Racial variation in retinopathy of prematurity
Racial variation in retinopathy of prematurity
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DOI：
10.1001/archopht.1997.01100150606005
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发表时间：
1997-05-01
影响因子：
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通讯作者：
Phelps, DL
中科院分区：
文献类型：
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作者：
Saunders, RA;Donahue, ML;Phelps, DL
目的：确定和比较黑人和白人低出生体重儿中严重、威胁视力的早产儿视网膜病变(ROP)的发生率。设计：前瞻性队列研究。背景：参加冷冻治疗早产儿视网膜病变多中心试验的美国23个中心的70个新生儿重症监护室。患者：共有4099名出生时体重小于1251g的早产儿纳入评估ROP的自然病史。根据自然历史方案对2158名白人婴儿和1584名黑人婴儿进行前瞻性随访。主要观察指标：急性ROP的发生率和严重程度。结果：虽然ROP在所有种族亚组中发生的频率相似，但严重ROP在黑人婴儿中较少见。在2158名白人婴儿中，有160名(7.4%)达到了阈值ROP(定义为在存在加病[后极部血管扩张和弯曲]的情况下，在1区或2区出现至少5个连续或8个时钟小时的3期视网膜病变)，但在1584名黑人婴儿中，只有51名(3.2%)进展到阈值ROP。经多元Logistic回归分析，即使考虑出生体重、分娩时胎龄状况、性别、多胎和运输状况，种族也是发生阈值疾病的一个非常显著的因素(P<；.001)。结论：严重、威胁视力的ROP在低出生体重白人婴儿中的发生率高于似乎处于同等风险的低出生体重黑人婴儿。造成这种差异的原因尚不清楚。我们推测，在黑人婴儿中，视网膜色素沉着的差异可能对自由基介导的光毒性损伤提供相对的保护。
Objectives: To determine and compare the incidence of severe, vision-threatening retinopathy of prematurity (ROP) in black and white low-birth-weight infants.Design: Prospective cohort study.Setting: Seventy neonatal intensive care units in 23 US participating centers in the Multicenter Trial of Cryotherapy for Retinopathy of Prematurity.Patients: A total of 4099 premature infants weighing less than 1251 g at birth were enrolled to evaluate the natural history of ROP. This 'Natural History' cohort included 2158 white infants and 1584 black infants who were followed up prospectively according to a Natural History protocol.Main Outcome Measures: Incidence and severity of acute ROP.Results: While ROP occurred with similar frequency in all racial subgroups, severe ROP was less common in black infants. One hundred sixty (7.4%) of 2158 white infants reached threshold ROP (defined as at least 5 contiguous or 8 cumulative clock-hours of stage 3 retinopathy in zone 1 or zone 2 in the presence of ''plus disease'' [dilation and tortuosity of the posterior pole blood vessels]), but only 51 (3.2%) of 1584 black infants progressed to threshold ROP. Using multiple logistic regression analysis, race emerged as a highly significant factor (P < .001) in the development of threshold disease, even when birth weight, gestational age status at delivery, sex, multiple births, and transport status were considered.Conclusions: Severe, vision-threatening ROP occurs with greater frequency in low-birth-weight white infants than in low-birth-weight black infants who are seemingly at equivalent risk. The reason for this disparity is unknown. We speculate that differences in retinal pigmentation may confer relative protection against free radical-mediated phototoxic injury in black infants.