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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (4): 270-274.

• 论著 • 上一篇    下一篇

应用闪光视网膜电图评估早产儿视网膜病变自然退行者视网膜功能的病例对照研究

杨晨皓1,3,蔡晓静1,3,沈李1,周晓红1,陈超2   

  1. 复旦大学附属儿科医院 1 眼科，2 新生儿科 上海，201102；3 共同第一作者
  • 收稿日期:2016-07-07 修回日期:2016-08-29 出版日期:2016-08-25 发布日期:2016-08-25
  • 通讯作者: 陈超

Retinal function after spontaneously regressed ROP in preterm infants assessed with F-ERG: a case-control study

YANG Chen-hao1,3, CAI Xiao-jing1,3, SHEN Li1, ZHOU Xiao-hong1, CHEN Chao2   

  1. 1 Department of Ophthalmology, 2 Department of Neonatology, Children′s Hospital of Fudan University, Shanghai 201102, China; 3 Co-first author
  • Received:2016-07-07 Revised:2016-08-29 Online:2016-08-25 Published:2016-08-25
  • Contact: CHEN Chao

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摘要：

目的 应用闪光视网膜电图（F-ERG）评估早产儿视网膜病变（ROP）自然退行者在终止检查时点的视网膜功能。方法 采用病例对照研究设计，ROP自然退行者作为病例组，未发生ROP的早产儿作为对照组，病例组以筛查间隔期分3个亚组（A亚组：Ⅲ区 1期病变3周检查1次；B亚组：Ⅱ区1期、Ⅲ区2期病变2周检查1次；C亚组：Ⅰ区无ROP、Ⅰ区1期或2期、Ⅰ区退行ROP和Ⅱ区2期或3期病变每周检查1次）。依据中国ROP筛查指南方案至终止检查时点，应用F-ERG对两组早产儿进行视网膜功能评估，比较两组指标的差异，P<0.05为差异有统计学意义；A、B、C 3亚组间比较P<0.016 7为差异有统计学意义。结果 2015年1月至2016年1月复旦大学附属儿科医院新生儿病房符合本文病例组和对照组纳入标准的早产儿分别为119例和160例。依据排除标准，病例组39例（78眼）、对照组37例（74眼）进入本文分析。病例组较对照组视杆反应b波、最大混合反应a波、最大混合反应b波、振荡电位峰值、视锥反应b波平均振幅降低，差异均有统计学意义；各反应平均潜伏期均延长，差异均有统计学意义。B亚组较A亚组各反应平均振幅和平均潜伏期差异均无统计学意义； C亚组较A亚组视杆反应b波、振荡电位峰值和视锥反应b波平均振幅下降，差异有统计学意义，平均潜伏期除最大混合反应a波和视锥反应a波外，余反应均延迟，差异有统计学意义；C亚组较B亚组各反应平均振幅和平均潜伏期差异均无统计学意义。结论 ROP自然退行者在终止筛查时点，其视网膜功能发育落后于相同矫正胎龄的未发生ROP的早产儿，ROP病变程度越重、越靠近后级部，对视网膜功能影响越明显。

Abstract:

Objective To study the retinal function of preterm infants with the history of spontaneously regressed retinopathy of prematurity (ROP) after the final screening by flash electroretinogram (F-ERG).Methods A case-control study was conducted among the preterm infants with the history of spontaneously regressed ROP and they were defined as case group, and those without ROP as control group. The case group was further divided into three subgroups (A, B, C) based on the screening interval periods. According to the guidelines for ROP screening in China, the retinal function was assessed in both groups by F-ERG at the final screening point.Results 119 preterm infants in case group and 160 in control group met the inclusion criteria in neonatology department of Children's Hospital of Fudan University from January 2015 to January 2016. According to the exclusion criteria, 39(78 eyes) of the case group and 37 (74 eyes) of the control group were analyzed in this study. Compared with the control group, the average response amplitude of b-wave of the rod, a-wave and b-wave of the largest mixed reaction, oscillatory potentials (OPs), b-wave of the cone of case group were statistically reduced, and the average latency of responses was significantly prolonged in all of the case groups. There was no statistical difference of the average amplitude and the average latency of all responses between group A and group B; Compared to group A, the average amplitude of b-wave of the rod, OPs and b-wave of the cone of group C was significantly reduced , and the average latency of all the other responses of group C was significantly prolonged except a-wave of the largest mixed reaction and a-wave of the cone. There was no statistical difference of the average amplitude and the average latency of all responses between group B and group C.Conclusion Compared to no-ROP preterm infants, the retinal development of preterm with the history of spontaneously regressed ROP was delayed at the final screening point. There was a close correlation between the stage and position of ROP and the retinal development.