CAJ | 학술논문

目的观察并分析广东省3家医院早产儿视网膜病变(ROP)的发生发展特点及治疗后转归情况.方法前瞻性研究.采用双目间接检眼镜对出生或收治于广东省3家妇幼保健院的出生体重＜2000 g早产儿和低体重儿638例进行ROP筛查.排除未完成随访的52例,共586例1172只眼纳入研究.首次眼底筛查时间为出生后4.0～6.0周或矫正胎龄32.0周.对阈值期前1型病变考虑激光光凝治疗,阈值期病变48 h内首选激光治疗.所有患儿均随访至周围视网膜完全血管化,ROP病变自然退行或治疗后病变退行且治疗后至少1个月.观察并分析ROP发生率,ROP发生时患儿矫正胎龄、出生日龄,ROP治疗时患儿矫正胎龄、出生日龄,ROP病变进展天数以及随访期间治疗眼的预后情况.对ROP患儿胎龄与其ROP发生、治疗时出生日龄之间行Spearman相关性分析.结果 1172只眼中,发生ROP者118只眼,占10.07％;视网膜完全血管化1054只眼,占89.93％.发生ROP者胎龄中位数30.2周,矫正胎龄中位数36.4周；发生ROP时出生日龄中位数40.5 d.共60只眼需进行ROP治疗.其胎龄中位数29.3周,矫正胎龄中位数37.5周；需治疗时的出生日龄中位数59.5 d.相关性分析发现,胎龄与ROP发生、需治疗时出生日龄均呈负相关(R=-0.65,-0.80；P=0.000).ROP 1期进展至2期、2期进展至3期、3期进展至需治疗的3个阶段,其病情进展天数中位数分别为14.0、10.5、3.0d.随着病变加重,病情进展时间缩短,并呈非正态分布.各进展阶段病情进展天数中位数比较,差异有统计学意义(H=30.69,P=0.000).治疗眼治疗后追光、注视反应正常,视盘、黄斑、视网膜结构正常,无视网膜血管行径异常,亦未发现玻璃体、视网膜增生病变形成.结论广东省3家医院ROP发生时间在矫正胎龄36.4周左右,ROP治疗时间在矫正胎龄37.5周左右.随着ROP病变加重,其病情进展时间缩短.治疗眼预后良好. 目的觀察併分析廣東省3傢醫院早產兒視網膜病變(ROP)的髮生髮展特點及治療後轉歸情況.方法前瞻性研究.採用雙目間接檢眼鏡對齣生或收治于廣東省3傢婦幼保健院的齣生體重＜2000 g早產兒和低體重兒638例進行ROP篩查.排除未完成隨訪的52例,共586例1172隻眼納入研究.首次眼底篩查時間為齣生後4.0～6.0週或矯正胎齡32.0週.對閾值期前1型病變攷慮激光光凝治療,閾值期病變48 h內首選激光治療.所有患兒均隨訪至週圍視網膜完全血管化,ROP病變自然退行或治療後病變退行且治療後至少1箇月.觀察併分析ROP髮生率,ROP髮生時患兒矯正胎齡、齣生日齡,ROP治療時患兒矯正胎齡、齣生日齡,ROP病變進展天數以及隨訪期間治療眼的預後情況.對ROP患兒胎齡與其ROP髮生、治療時齣生日齡之間行Spearman相關性分析.結果 1172隻眼中,髮生ROP者118隻眼,佔10.07％;視網膜完全血管化1054隻眼,佔89.93％.髮生ROP者胎齡中位數30.2週,矯正胎齡中位數36.4週；髮生ROP時齣生日齡中位數40.5 d.共60隻眼需進行ROP治療.其胎齡中位數29.3週,矯正胎齡中位數37.5週；需治療時的齣生日齡中位數59.5 d.相關性分析髮現,胎齡與ROP髮生、需治療時齣生日齡均呈負相關(R=-0.65,-0.80；P=0.000).ROP 1期進展至2期、2期進展至3期、3期進展至需治療的3箇階段,其病情進展天數中位數分彆為14.0、10.5、3.0d.隨著病變加重,病情進展時間縮短,併呈非正態分佈.各進展階段病情進展天數中位數比較,差異有統計學意義(H=30.69,P=0.000).治療眼治療後追光、註視反應正常,視盤、黃斑、視網膜結構正常,無視網膜血管行徑異常,亦未髮現玻璃體、視網膜增生病變形成.結論廣東省3傢醫院ROP髮生時間在矯正胎齡36.4週左右,ROP治療時間在矯正胎齡37.5週左右.隨著ROP病變加重,其病情進展時間縮短.治療眼預後良好.
