程度、光凝点数量、机械辅助呼吸、败血症、新生儿肺炎等因素与光凝术后病变进展的相关性。结果:ROP89眼经激光光凝治疗后病变完全消退79眼(89%),病变进展10眼(11%)。光凝治疗ROP病变消退组与进展组比较,出生胎龄、出生体重、首次光凝校正胎龄差异无统计学意义(P=0.668,0.495,0.143)。病变进展组的Ⅰ区病变、阈值病变、急性进展性后极部早产儿视网膜病变(AP-ROP)、光凝点数量均较病变消退组明显增加,差异有统计学意义(P=0.035,0.017,0.000,0.031)。Logistic回归分析结果显示,AP-ROP与光凝术后病变进展有关(P=0.001)。AP-ROP患眼光凝术后病变进展的可能性是非AP-ROP患眼的12.167倍(95%CI:2.733～54.154)。结论:激光光凝术能有效控制早期ROP的病变进展,使大部分阈值前Ⅰ型和阈值期ROP病变完全消退。急性进展性后极部早产儿视网膜病变光凝术后容易发生视网膜脱离,是影响光凝术后疗效的最主要因素。