The Correlation between Routine Blood Indicators and Severity of Retinopathy of Prematurity
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摘要:
目的 分析血常规指标与早产儿视网膜病变发病率（retinopathy of prematurity，Rop）及严重程度的相关性，为临床防治及减轻ROP严重程度提供依据。 方法 回顾性系列病例研究（Retrospective case study），选取自2018年9月至2023年9月到昆明市儿童医院进行眼底检查的早产儿648例，男371例，女277例，分为无ROP组和ROP组（包括阈值前ROP、阈值ROP及急进型后极部ROP（A-ROP），收集患儿胎龄、出生体重、血常规各参数，采用卡方检验检测性别组间差异，单因素方差分析胎龄、出生体重的组间差异，采用秩和检验检测血常规各项数据组间差异，及Logistic回归分析确立相关独立危险因素，并通过绘制受试者工作特征（ROC）曲线，评估LMR及NLR对ROP的早期预测价值。 结果 性别在组间比较差异无统计学意义（P > 0.05），BW、GA在4组间比较中差异具有统计学意义（P < 0.05）。3组ROP相较于无ROP组患儿WBC、N、M、HB、NLR比值均明显降低，LMR比值明显增高，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析提示BW、GA、HB、NLR、N、M、LMR是发生 ROP 的独立危险因素（P < 0.05）。ROC曲线显示，LMR的曲线下面积为0.651，LMR 对 ROP具有一定早期预测价值。 结论 BW、GA、HB、NLR、N、M、LMR是ROP的独立危险因素， LMR 对 ROP具有一定早期预测价值。 Abstract:Objective To analyze the morbidity rate and severity of retinopathy of prematurity （ROP） so as to provide a basis for the clinical prevention and treatment and reduce the severity of ROP. Methods 648 premature infants, including 371 males and 277 females, who underwent the fundus examination at Kunming Children’ s Hospital from September 2018 to September 2023 were selected and divided into a non ROP group and a ROP group （including pre threshold ROP, threshold ROP, and rapidly advancing posterior pole ROP （A-ROP）. The parameters of gestational age, birth weight, and blood routine were collected, and chi square test was used to detect gender group differences. Univariate analysis of variance was used to analyze the inter group differences in gestational age and birth weight. Rank sum test was used to detect the inter group differences in blood routine data, and the logistic regression analysis were conducted to establish the relevant independent risk factors, and evaluate the early predictive value of LMR and NLR for ROP by drawing receiver operating characteristic （ROC） curves. Results The rank-sum test showed that the differences in gestational age, daytime age, and birth weight were statistically significant （P < 0.05） in the four groups compared with the no-ROP, pre-threshold, threshold, and A-ROP groups. The white blood cell count, neutrophil count, monocyte count, hemoglobin, and NLR ratio were significantly lower and the LMR ratio was significantly higher in the three ROP groups compared to the children in the no-ROP group, and the differences were statistically significant （P < 0.05）. Multi-factor logistic regression analysis suggested that birth weight, gestational age, hemoglobin, NLR, and LMR were independent risk factors for the development of ROP （P < 0.05）. The ROC curve showed that the area under the curve for LMR was 0.651 （95%CI: 0.605-0.698）, with a best predictive value was 7.36, corresponding to a sensitivity of 55.8% and a specificity of 71.4%. Conclusion Birth weight, gestational age, hemoglobin, and NLR are independent risk factors for ROP, with birth weight, gestational age, and hemoglobin as the protective factors. LMR has some early predictive value for ROP. -