목적 관찰병분석광동성3가의원조산인시망막병변(ROP)적발생발전특점급치료후전귀정황.방법 전첨성연구.채용쌍목간접검안경대출생혹수치우광동성3가부유보건원적출생체중＜2000 g조산인화저체중인638례진행ROP사사.배제미완성수방적52례,공586례1172지안납입연구.수차안저사사시간위출생후4.0～6.0주혹교정태령32.0주.대역치기전1형병변고필격광광응치료,역치기병변48 h내수선격광치료.소유환인균수방지주위시망막완전혈관화,ROP병변자연퇴행혹치료후병변퇴행차치료후지소1개월.관찰병분석ROP발생솔,ROP발생시환인교정태령、출생일령,ROP치료시환인교정태령、출생일령,ROP병변진전천수이급수방기간치료안적예후정황.대ROP환인태령여기ROP발생、치료시출생일령지간행Spearman상관성분석.결과 1172지안중,발생ROP자118지안,점10.07％;시망막완전혈관화1054지안,점89.93％.발생ROP자태령중위수30.2주,교정태령중위수36.4주；발생ROP시출생일령중위수40.5 d.공60지안수진행ROP치료.기태령중위수29.3주,교정태령중위수37.5주；수치료시적출생일령중위수59.5 d.상관성분석발현,태령여ROP발생、수치료시출생일령균정부상관(R=-0.65,-0.80；P=0.000).ROP 1기진전지2기、2기진전지3기、3기진전지수치료적3개계단,기병정진전천수중위수분별위14.0、10.5、3.0d.수착병변가중,병정진전시간축단,병정비정태분포.각진전계단병정진전천수중위수비교,차이유통계학의의(H=30.69,P=0.000).치료안치료후추광、주시반응정상,시반、황반、시망막결구정상,무시망막혈관행경이상,역미발현파리체、시망막증생병변형성.결론 광동성3가의원ROP발생시간재교정태령36.4주좌우,ROP치료시간재교정태령37.5주좌우.수착ROP병변가중,기병정진전시간축단.치료안예후량호.
Objective To overview the characteristic in development and progress of retinopathy of prematurity (ROP).Method Six hundred and thirty eight premature birth infants with birth weight less than 2000 grams born or hospitalized in three hospitals in Guangdong province were examined by indirect ophthalmoscopy as part of ROP screening.1172 eyes in 586 infants are included.Follow-up has not been completed in 52 infants.The first time of screening was 4 to 6 weeks after birth or 32 weeks corrected for gestational age.Threshold and pre-threshold (type Ⅰ) disease was treated by laser photo-coagulation within 48 hours.All infants were followed until complete vascularization,natural regress or for more than 1 month after effective therapy.Data regarding incidence of ROP,corrected gestational age and days after birth of ROP onset,corrected gestational age and days after birth of getting treatment,progress pace and prognosis were collected and analyzed by Spearman statistical analyses.Results In 1172 eyes,ROP developed in 118 eyes (10.07 ％).In 1054 eyes (89.93 ％) were completed vascularized.Sixty eyes received laser treatment.In ROP infants,the median gestational age was 29.3 weeks and the median corrected gestational age and days after birth when ROP develops were 36.4 weeks and 59.5 days respectively.There was a negative correlation between gestational age and ROP development and treatment timing (R=-0.65,-0.80；P=0.000).The median interval days from stage 1 to stage 2,from stage 2 to stage 3,and stage 3 to getting treatment were 14.0,10.5 and 3.0 days respectively.The interval showed a non-normal distribution and there is statistical difference (H=30.69,P=0.000).During the follow-up after treatment,the ocular fixation and following reactions were normal.The structure of optic disc,the macula lutea and retina were normal.Conclusions Timing of ROP development is about 36.4 weeks corrected for gestational age and 37.5 weeks when treated.The interval is shorter when ROP progresses.The prognosis is good for the treatment of aular.