早产儿视网膜病变的筛查策略探讨

目的:根据早产儿出生体重和出生胎龄为指标,探讨早产儿视网膜病变的临床筛查标准和初次筛查时间。方法:收集2008年2月～2011年2月厦门市妇幼保健院NICU病区1 148例早产儿,使用双目间接眼底镜进行眼底检查,收集相关临床资料进行统计分析。结果:出生体重≤1 000 g、1 001～1 250 g、1 251～1 500 g、1 501～1 750 g、1 751～2 000 g、>2 000 g各组间阈值ROP发生率比较有统计学差异(χ2=201.54,P<0.001),其OR值为1.00、0.45、0.24、0.07、0.02、0.003,出生体重﹥1 500 g时阈值ROP发病率显著降低;ROC曲线示在出生体重为1 532.5g面积最大;出生胎龄﹤28周、28～30周、30～32周、32～34周、≥34周各组间阈值ROP发生率差异有统计学意义(χ2=213.14,P<0.001),其OR值为1.00、0.68、0.29、0.07、0.02,出生胎龄>32周时阈值ROP发病率明显降低;ROC曲线显示在出生胎龄32.07周面积最大;出现阈值ROP时的矫正胎龄﹤35周的8例早产儿,出生后周龄均在4～6周。结论:出生体重≤1 500 g和出生胎龄≤32周是ROP筛查指标;初次筛查时间在矫正胎龄≥35w或出生后4～6周。

Discussion of screening strategy of retinopathy of prematurity

Objective:To explore the clinical screening criteria and screening time for the first time according to birth weight and birth gestational age of premature infants.Methods:A total of 1 148 premature infants from NICU of the hospital from February 2008 to February 2011 were collected,bilateral indirect ophthalmoscope was used for fundus examination,related clinical data were collected for statistical analysis.Results:There was statistically significant difference in the incidence of threshold retinopathy of prematurity(ROP) among the infants with birth weight ≤1 000 g,1 001-1 250 g,1 251-1 500 g,1 501-1 750 g,1 751-2 000 g,and >2 000 g(χ2=201.54,P<0.001),the OR values were 1.00,0.45,0.24,0.07,0.02,and 0.003,respectively;the incidence of threshold ROP in infants with birth weight>1 500 g decreased significantly.The area under ROC curve was the largest in the infants with birth weight=1 532.5 g;there was statistically significant difference in the incidence of threshold ROP among the infants with birth gestational age<28,28-30,30-32,32-34,and ≥34 weeks(χ2=213.14,P<0.001),the OR values were 1.00,0.68,0.29,0.07,and 0.02,respectively;the incidence of threshold ROP in infants with birth gestational age>32 weeks decreased significantly ROC curve showed that the area was the largest in the infants with birth gestational age=32.07 weeks;the gestational weeks of 8 premature infants with threshold ROP whose correct gestational weeks was less than 35 weeks were 4-6 weeks.Conclusion:Birth weight≤1 500 g and birth gestational weeks≤32 weeks are screening indexes of ROP;the screening time for the first time was correct gestational weeks≥35 weeks or at 4-6 weeks after birth.