目的：探讨极低出生体质量儿出生后体质量增长速率与阈值病变早产儿视网膜病变(TDROP)的相关性，评估其预测TDROP发生的价值。

方法：回顾性病例分析。收集2017-01/2018-12于厦门大学附属第一医院住院的早产儿386例，出生体质量<1 500g，分析其性别、出生体质量、胎龄、分娩方式、是否吸氧、Apgar评分、是否试管婴儿、是否双生、有无合并新生儿肺炎及出生后1～4wk的体质量增长速率等与TDROP的相关性。将入组患儿分为无ROP组298例和TDROP组88例。多因素Logistic回归分析TDROP的相关危险因素。ROC曲线确定临床诊断临界值，通过ROC曲线下面积(AUC)评估出生后2wk体质量增长速率对TDROP的预测价值。

结果：两组患儿出生体质量(t=2.264，P=0.024)、出生胎龄(t=3.158，P=0.002)、出生后2wk体质量增长速率(t=3.517，P<0.001)、是否吸氧(χ²=20.514，P<0.001)差异有统计学意义。多因素Logistic回归分析显示，出生体质量(β=0.699，P=0.016)，出生胎龄(β=-0.631，P=0.039)，出生后2wk体质量增长速率(β=-0.636，P=0.039)，是否合并吸氧(β=-1.542，P<0.001)与TDROP显著相关，其OR(95%CI)分别为2.013(1.140～3.553)、0.532(0.292～0.970)、0.529(0.289～0.969)和0.214(0.113～0.404)。进一步分析出生后2wk体质量增长速率的ROC曲线，结果显示AUC为0.710，诊断临界值为4.14g/d，敏感性为70.8%，特异性为65.9%。

结论：出生体质量是TDROP发生的独立危险因素之一，而极低出生体质量儿出生2wk体质量增长速率与TDROP的发生有显著相关，对其发生具有一定的预测价值。

METHODS: A retrospective cohort study. Totally 386 preterm infants in the First Affiliated Hospital of Xiamen University from January 2017 to December 2018, whose weight was less than 1 500g were enrolled in this study. The gender, BW, gestational age(GA), delivery mode, history of oxygen, Apgar score in 1-10min, in vitro fertilization infants, embryo number, neonatal pneumonia, PWGR with 4wk after birth, congenital heart disease were analyzed. The patients were divided into two groups: Non-ROP(NROP)group(n=298)and TDROP group(n=88). Multiple Logistic regression and receiver operating characteristic(ROC)curve were used to determine if the PWGR was independently related to TDROP development and if it was capable of predicting TDROP. This study determines the predict value by comparing the area under the ROC curve(AUC)of independent risk factors.

RESULTS: BW(t=2.264, P=0.024), GA(t=3.158, P=0.002), PWGR at 2wk(χ²=20.514, P<0.001), history of oxygen(χ²=20.514, P<0.001), had significant difference between two groups. Multiple Logistic regression analysis revealed that BW(β=0.699, P=0.016), GA(β= -0.631, P=0.039), PWGR at 2wk(β=-0.636, P=0.039), history of oxygen(β=-1.542, P<0.001)were correlated to TDROP, and their OR were 2.013 \〖95% CI: 1.140-3.553\〗, 0.532 \〖95% CI: 0.292-0.970\〗, 0.529 \〖95% CI: 0.289-0.969\〗, 0.214, \〖95% CI: 0.113-0.404\〗 respectively. Further study showed that the area of PWGF at 2wk under the ROC was 71%, and its optimal cut-off points was 4.14g/d, its sensitivity and specificity were 70.8%, 65.9% respectively.

CONCLUSION: BW and PWGF at 2wk of very low BW preterm babies is an independent risk factor for TDROP, and has certain predictive value for the onset of TDROP.