极低出生体重早产儿脐带血胰岛素样生长因子1水平与严重视网膜病变的相关性
Association of umbilical cord insulin-like growth factor 1 levels with severe retinopathy in extremely preterm infants.
作者信息
Nagano Nobuhiko, Katayama Daichi, Hara Koichiro, Akimoto Takuya, Imaizumi Takayuki, Seimiya Ayako, Aoki Ryoji, Hijikata Midori, Fuwa Kazumasa, Okahashi Aya, Morioka Ichiro
机构信息
Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan.
出版信息
Pediatr Neonatol. 2023 Mar;64(2):126-132. doi: 10.1016/j.pedneo.2022.05.015. Epub 2022 Sep 17.
BACKGROUND
The association between umbilical cord blood insulin-like growth factor 1 (IGF-1) levels and retinopathy of prematurity (ROP) remains unclear. This study aimed to investigate whether umbilical cord blood IGF-1 levels can predict the development of severe ROP in extremely preterm infants.
METHODS
This hospital-based retrospective cohort study included infants born at <37 weeks gestational age (GA) between 2019 and 2021 and then classified them into the two GA groups: extremely preterm, <28 weeks and preterm infants, 28-36 weeks. Extremely preterm infants were further subclassified into two groups according to the laser treatment as follows: the severe ROP (ROP-Tx) and ROP (No ROP-Tx) groups. Median umbilical cord blood IGF-1 values were compared between the groups. Perinatal risk factors were identified by univariate and multivariate analyses. Finally, umbilical cord IGF-1 cut-off values requiring ROP treatment with laser were determined by receiver operating characteristic (ROC) curve analyses.
RESULTS
A total of 205 infants were enrolled, with 32 being extremely preterm (ROP-Tx: n = 11; No ROP-Tx: n = 21) and 173 being preterm. IGF-1 levels were significantly lower in extremely preterm (13.5 ng/mL) than preterm infants (36 ng/mL, p < 0.001). In extremely preterm infants, IGF-1 levels were significantly lower in the ROP-Tx group than the No ROP-Tx group (10 vs. 19 ng/mL, respectively, p = 0.024). Only GA, umbilical cord blood IGF-1 levels, birth head circumference, and birth chest circumference were identified as risk factors by univariate analysis (p < 0.05). Multivariate analysis showed that only umbilical cord blood IGF-1 was an independent risk factor (odds ratio: 1.26, p = 0.021). ROC curves revealed an IGF-1 cut-off value of 14 ng/mL.
CONCLUSION
The need of laser treatment for ROP was found to be associated with low umbilical cord blood IGF-1 levels in extremely preterm infants. Umbilical cord blood IGF-1 can be used as a biomarker for the risk of developing severe ROP.
背景
脐带血胰岛素样生长因子1（IGF-1）水平与早产儿视网膜病变（ROP）之间的关联尚不清楚。本研究旨在调查脐带血IGF-1水平是否能够预测极早产儿严重ROP的发生。
方法
这项基于医院的回顾性队列研究纳入了2019年至2021年间孕周小于37周（GA）出生的婴儿，然后将他们分为两个GA组：极早产儿（<28周）和早产儿（28-36周）。极早产儿根据激光治疗情况进一步分为两组：严重ROP（ROP-Tx）组和ROP（未进行ROP-Tx）组。比较两组之间脐带血IGF-1的中位数。通过单因素和多因素分析确定围产期危险因素。最后，通过受试者工作特征（ROC）曲线分析确定需要进行激光治疗ROP时脐带血IGF-1的临界值。
结果
共纳入205例婴儿，其中32例为极早产儿（ROP-Tx组：n = 11；未进行ROP-Tx组：n = 21），173例为早产儿。极早产儿的IGF-1水平（13.5 ng/mL）显著低于早产儿（36 ng/mL，p < 0.001）。在极早产儿中，ROP-Tx组的IGF-1水平显著低于未进行ROP-Tx组（分别为10 ng/mL和19 ng/mL，p = 0.024）。单因素分析仅将GA、脐带血IGF-1水平、出生时头围和胸围确定为危险因素（p < 0.05）。多因素分析显示，只有脐带血IGF-1是独立危险因素（比值比：1.26，p = 0.021）。ROC曲线显示IGF-1临界值为14 ng/mL。
结论
发现极早产儿ROP的激光治疗需求与脐带血IGF-1水平低有关。脐带血IGF-1可作为发生严重ROP风险的生物标志物。
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