母婴围生期感染因素对早产儿视网膜病的影响  

Effects of perinatal infection on retinopathy of prematurity

作　　者：谢露露[1] 罗先琼[2] 聂川[2] 梁志江[3] 谢素贞[4] 黄学林[4] 

机构地区：[1]广州医科大学附属广东省妇儿医院新生儿科,511442 [2]广东省妇幼保健院新生儿科,广州511442 [3]广东省妇幼保健院保健部,广州511442 [4]广东省妇幼保健院眼科,广州511442

出　　处：《中华实用儿科临床杂志》2017年第10期759-762,共4页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金（71173055）

摘　　要：目的探讨母婴围生期感染因素对早产儿视网膜病（ROP）的影响。方法采用回顾性队列研究方法，收集2014年11月至2015年10月在广东省妇幼保健院出生的符合入选标准的238例胎龄≤32周的早产儿的围生期病历资料及眼底检查结果。早产儿纠正胎龄45周终止观察。根据眼底病变严重程度分为轻度ROP（Ⅱ区、Ⅲ区的1期或2期病变，不伴附加性病变）、重度ROP[≥3期病变、Ⅰ区病变、阈值前病变/阈值病变、附加性病变、急进型ROP（AP－ROP）] 、手术治疗的ROP。对发生ROP、轻度ROP、重度ROP及手术治疗的ROP患儿的病历资料进行分析。结果238例早产儿出生胎龄为（30.10±1.34）周（25.29～32.00周），出生体质量为（1 373±272） g（720～2 330 g）。有76例发生ROP，ROP的发生率为31.9 %。其中39例（16.4%）发生轻度ROP，37例（15.5%）发生重度ROP，手术治疗的ROP共有22例（9.2%）。76例ROP中，早产儿从出生到ROP发生时间为（35.16±14.26） d，从出生到该病例发生ROP的最严重阶段的时间为（44.62±18.99） d。在22例需要手术治疗的ROP中，早产儿从出生到ROP手术的时间为（50.27±17.24） d。单因素分析提示，母亲围生期感染性疾病与ROP的发生和ROP手术治疗有关（χ^2＝7.891、4.494，P＝0.005、0.034）。孕周小、低出生体质量及吸氧时间长与ROP的发生及发展有关（t＝－5.803、－5.290、－4.150，均P〈0.001；t＝－4.942、－4.058、－3.126，P〈0.001、〈0.001、＝0.002；t＝2.351、2.473，P＝0.020、0.018）。出生1 min或5 min Apgar评分≤7分与重度ROP的发生有关（χ^2＝4.803，P＝0.028）。新生儿脓毒症及新生儿真菌感染与ROP的发生有关（χ^2＝6.071、4.070，P＝0.014、0.044），其中新生儿真菌感染与重度ROP的发生相关（χ^2＝5.479，P＝0.019）。多因素回归分析提示，母亲围生期感染性疾病是ROP发生及ROP手术治疗的独立危险因素�Objective To explore the effects of perinatal infection on retinopathy of prematurity（ROP）.Methods A retrospective cohort study was performed to analyzed the clinical data of 238 preterm infants at gestational age ≤32 weeks who were delivered in Guangdong Women and Children Hospital from November 2014 to October 2015 and ROP screening examinations.Observation was not terminated until they were 45 weeks of corrected gestational age.Mild ROP was defined as having stage 1 or stage 2 ROP in zone Ⅱ or Ⅲ without additional disease, and severe ROP was defined as stage 3 or higher, any ROP in zone Ⅰ, prethreshold/threshold, with additional disease, and aggressive posterior retinopathy of prematurity （AP-ROP）. Medical records of eligible preterm infants were retrospectively reviewed and analyzed.Occurrences of ROP, severe ROP, and clinically significant ROP requiring surgical treatment were assessed.Results The mean gestational age of the cohort was （30.10±1.34） weeks （25.29-32.00 weeks） and the mean birth weight was （1 373±272） g（720~2 330 g）. ROP was diagnosed in 76 of 238 infants （31.9%）, including 39 cases with mild ROP （16.4%） and 37 cases with severe ROP （15.5%）. Surgical treatment was performed on 22 infants （9.2%）. In the patients with ROP, the time to develop ROP from birth was （35.16±14.26） d and the mean time of its most serious stage was （44.62±18.99） d. In 22 patients with ROP who required surgical treatment, the time of surgical treatment was （50.27±17.24） d. In univariate analysis, maternal perinatal infection disease was found to be associated with ROP occurrence （χ^2=7.891, P=0.005） and ROP progression requiring surgical treatment （χ^2=4.494, P=0.034 ）. Small gestational age, low birth weight and long-term oxygen therapy were found to be associated with ROP occurrence and severe ROP （ gestational age： t=-5.803, P〈0.001; t=-5.290, P〈0.001; t=-4.150, P〈0.001; birth weight： t=-4.942, P〈0.001; t=-4.058, P〈0.001; t=-3.12

关 键 词：围生期因素 炎症和感染 早产儿视网膜病 回顾性队列研究 

分 类 号：R774.1[医药卫生—眼科]