Dept. of Public Health & Community Medicine, Tufts University School of Medicine, Boston, USA; Dept. of Gynecology & Obstetrics, Hannover Medical School, Hannover, Germany; Dept. of Neuromedicine & Movement Science, Norwegian University of Science & Technology, Trondheim, Norway; Dept. of Philosophy, University of Johannesburg, Johannesburg, South Africa.
Dept. of Pediatrics, Augusta University, Augusta, USA.
Prog Retin Eye Res. 2024 Jan;98:101230. doi: 10.1016/j.preteyeres.2023.101230. Epub 2023 Nov 19.
Retinopathy of prematurity (ROP) is a complex neonatal disorder with multiple contributing factors. In this paper we have mounted the evidence in support of the proposal that neonatal sepsis meets all requirements for being a cause of ROP (not a condition, mechanism, or even innocent bystander) by means of initiating the early stages of the pathomechanism of ROP occurrence, systemic inflammation. We use the model of etiological explanation, which distinguishes between two overlapping processes in ROP causation. It can be shown that sepsis can initiate the early stages of the pathomechanism via systemic inflammation (causation process) and that systemic inflammation can contribute to growth factor aberrations and the retinal characteristics of ROP (disease process). The combined contribution of these factors with immaturity at birth (as intrinsic risk modifier) and prenatal inflammation (as extrinsic facilitator) seems to provide a cogent functional framework of ROP occurrence. Finally, we apply the Bradford Hill heuristics to the available evidence. Taken together, the above suggests that neonatal sepsis is a causal inducer of ROP.
早产儿视网膜病变（ROP）是一种复杂的新生儿疾病，有多种致病因素。本文通过引发 ROP 发生的病理机制的早期阶段——全身炎症，为新生儿败血症符合成为 ROP 病因（而非疾病、机制，甚至无辜的旁观者）这一观点提供了支持证据。我们使用病因解释模型，该模型区分了 ROP 病因学中的两个重叠过程。可以证明败血症可以通过全身炎症（病因过程）引发病理机制的早期阶段，而全身炎症可能导致生长因子异常和 ROP 的视网膜特征（疾病过程）。这些因素与出生时的不成熟（作为内在风险调节剂）和产前炎症（作为外在促进因素）的共同作用，似乎为 ROP 的发生提供了一个有力的功能框架。最后，我们将布拉德福德·希尔启发式应用于现有证据。综上所述，这些证据表明新生儿败血症是 ROP 的病因诱导剂。
