超早产儿早产儿视网膜病变的发病情况及危险因素分析

目的分析8年间孕周<28周的超早产儿(EPI)早产儿视网膜病变(ROP)的发生情况及危险因素。方法回顾性研究。2011年1月1日至2018年12月31日天津市中心妇产科医院新生儿重症监护病房收治的孕周<28周的EPI 300例纳入研究。记录EPI出生孕周(GA)、出生体重(BW)、性别等基本资料和新生儿呼吸窘迫综合征、吸氧(≥10 d)、支气管肺发育不良(BPD)等住院治疗情况及并发症。依据ROP国际分类标准对ROP进行分期。重症ROP定义为需要治疗的ROP。所有受检儿的筛查起始时间、筛查间隔、干预时间均按照《早产儿视网膜病变筛查指南》要求进行,直至随访终止。将每位受检儿随访过程中出现的最严重ROP记为该受检儿的最终筛查结果,双眼非对称者记录其发病严重侧的筛查结果。回顾分析8年间EPI ROP总体发生率、重症ROP发生率以及第一、二阶段即2011年1月1日至2014年12月31日和2015年1月1日至2018年12月31日ROP发生率、重症率的变化情况。采用logistic回归分析筛选重症ROP的独立危险因素。结果 300例EPI中,平均GA为(26.7±1.8)周;平均BW为(993.3±178.7)g。205例(68.3%)诊断为ROP,Ⅰ、Ⅱ、Ⅲ期病变分别为116 (56.6% )、57 (27.8% )、32 (15.6%)例,无Ⅳ期和Ⅴ期患者。合并附加病变30例(14.6% ),需要治疗的重症ROP 59例(19.7% )。随着GA (χ2=52.391、44.521 ,P=0.000、0.000)和BW (χ2=43.772、26.138,P=0.000、0.000)增加,EPI ROP发生率和重症ROP发生率均明显降低。2011年至2018年EPI存活人数逐年增加,尤其小GA (<26周)、低BW (<750 g)者增加明显。第二阶段EPI的平均GA低于第一阶段,差异有统计学意义(t=2.243 ,P=0.026 );第二阶段EPI的平均BW低于第一阶段,但差异无统计学意义(t=1.428,P=0.154 )。第二阶段EPI的ROP发生率略高于第一阶段,重症ROP发生率低于第一阶段,但差异均无统计学意义(χ2=1.069、1.723,P=0.301、0.189 )。多因素logistic回归分析结果显示,GA<27周(β=-2.584,P=0.032 )、母亲绒毛膜羊膜炎(CA)(β=-0.935,P=0.038)和BPD (β=-1.432 ,P=0.001)是重症ROP的独立危险因素。结论 EPI ROP和重症ROP发生率分别为68.3%和19.7%。2011年至2018年EPI存活人数逐年增加,小GA、低BW者增加明显,但ROP和重症ROP发生率维持稳定。GA、CA和BPD是重症ROP的独立危险因素。

Incidence and risk factors of retinopathy of prematurity in extremely preterm infants

Objective To investigate the incidence and risk factors of retinopathy of prematurity(ROP)in extremely preterm infants(EPI)before 28 weeks of gestation during 8-years period.Methods A retrospective study.From January 1,2011 to December 31,2018,300 EPI infants with a gestational age of less than 28 weeks admitted to the neonatal intensive care unit(NICU)of Tianjin Central Hospital of Gynecology Obstetrics were included in the study.EPI birth gestational week(GA),birth weight(BW),gender and other basic information,as well as neonatal respiratory distress syndrome,oxygen(≥10 d),bronchopulmonary dysplasia(BPD)and other hospitalizations and complications were recorded.According to ROP international classification standards,ROP was staged.Severe ROP was defined as ROP that requires treatment.The screening start time,screening interval,and intervention time of all children tested were carried out in accordance with the requirements of the“Guidelines for Screening Retinopathy of Prematurity”,until the end of follow-up.The most severe ROP during the follow-up of each examined child was recorded as the final screening result of the examined child,and those with asymmetric eyes with the screening results of the severe side of the diseas was recorded.A retrospective analysis of the overall incidence of EPI ROP showed the incidence of severe ROP,and the first and second stages of EPI ROP during the 8 years(from January 1,2011 to December 31,2014,and January 1,2015 to December 31,2018),changes in the rate of severe illness.Logistic regression analysis was used to screen independent risk factors for severe ROP.Results Among 300 EPI infants,the average GA was(26.7±1.8)weeks;the average BW was(993.3±178.7)g.Two hundred and five infants(68.3%)were diagnosed with ROP,116(56.6%),57(27.8%),and 32(15.6%)infants of stageⅠ,Ⅱ,andⅢdisease,respectively.There were no infants of stageⅣandⅤ.There were 30 infants(14.6%)with additional lesions and 59 infants(19.7%)with severe ROP requiring treatment.With the increase of GA of(χ^2=52.391,44.521;P=0.000,0.000)and BW(χ^2=43.772,26.138;P=0.000,0.000),the incidence of EPI ROP and the incidence of severe ROP decreased significantly.From 2011 to 2018,the number of people surviving EPI obviously increased,especially those with small GA(26 weeks)and low BW(750 g).The average GA of the second stage EPI was lower than that of the first stage,the difference was statistically significant(t=2.243,P=0.026);the average BW of the second stage EPI was lower than the first stage,the difference was not statistically significant(t=1.428,P=0.154).The incidence of ROP in the second stage EPI was slightly higher than that in the first stage,and the incidence of severe ROP was lower than that in the first stage,the difference was not statistically significant(χ^2=1.069,1.723;P=0.301,0.189).Multivariate logistic regression analysis showed that GA<27 weeks(β=-2.584,P=0.032),maternal chorioamnionitis(CA)(β=-0.935,P=0.038)and BPD(β=-1.432,P=0.001)was an independent risk factor for severe ROP.Conclusions The incidence of EPI ROP and severe ROP are 68.3%and 19.7%,respectively.From 2011 to 2018,the number of survivors of EPI obviously increase,and those with small GA and low BW increase significantly;however,the incidence of ROP and severe ROP remaine stable.GA,CA and BPD are independent risk factors for severe ROP.