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广东省部分三级医院早产儿视网膜病变发生率调查

Clinical study on the effect of polycythemia on retinopathy of prematurity

Objective　To explore the effect of polycythemia on retinopathy of prematurity (ROP). Methods　The clinical data of 262 premature cases was analyzed retrospectively in Xi'an Children Hospital from January 2005 to January 2009. Polycythemia was found in 46 cases (17.56%), including 27 males and 19 females. In 216 infants without polycythemia (82.46%), 155 were male and 61 were female. The difference of the birth weight (t=0.730, P=0.466), gestational age (t=1.603,P=0.110), oxygen inhalation numbers (chi;2=0.04,P＞0.90) and times (t=1.225,P=0.223), and concentration (t=1.823,P=0.071) between polycythemia group and no polycythemia group were not significant. In order to diagnose ROP, the ocular fundus of all premature infants was examined with binocular indirect ophthalmoscope,and the stage of ROP was assessed.Results　In all the premature infants,ROP was found in 120 cases (45.80%). In 46 cases of polycythemia, ROP was found in 25 cases (54.34%); in 216 infants without polycythemia, ROP was found in 95 cases (43.98%); the difference of ROP incidence between the two groups was not significant (chi;2=1.64, Pgt;0.1).In 120 ROP patients, 104 cases (86.67%) with ROP＜3 stage and 16 cases (13.33%) with ROP ge;3 stage were found. In 25 ROP patients with polycythemia, 18 cases (72.00%) with ROP ＜3 stage and 7 cases (28.00%) with ROP ge;3 stage were found. In 95 ROP patients without polycythemia, 86 cases (90.53%) with ROP ＜3 stage and 9 cases (9.47%) with ROP ge;3 stage were found. The difference of the incidence of ROP ＜and ge;3 stage between the two group was significant (chi;2=4.38, Plt;0.05). In 120 cases of ROP, prethreshold retinopathy was found in 106 cases (88.33%), while threshold and post-threshold retinopathy was in 14 cases (11.67%). In 25 ROP patients with polycythemia, prethreshold retinopathy was found in 19 cases (76.00%), and threshold and post-threshold retinopathy was in 6 cases (24.00%).In 95 ROP infants without polycythemia, pre-threshold retinopathy was found in 87 cases (91.58%),while threshold and post　threshold retinopathy was in 8 cases (8.42%).The difference of the incidence of ROP with prethreshold, and threshold and post-threshold retinopathy between the two groups was not significant (chi;2=3.27,P＞0.05).Conclusion　Polycythemia may not affect the incidence of ROP,but impact on the severity of ROP.

肾素-血管紧张素系统阻滞剂预防早产儿视网膜病变研究

血管紧张素Ⅱ（Ang Ⅱ）是肾素血管紧张素系统（RAS）的主要效应产物和多种器官有效的生长因子。在早产儿视网膜病变（ROP）等缺血性视网膜病变中，RAS上调，视网膜RAS被激活，刺激具有促微血管渗漏、周细胞迁移、新生血管生成和纤维化功能的血管内皮生长因子（VEGF）等上调。对RAS的阻滞主要通过血管紧张素转换酶抑制剂和血管紧张素Ⅱ受体拮抗剂来实现。RAS阻滞剂在ROP的发生发展过程中可能具有防止和减弱病理性血管生成的作用。对RAS的阻断有望成为ROP的治疗途径。