Department of Pediatric Retina, Narayana Nethralaya Postgraduate Institute of Ophthalmology, Bangalore, India.
Retina. 2010 Apr;30(4 Suppl):S20-3. doi: 10.1097/IAE.0b013e3181cafc30.
The purpose of this study was to report the possible role of thrombocytopenia in the pathogenesis of aggressive posterior retinopathy of prematurity (APROP).
The index case described in this study showed spontaneous resolution of APROP with plus disease within 3 days of correcting thrombocytopenia and did not require laser treatment. The retrospective cohort of nine consecutive Asian Indian infants with APROP with similar stage and plus disease as the index case was studied. The mean platelet count of these infants before laser treatment was compared with 21 age- and birth weight-matched control subjects. Correlation of platelet count with APROP is discussed.
The mean birth weight of the 10 cases with APROP was 1,030 g (+/-178 g), and the mean period of gestation was 29.4 weeks (+/-2.0 weeks). The mean platelet count of the cases was 82,870/mm3 (+/-58,702/mm3) and that of the control subjects was 178,285 +/- 57,051/mm3 (P = 0.0002). Five of the 10 cases (50%) and 1 of the 21 control subjects (4.8%) had a platelet count of <100,000/mm3 (P = 0.007). In all, 19.4% of infants had culture-proven sepsis. There was no correlation between sepsis and thrombocytopenia in our cohort (P = 0.567).
The role of low platelets in the etiopathogenesis of APROP has not been previously elucidated. Our study shows that a platelet count of <100,000 was associated with severe disease. Recently, platelets have been reported to play a key role in angiogenic regulatory protein delivery. It is possible that premature infants who develop retinopathy of prematurity in the setting of low platelet counts may lack the function of either delivering the optimal level or incompletely scavenging the excess of vascular endothelial growth factor A present in APROP. The spontaneous resolution of disease in our index case with platelet correction alone needs additional studies to correlate the timing and magnitude of correction that may play a role.
本研究旨在报告血小板减少症在侵袭性早产儿后部视网膜病变（APROP）发病机制中的可能作用。
本研究中描述的指数病例在纠正血小板减少症后 3 天内自发缓解 APROP 合并 PLUS 病，且无需激光治疗。研究了与指数病例具有相似分期和 PLUS 病的 9 例连续亚裔印度婴儿的 APROP 回顾性队列。这些婴儿在激光治疗前的平均血小板计数与 21 名年龄和出生体重匹配的对照者进行比较。讨论了血小板计数与 APROP 的相关性。
10 例 APROP 患儿的平均出生体重为 1030g（+/-178g），平均胎龄为 29.4 周（+/-2.0 周）。病例组的平均血小板计数为 82870/mm3（+/-58702/mm3），对照组为 178285 +/- 57051/mm3（P=0.0002）。10 例中有 5 例（50%）和 21 例对照组中有 1 例（4.8%）血小板计数<100000/mm3（P=0.007）。共有 19.4%的婴儿患有培养阳性败血症。在我们的队列中，败血症与血小板减少症之间没有相关性（P=0.567）。
血小板减少在 APROP 的病因发病机制中的作用尚未阐明。我们的研究表明，血小板计数<100000 与严重疾病相关。最近，血小板已被报道在血管生成调节蛋白的传递中发挥关键作用。可能是在血小板计数低的情况下发生早产儿视网膜病变的早产儿缺乏输送最佳水平的功能，或者不完全清除 APROP 中存在的血管内皮生长因子 A 的过量。单独纠正血小板计数就可使疾病自发缓解的指数病例需要进一步研究来关联可能起作用的校正时间和幅度。
