The Correlation between Routine Blood Indicators and Severity of Retinopathy of Prematurity
-
摘要:
目的 分析血常规指标与早产儿视网膜病变发病率及严重程度的相关性研究，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 analysis the morbidity rate andseverity of retinopathy of prematurity （ROP） so as to provide a basis for 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
-
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
Table 1. Comparison of Gestational age （weeks），Birth weight （grams） 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） 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。 
下载: 导出CSV
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* *P < 0.05；①无ROP组；②阈值前组；③阈值组；④A-ROP组。
下载: 导出CSV
表 3 血常规参数4组比较
Table 3. Comparison of RoutineBlood 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。
下载: 导出CSV
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
下载: 导出CSV
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。
下载: 导出CSV
-
[1] 中华医学会眼科学分会眼底病学组. 中国早产儿视网膜病变筛查指南(2014年)[J]. 中华眼科杂志,2014,50(12):933-935. [2] Hellström A,Smith L E H,Dammann O. Retinopathy of prematurity[J]. Lancet,1991,337(8733):83-84. doi: 10.1016/0140-6736(91)90742-8 [3] Kim T I,Sohn J,Pi S Y,et a1. Postnatal risk factors of retinopathy of prematurity[J]. Paediatr Perinat Epidemiol,2004,18(2):130-134. doi: 10.1111/j.1365-3016.2003.00545.x [4] Ronit,Lubetzky,Chaim,et a1. Nucleated red blood cells in preterm infants with retinopathy of prematurity[J]. Pediatrics,2005,116(5):e619-22. doi: 10.1542/peds.2005-0915 [5] 姜海涛,李国仁. 我国早产儿视网膜病变的筛查现状[J]. 国际眼科杂志,2021,21(8):1386-1389. [6] 陈志伟,凌华,林琳. 早产儿视网膜病变筛查结果及其高危因素分析[J]. 中国医药科学,2019,9(2):77-80. [7] Waheeb S,Alshehri K. Incidence of retinopathy of prematurity at two tertiary centers in Jeddah,Saudi Arabia[J],Saudi J Ophthalmol,2016,30(2) : 109- 112. [8] Akdogan M,Ustundag Y,Cevik S G,et al. Correlation between systemic immune-inflammation index and routine hemogram-related inflammatory markers in the prognosis of retinopathy of prematurity[J]. Indian J Ophthalmol,2021,69(8):2182-2187. doi: 10.4103/ijo.IJO_2745_20 [9] Song Y,Jiahua Z,Jingyang W ,et al. Use of the monocyte-to-lymphocyte ratio to predict diabetic retinopathy[J]. International Journal of Environmental Research and Public Health,2015,12(8): 10009-10019. [10] 中国医师协会新生儿科医师分会. 早产儿治疗用氧和视网膜病变防治指南(2016年)[J]. 发育医学电子杂志,2016,4(4):196-198. [11] Paul,Courtright,Amy,et al. Visual impairment in children in middle- and lower-income countries[J]. Archives of Disease in Childhood,2011,96(12):1129. doi: 10.1136/archdischild-2011-300093 [12] 高宏程,陈晨,张迎秋,等. 早产儿视网膜病变的危险因素研究进展[J]. 国际眼科杂志,2018,18(1):80-83. [13] 陈鹤. 早产儿视网膜病变危险因素分析及发病预测模型研究[D]. 广州: 南方医科大学,2019. [14] Modrzejewska M. Retinopathy of prematurity-pathogenesis and prevalence[J]. Ann Acad Med Stetin,2006,52(1):67-72. [15] Lundgren P,Klevebro S,Brodin P,et a1. Leucocytosis is associated with retinopathy of prematurity in extremely preterm infants[J]. Acta Paediatr,2019,108(7):1357-1358. doi: 10.1111/apa.14798 [16] Hong H,Lee H,Ko J ,et al. Neonatal systemic inflammation in rats alters retinal vesseldevelopment and simulates pathologic features of retinopathy of prematurity[J]. Journal of Neuroinflammation,2014,11(1): 707-717. [17] Correa-Rocha R ,Alicia Pérez,Lorente R ,et al. Preterm neonates show marked leukopenia and lymphopenia that are associated with increased regulatory T-cell values and diminished IL-7[J]. Pediatric Research,2012,71(5): 590. [18] Mosser D M ,Edwards J P . Exploring the full spectrum of macrophage activation[J]. Nature Reviews Immunology,2008,8(12): 958-969. [19] 高翔,王雨生. 巨噬细胞在小鼠氧诱导视网膜新生血管形成中的作用[J]. 眼科新进展,2015,35(3):201-4. [20] Jopling J,Henry E,Wiedmeier S E ,et al. Reference ranges for hematocrit and blood hemoglobin concentration during the neonatal period: Data from a multihospital health care system[J]. Pediatrics,2009,123(2): peds. 2008-2654. [21] Lundgren P,Athikarisamy S E,Patole S,et al. Duration of anaemia during the first week of life is an independent risk factor for retinopathy of prematurity[J]. Acta Paediatr,2018,107(5):759-766. doi: 10.1111/apa.14187 [22] Lundgren P,Hellgren G,Pivodic A,et al. Erythropoietin serum levels,versus anaemia as risk factors for severe retinopathy of prematurity[J]. Pediatr Res,2019,86(2):276-282. doi: 10.1038/s41390-018-0186-6 [23] Dani C,Martelli E,Bertini G,et al. Effect of blood transfusions on oxidative stress in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed,2004,89(5):F408-F411. doi: 10.1136/adc.2003.037085 [24] 申金付,张琴,李茂,等. 中性粒细胞/淋巴细胞比值与糖尿病视网膜病变的相关性分析[J]. 中国糖尿病杂志,2016,24(7):617-621. [25] Hu Y X ,Xu X X ,Shao Y ,et al. The prognostic value of lymphocyte-to-monocyte ratio in retinopathy of prematurity citation[J]. International Journal of Ophthalmology,2017,10(11): 1716-1721. [26] Kurtul B E. Neutrophil-to-lymphocyte ratio in ocular diseases: A systematic review[J]. International Journal of Ophthalmology,2019,12(12):1951-1958. doi: 10.18240/ijo.2019.12.18 -
点击查看大图
图(1) / 表(5)
计量
- 文章访问数: 152
- HTML全文浏览量: 91
- PDF下载量: 3
- 被引次数: 0
