摘要
目的探讨相关临床资料及血象对小于32周早产儿视网膜病(ROP)的影响。方法回顾性分析资料完整的2021年06月—2024年01月新生儿科收治的小于32周的早产儿,包括极早产儿组(胎龄28~31+6周)327例及超早产儿组(胎龄<28周)50例;收集两组早产儿的ROP组和非ROP组住院资料及所有血常规结果,通过单因素和多因素分析探讨ROP发生的高危因素;以受试者工作特征曲线(ROC)确定临界值,曲线下面积(AUC)评估危险因素的预测价值。结果极早产儿ROP检出率为12.5%(41/327),其中需手术比例为1.22%(4/327);超早产儿ROP的检出率为76.0%(38/50),其中需手术比例为20.0%(10/50)。极早产儿ROP组与非ROP组在胎龄、出生体重、有创机械通气时间、吸氧总时长、BPD、败血症、NEC、PNAC、ICH及住院期间血红蛋白最低值、白细胞平均值、嗜酸性粒细胞平均值、单核细胞平均值等差异有统计学意义(P<0.05);超早产儿ROP组与非ROP组在出生体重、吸氧总时长、BPD方面差异有统计学意义(P<0.05),全血计数资料差异均无统计学意义。经多因素Logistic回归分析结果显示,有创通气时间、NEC、ICH、血红蛋白最低值、嗜酸性粒细胞平均值是极早产儿组ROP发生的独立危险因素;超早产儿组未发现ROP独立危险因素。通过ROC曲线,有创机械通气对应的诊断临界值为5.5 d,提示极早产儿有创机械通气时间超过5.5 d,发生ROP的风险将增加;嗜酸性粒细胞对应的诊断临界值为0.245×10^(9)/L,提示极早产儿有嗜酸性粒细胞超过0.245×10^(9)/L,发生ROP的风险将增加;两者AUC在0.5~0.7,提示预测ROP效能较低。结论有创通气时间长、发生NEC、颅内出血、贫血程度越重、嗜酸性粒细胞升高是极早产儿ROP发生的独立危险因素;有创通气超过5.5 d或者嗜酸性粒细胞超过0.245×10^(9)/L的极早产儿,应高度重视发生ROP的风险;超早产儿ROP发生率及手术率高,可能因病情变化复杂,需要更多样本资料,去发现独立危险因素。
Objective To investigate the effects of clinical data and blood routine on retinopathy of prematurity(ROP)in premature infants less than 32 weeks.Methods Retrospective analysis of clinical data of prematurity less than 32 weeks in neonatal ward from June 2021 to January 2024 was done.There were 327 cases in the very preterm infant group(28-31+6 weeks)and 50 cases in the extremely preterm infant group(<28 weeks).Relevant information and ROP screening results were recorded for all children,and were compared between the ROP and non-ROP groups.The independent risk factors were determined by multivariate Logistic analysis.Moreover,receiver operating characteristic curve(ROC)was used to determine the critical value and area under curve(AUC)was used to evaluate the predictive value of risk factors.Results The detection rate of ROP in 327 very preterm infants was 12.5%(41/327),and the proportion of surgery in ROP infants was 1.22%(4/327).The detection rate of ROP in 50 extremely preterm infants was 76.0%(38/50),of which the proportion requiring surgical intervention was 20.0%(10/50).Univariate analysis showed that there were significant differences in gestational age,birth weight,duration of oxygen and mechanical ventilation,BPD,NEC,sepsis,ICH,PNAC,minimum level of hemoglobin during hospitalization,the mean cell count of WBC,EO,MO in the very preterm infant group between the ROP and non-ROP groups(P<0.05).There were significant differences in birth weight,duration of oxygen,BPD in the extremely preterm group between the ROP and non-ROP groups(P<0.05).None of the routine blood count data was significant difference for ROP in the extremely preterm infants.Multivariate Logistic analysis showed that duration of mechanical ventilation,NEC,ICH,PNAC,minimum level of hemoglobin were independent risk factors for ROP in the very preterm group,and there were no independent risk factors for ROP in the extremely preterm group.Moreover,ROC curve suggested that the critical value of mechanical ventilation duration was 5.5 days in the very preterm infants,suggesting that the higher risk of ROP was increased with mechanical ventilation duration more than 5.5 days.The critical value of EO count was 0.245×10^(9)/L,and the risk of ROP with EO count more than 0.245×10^(9)/L was increased.In addition,both of the AUC were between 0.5-0.7,which had lower predictive value.Conclusion 1.Longer duration of mechanical ventilation,NEC,ICH,PNAC,and lower minimum level of hemoglobin were independent risk factors for ROP in the very preterm infants.2.More attention should be paid to those with mechanical ventilation duration more than 5.5 days and EO count more than 0.245×10^(9)/L.3.The extremely preterm infant group has a higher incidence of ROP,and a higher incidence of surgery.With more complicated process duration of hospital stay,more cases should be needed to discover independent risk factors in the extremely preterm infant.
作者
高沙沙
管欣娴
俞生林
缪欣欣
GAO Sha-sha;GUAN Xin-xian;YU Sheng-lin;MIAO Xin-xin(Department of Neonatology,Children's Hospital of Soochow University,Suzhou,Jiangsu,215003,China)
出处
《中国血液流变学杂志》
CAS
2024年第2期278-283,共6页
Chinese Journal of Hemorheology
关键词
极早产儿
超早产儿
早产儿视网膜病变
危险因素
血常规计数平均值
very preterm infant
extremely preterm infants
retinopathy of prematurity
risk factors
the mean of blood routine index
