[西安早产儿视网膜病变筛查的初步结果]

Wang Yu-sheng, Zhang Zi-feng, Li Man-hong, Zhang Peng, Liu Xiao-yan

Department of Ophthalmology, Eye Institute of Chinese PLA, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China.

Zhonghua Yan Ke Za Zhi. 2010 Feb;46(2):119-24.

OBJECTIVE

To investigate the appropriate criteria for the screening of retinopathy of prematurity (ROP) in Xi'an region and to determine the risk factors for ROP.

METHODS

Screening criteria were established basing on the ROP screening guidelines, implemented by Ministry of Public Health with minor modification. It included newborn infants with birth weight of 2000 g or less, or gestational age of 34 w or less. The results obtained by the present screening criteria were compared with those obtained from the national screening criteria. Gestation age and birth weight between groups of ROP and normal fundus were compared by Student t-test, the ratios of persistent oxygen inhalation were examined by Chi-square test, and the risk factors for ROP were analyzed by Fisher exact test. A P < 0.05 was considered significant.

RESULTS

In all the infants examined, 18 cases (36 eyes, 13.43%) developed ROP, including 4 cases (8 eyes) suffering from stage 1, 5 cases (10 eyes) from stage 2 (one was affected in zone II with plus disease), 5 cases (10 eyes) from stage 3 with plus disease, 1 case (2 eyes) from stage 4 A, 1 case (2 eyes) from stage 5, and 2 cases (4 eyes) from regressed stage. In ROP cases, gestation age ranged from 28 to 34 w, (30.58 +/- 1.97) w; birth weight ranged from 880 to 1950 g, (1388.89 +/- 268.39) g. Statistical analysis showed that, the gestation age and birth weight in normal fundus group were (32.56 +/- 2.00) w and (1773.91 +/- 349.73) g respectively, which were higher than group of ROP (gestation age t = 3.90, P < 0.01; birth weight t = 4.45, P < 0.01). The ratios of persistent oxygen inhalation in group of normal fundus and ROP were 59.48% and 61.11% (chi(2) = 0.017, P > 0.05). It was also observed that the ratios of hypoxic-ischemic encephalopathy and placenta abruption in those two groups were 12.07%, 33.33% (P = 0.030) and 0.86%, 11.11% (P = 0.047). Clinical analysis indicated that prematurity, low birth weight, hypoxic-ischemic encephalopathy and placenta abruption were closely related to the occurrence of ROP. On the other hand, if using national screening criteria, only 108 infants in all 134 cases required screening, and all of the ROP cases could be detected with a detection rate at 16.67%.

CONCLUSIONS

The detection rate of ROP is 13.43% (18/134) in the present study, which is consistent with the results obtained in previous studies in China. The national criteria are appropriate for the ROP screening in Xi'an region. Prematurity, low birth weight and the relative hypoxia are high risk factors for the occurrence of ROP.

目的

探讨西安地区早产儿视网膜病变（ROP）筛查的适宜标准，并确定ROP的危险因素。

方法

依据卫生部实施的ROP筛查指南并略作修改制定筛查标准。纳入出生体重2000g及以下或胎龄34周及以下的新生儿。将本筛查标准所得结果与国家筛查标准所得结果进行比较。ROP组与正常眼底组的胎龄和出生体重采用Student t检验进行比较，持续吸氧比例采用卡方检验，ROP的危险因素采用Fisher确切概率法分析。P<0.05认为差异有统计学意义。

结果

在所有检查的婴儿中，18例（36眼，13.43%）发生ROP，其中1期4例（8眼），2期5例（10眼）（1例在Ⅱ区合并增值性病变），3期合并增值性病变5例（10眼），4A期1例（2眼），5期1例（2眼），退行期2例（4眼）。ROP病例中，胎龄为28～34周，（30.58±1.97）周；出生体重为880～1950g，（1388.89±268.39）g。统计学分析显示，正常眼底组的胎龄和出生体重分别为（32.56±2.00）周和（1773.91±349.73）g，高于ROP组（胎龄t=3.90，P<0.01；出生体重t=4.45，P<0.01）。正常眼底组与ROP组的持续吸氧比例分别为59.48%和61.11%（χ²=0.017，P>0.05）。还观察到两组中缺氧缺血性脑病和胎盘早剥的比例分别为12.07%、33.33%（P=0.030）和0.86%、11.11%（P=0.047）。临床分析表明，早产、低出生体重、缺氧缺血性脑病和胎盘早剥与ROP的发生密切相关。另一方面，若采用国家筛查标准，134例中仅108例婴儿需要筛查，且所有ROP病例均可被检出，检出率为16.67%。