出生后第一周胆汁酸水平与早产儿视网膜病变的关系

Relationship between bile acids level in the first postnatal week and retinopathy of prematurity in premature infants

摘要

目的 探讨早产儿出生后第一周胆汁酸水平与早产儿视网膜病变(ROP)的关系。方法 选取2018年9月至2022年12月于徐州医科大学附属医院新生儿重症监护病房(NICU)住院的早产儿作为研究对象,根据眼底筛查结果将纳入的345例早产儿分为ROP组150例和非ROP组195例,比较两组早产儿临床资料的差异性,Logistic回归分析ROP发生的危险因素,采用受试者工作特征(ROC)曲线判断胆汁酸水平对ROP发生的预测价值。结果 ROP组患儿出生胎龄、出生体重、出生后5min Apgar评分均低于非ROP组,输注悬浮少白红细胞≥3次、呼吸机使用时长、禁食时间、静脉营养时间、出生后第1周最高胆汁酸水平及支气管肺发育不良(BPD)、败血症、贫血、颅内出血(ICH)发生率均高于非ROP组,差异有统计学意义(χ²/Z值介于-7.527~35.903之间,P<0.05);多因素Logistic回归分析结果显示出生胎龄是ROP发生的独立保护因素(OR=0.776,95%CI:0.636~0.946,P<0.05),出生后第一周最高胆汁酸水平是ROP发生的独立危险因素(OR=1.099,95%CI:1.048~1.152,P<0.05);ROC曲线分析显示,出生后第一周最高胆汁酸水平预测ROP的曲线下面积(AUC)为0.728(95%CI:0.673~0.783),敏感度为69.30%,特异度为75.40%,截断值为10.25μmol/L;当第一周最高胆汁酸水平≥10.25μmol/L时,ROP发生风险增加(OR=6.180,P<0.05)。结论 胎龄较小、出生后第一周高胆汁酸水平可能与ROP发生风险增高有关.

Abstract

Objective To investigate relationship between bile acids level in the first postnatal week and retinopathy of prematurity (ROP) in premature infants. Methods A total of 345 premature infants who hospitalized in Neonatal Intensive Care Unit (NICU) of The Affiliated Hospital of Xuzhou Medical University from September 2018 to December 2022 were selected as the study subjects, and were divided into ROP group (n=150) and non-ROP group (n=195) according to the result of fundus screening of the premature infants. The differences in clinical data between the two groups was compared. Binary Logistic regression analysis was used to analyze risk factors of ROP. Receiver operating characteristic (ROC) curve was used to judge predictive value of serum bile acids level for ROP. Results The gestational age at birth, birth weight, Apgar scores at postnatal 5 minutes of the premature infants in the ROP group were lower than those in the non-ROP group, however, the proportion of red blood cell transfusion ≥3 times, duration of mechanical ventilation, time of fasting, time of intravenous nutrition, the highest serum bile acids level in the first week after birth, and the incidence rates of bronchopulmonary dysplasia (BPD), sepsis, anemia and intracranial hemorrhage (ICH) in the ROP group were longer and higher than those in the non-ROP group, and the differences were statistically significant (χ²/Z=-7.527-35.903, all P<0.05). Multivariate Logistic regression analysis showed that the gestational age at birth (OR=0.776, 95%CI:0.636-0.946, P<0.05) was a protective factor for ROP, and the highest bile acids level in the first postnatal week (OR=1.099, 95%CI:1.048-1.152, P<0.05) was independent risk factor for ROP. ROC curve analysis showed that area under the curve (AUC) of the highest bile acids level in the first postnatal week for predicting occurrence of ROP was 0.728 (95%CI:0.673-0.783), the sensitivity was 69.3%, the specificity was 75.4%, and the cut-off value was 10.25μmol/L. When the highest bile acids level in the first postnatal week was ≥10.25μmol/L, the risk of ROP increased (OR=6.180, P<0.05). Conclusion Small gestational age and high bile acids level in the first postnatal week may be associated with increased risk of ROP in premature infants.

关键词

早产儿视网膜病变 / 胆汁酸 / 早产儿 / 危险因素

Key words

retinopathy of prematurity / bile acids / premature infant / risk factor

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