胎龄小于32周超低出生体重儿早产儿视网膜病变的危险因素分析及预测指标研究

Risk factors and predictive markers for retinopathy of prematurity in extremely low birth weight infants born before 32 weeks of gestation

摘要

目的 分析胎龄小于32周超低出生体重儿早产儿视网膜病变(ROP)的危险因素并探讨ROP发生的预测指标,为制定精准防控策略和改善预后提供科学依据。方法 基于回顾性研究,选择2016年1月至2023年6月在东莞市妇幼保健院住院治疗的145名胎龄小于32周超低出生体重儿为研究对象.根据视网膜筛查结果,分为ROP组(86例)和非ROP组(59例).比较2组患儿临床资料及实验室指标,分析超低出生体重儿发生ROP的危险因素。结果 单因素结果显示:两组新生儿小于胎龄儿、胎膜早破、母亲妊娠期合并高血压、母亲妊娠期合并糖尿病、体外受精胚胎移植术率的比较,差异均有统计学意义(χ²值分别为4.149、4.722、7.879、5.358、6.079,均P＜0.05).ROP组支气管肺发育不良(BPD)发生率、输注红细胞次数、有创呼吸通气时间及呼吸机辅助通气总时间高于非ROP组,差异有统计学意义(χ²/Z值分别为3.860、-2.505、-3.070、-3.021,均P＜0.05).两组血红蛋白、C反应蛋白、活化部分凝血活酶时间及尿素比较,差异均有统计学意义(t/Z值分别为2.070、-2.525、-2.258、-2.834,P＜0.05).多因素二元Logistic回归分析显示:母亲妊娠期糖尿病(OR＝3.605,95％CI:1.385~9.387)及患儿呼吸机辅助通气总时间(OR＝1.028,95％CI:1.012~1.044)是ROP发生的独立危险因素(P＜0.05).受试者工作特征(ROC)曲线显示呼吸机辅助通气总时间对ROP的预测效果较好,其ROC曲线下面积(AUC)为0.648(95％CI:0.564~0.725),灵敏度为62.8％,特异度为62.1％,截断值为43.55天。结论 母亲妊娠期糖尿病及患儿呼吸机辅助通气总时间是胎龄小于32周超低出生体重儿ROP发生的独立危险因素,且呼吸机辅助通气总时间对ROP的发生有较好的预测价值.

Abstract

Objective To analyze the risk factors for retinopathy of prematurity (ROP) in extremely low birth weight (ELBW) infants with a gestational age of less than 32 weeks and to explore predictive indicators of ROP occurrence, aiming to provide a scientific basis for precise prevention strategies and improved prognosis. Methods This retrospective study included 145 ELBW infants with a gestational age of <32 weeks who were hospitalized at Dongguan Maternal and Child Health Hospital between January 2016 and June 2023. According to retinal screening results, infants were divided into an ROP group (n=86) and a non-ROP group (n=59). Clinical characteristics and laboratory indicators were compared between the two groups to identify risk factors for ROP. Results Univariate analysis showed statistically significant differences between the two groups in terms of small for gestational age status, premature rupture of membranes, maternal gestational hypertension, maternal gestational diabetes mellitus, and rate of in vitro fertilization and embryo transfer (χ²=4.149, 4.722, 7.879, 5.358 and 6.079, respectively, P<0.05). The ROP group had significantly higher rates of bronchopulmonary dysplasia (BPD), more frequent red blood cell transfusions, longer durations of invasive ventilation, and total mechanical ventilation compared to the non-ROP group (χ²/Z=3.860, -2.505, -3.070 and -3.021, respectively, P<0.05). Significant differences were also observed in hemoglobin, C-reactive protein, activated partial thromboplastin time (APTT), and urea levels (t/Z=2.070, -2.525, -2.258 and -2.834, respectively, P<0.05). Multivariate binary logistic regression identified maternal gestational diabetes (OR=3.605, 95%CI: 1.385-9.387) and total mechanical ventilation duration (OR=1.028, 95%CI: 1.012-1.044) as independent risk factors for ROP (P<0.05). Receiver operating characteristic (ROC) curve analysis demonstrated that total mechanical ventilation duration had moderate predictive value for ROP (AUC=0.648, 95%CI: 0.564-0.725), with a sensitivity of 62.8%, specificity of 62.1%, and a cutoff value of 43.55 days. Conclusion Maternal gestational diabetes and prolonged total mechanical ventilation are independent risk factors for ROP in ELBW infants born before 32 weeks of gestation. Moreover, total mechanical ventilation duration shows moderate predictive value for the development of ROP.

关键词

超低出生体重儿 / 早产儿视网膜病变 / 危险因素 / 预测价值

Key words

extremely low birth weight infant / retinopathy of prematurity / risk factor / predictive value

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基金资助

东莞市社会科技发展项目(20231800905282)