高血糖作为早产儿视网膜病变发生的一个危险因素。
Hyperglycemia as a risk factor for the development of retinopathy of prematurity.
作者信息
Mohamed Shakir, Murray Jeffrey C, Dagle John M, Colaizy Tarah
出版信息
BMC Pediatr. 2013 May 16;13:78. doi: 10.1186/1471-2431-13-78.
BACKGROUND
Hyperglycemia has recently been described as a risk factor for the development of retinopathy of prematurity (ROP), a proliferative vascular disease of the retina that primarily affects premature infants. This study was to evaluate the relationship of hyperglycemia and the development of ROP in premature infants less than 32 weeks gestation.
METHODS
This was a retrospective cohort study of all infants less than 32 weeks gestation from 2003-2007 who survived to discharge in our NICU. Demographic data including birthweight, gestational age, Apgar scores, method of delivery, antenatal steroid use, neonatal steroid use, and size for gestational age was collected for each infant. Episodes of sepsis, grade of intraventricular hemorrhage, presence of a patent ductus arteriosus, number of days on the ventilator, and stage of necrotizing enterocolitis were assessed as well as days of hyperglycemia, defined as number of days with whole blood glucose > 150 mg/dl. In addition, the highest stage of ROP was recorded for each infant. A Student's two tailed t-test or Fisher's exact test was performed to identify significant clinical risk factors associated with the development of ROP. From this univariate analysis, a multiple logistic regression was performed to determine the effect of hyperglycemia on the development of ROP, adjusting for significant clinical risk factors. Statistical analysis was performed using SAS v.9.2.
RESULTS
Univariate analysis demonstrated that infants with ROP were of lower birthweight and gestational age, and were affected by a patent ductus arteriosus, neonatal sepsis, intraventricular hemorrhage, have significant lung disease and received postnatal glucocorticoid therapy. Infants with ROP experienced more days with hyperglycemia (7 vs. 2, p = < 0.0001). Using multiple logistic regression analysis to compare no ROP vs. all stages of ROP, gestational age (OR 0.745, 95% CI [0.634, 0.877], p = 0.0004), mean days of hyperglycemia (OR 1.073, 95% CI [1.004, 1.146], p = 0.04), and mean days receiving mechanical ventilation (OR 1.012, 95% CI [1.000, 1.025], p = 0.05) remained significantly associated with ROP after adjusting for other risk factors.
CONCLUSION
Our data suggests that hyperglycemia is associated with the development of ROP in premature infants.
背景
高血糖症最近被描述为早产儿视网膜病变（ROP）发生的一个风险因素，ROP是一种主要影响早产儿的视网膜增殖性血管疾病。本研究旨在评估孕周小于32周的早产儿高血糖与ROP发生之间的关系。
方法
这是一项对2003年至2007年在我们新生儿重症监护病房（NICU）存活至出院的所有孕周小于32周婴儿的回顾性队列研究。收集了每个婴儿的人口统计学数据，包括出生体重、孕周、阿氏评分、分娩方式、产前使用类固醇、新生儿使用类固醇以及小于胎龄儿情况。评估了败血症发作次数、脑室内出血分级、动脉导管未闭情况、机械通气天数以及坏死性小肠结肠炎分期，以及高血糖天数，高血糖定义为全血糖>150mg/dl的天数。此外，记录了每个婴儿的ROP最高分期。进行学生双尾t检验或Fisher精确检验以确定与ROP发生相关的显著临床风险因素。根据该单因素分析，进行多因素逻辑回归以确定高血糖对ROP发生的影响，并对显著临床风险因素进行校正。使用SAS v.9.2进行统计分析。
结果
单因素分析表明，患有ROP的婴儿出生体重和孕周较低，且受动脉导管未闭、新生儿败血症、脑室内出血影响，有严重肺部疾病并接受了产后糖皮质激素治疗。患有ROP的婴儿高血糖天数更多（7天对2天，p = <0.0001）。使用多因素逻辑回归分析比较无ROP与所有ROP分期，在对其他风险因素进行校正后，孕周（比值比0.745，95%可信区间[0.634, 0.877]，p = 0.0004）、平均高血糖天数（比值比1.073，95%可信区间[1.004, 1.146]，p = 0.04）以及平均机械通气天数（比值比1.012，95%可信区间[1.000, 1.025]，p = 0.05）仍与ROP显著相关。
结论
我们的数据表明，高血糖与早产儿ROP的发生有关。
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