Key words:
- Retinopathy of prematurity /
- Risk factors /
- Blood indices /
- Disease severity
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图 1 患儿NLR、LMR预测早产儿视网膜病变的ROC曲线
Figure 1. Receiver operating characterstic curve oF LMR and NLR
表 1 BW（g）和GA（周）4组比较（$\bar x \pm s $）
Table 1. Comparison of gestational age （weeks），birth weight （grams） in four groups （$\bar x \pm s $）
组别 无ROP组（n=189） 阈值前组（n=268） 阈值组（n=167） A-ROP组（n=24） F P BW（g） 1878.84±384.62 1476.73±337.52 1344.58±362.88 1408.2±428.78 11.73 <0.001* GA（周） 33.15±2.27 30.25±2.1 29.51±2.30 29.63±2.19 15.28 <0.001* *P < 0.05。 
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表 2 不同组之间BW与GA比较
Table 2. Comparison of gestational age （weeks），birth weight （grams） in two groups
组别 BW（g） GA（周） 均值差 P 均值差 P ① 与② 402.03 <0.001* 2.89 <0.001* ① 与③ 534.25 <0.001* 3.64 <0.001* ① 与④ 470.54 <0.001* 3.52 <0.001* ② 与③ 132.22 <0.001* 0.75 <0.001* ② 与④ 68.51 <0.001* 0.62 <0.001* ③ 与④ −63.71 <0.001* 1.27 <0.001* ①无ROP组；②阈值前组；③阈值组；④A-ROP组；*P < 0.05。
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表 3 血常规参数4组比较
Table 3. Comparison of routine blood indicators in four groups
组别 无ROP组（n=189） 阈值前组（n=268） 阈值组（n=167） A-ROP组（n=24） Z P WBC（×109/L） 9.37（7.01，12.18） 8.08（6.63，10.00） 8.24（6.36，10.70） 7.97（6.02，9.22） 12.035 0.007* L（×109/L） 4.55（3.51，6.18） 5.185（4.08，6.41） 4.94（3.67，6.45） 4.18（3.34，5.94） 9.643 0.22 N（×109/L） 2.65（1.72，4.10） 1.65（1.13，2.38） 1.68（1.23，2.73） 1.76（1.17，3.52） 53.659 <0.001* M（×109/L） 0.85（0.56，1.22） 0.645（0.46，0.87） 0.57（0.41，0.94） 0.68（0.34，0.97） 28.254 <0.001* RBC（×1012/L） 3.64（3.17，4.08） 3.5（3.19，3.86） 3.58（3.21，3.98） 3.45（3.24，3.90） 2.997 0.392 HB（g/L） 115（102.5，134） 103（94，111） 102（93，113） 102（96.5，116） 62.102 <0.001* PLT（×109/L） 385（255.5，481） 389（305.75，446.75） 371（287，449） 330.5（247.5，441.25） 1.619 0.655 E（×109/L） 0.31（0.15，0.51） 0.27（0.18，0.39） 0.24（0.16，0.42） 0.2（0.13，0.32） 4.73 0.193 B（×109L） 0.01（0，0.02） 0.01（0.01，0.02） 0.01（0.01，0.02） 0.01（0，0.01） 5.331 0.149 NLR 0.52（0.33，1.03） 0.32（0.22，0.47） 0.35（0.24，0.62） 0.39（0.23，1.05） 61.429 <0.001* LMR 5.74（3.68，8.16） 7.93（5.62，11.30） 7.87（5.09，12.18） 7.81（4.44，10.60） 36.97 <0.001* PLR 77.（55.27，108.83） 76.63（54.81，96.34） 73.（54.50，103.70） 73.56（58.38，108.72） 2.353 0.502 *P < 0.05。
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表 4 ROP多因素Logistic回归分析
Table 4. Multivarate logistic regression analysis of ROP
相关因素 回归系数B 回归系数标准误（sb） Wald P OR 95%CI BW 0.000 0.000 4.369 0.037 0.999 0.998～1.000 GA −0.423 0.069 37.936 0.000 0.655 0.573～0.749 HB −0.025 0.006 19.337 0.000 0.975 0.964～0.986 NLR −0.424 0.133 10.106 0.001 0.655 0.504～0.850 N −0.433 0.069 45.786 0.000 1.250 0.567～0.742 M −0.587 0.140 17.606 0.000 0.649 0.567～0.742 LMR −0.004 0.001 8.895 0.004 0.996 0.994～0.999
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表 5 各个指标早期预测价值比较
Table 5. Prediction value of each index to ROP
指标 AUC 灵敏度 特异度 最佳界值 95%CI P NLR 0.312 0.987 0.021 0.008 0.267～0.357 <0.001* LMR 0.651 0.558 0.714 0.272 0.605～0.698 <0.001* *P < 0.05。
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