Hematographic Analysis Of Retinopathy Of Prematurity In Children And Its Changes After Anti-VEGF

Objective:To study the risk factors for retinopathy of prematurity(ROP),observe the complete blood count blood-related indexes of children with ROP group and non-ROP group,children with severe ROP group and mild ROP,explore its changes after intravitreal injection anti-vascular endothelial growth factor(VEGF)drug,analyze the internal relationship with the occurrence,development and outcome of ROP,so as to indirectly reflect the systemic safety of anti-VEGF.Methods:Retrospective analysis was performed on preterm infants treated in the ophthalmology department of the First Affiliated Hospital of Dalian Medical University from January 2019 to October 2020.Twenty preterm infants with ROP were included in the ROP group,and twenty preterm infants without ROP at the same gestational age and birth weight were selected as the non-ROP group in a 1:1 ratio.The children with ROP group were divided into 12 cases of severe ROP group and 8 cases of mild ROP group for subgroup analysis according to treatment or not.The fifteen basic data of children including gestational age,birth weight,gender,5-minute Apgar score,delivery mode,number of fetuses,assisted reproduction,oxygen inhalation time,mechanical ventilation time,hyaluronic membrane disease,pneumonia,bronchiopulmonary dysplasia,sepsis,patent foramen ovale and patent ductus arteriosus were collected.The six basic data of mothers including childbearing age,premature rupture of membranes,placental abruption,placenta previa,gestational diabetes,gestational hypertension disease were collected.The twenty-two complete blood count blood-related indexes including red blood cell count,hematocrit,mean corpuscular volume,mean corpuscular hemoglobin,mean corpusular hemoglobin concerntration(MCHC),red blood cell distribution width-standard deviation(RDW-SD),red blood cell distribution width-coefficient of variationred(RDW-CV),hemoglobin,platelet count and platelet distribution width(PDW),mean platelet volume and thrombocytocrit,white blood cell count,neutrophils(NEUT),lymphocytes,monocytes,eosinophils(EO),basophil,the ratio of neutrophils to lymphocytes(NLR),the ratio of platelet count to lymphocytes,the ratio of lymphocytes to monocytes(LMR)and platelet mass index were collected.The collecting datas were compared between each groups.At the same time,The twenty-two hemogram indexes of children with severe ROP after intravitreal injectionl anti-VEGF drug were collected before and after 1,4,8 and 12 weeks to observe the effect of anti-VEGF on the hemogram.Results:(1)The oxygen inhalation time and mechanical ventilation time in the ROP group are significantly longer than those in the non-ROP group [17(5.5,33)d vs.2.5(0,14.5)d,7(2,23.25)d vs.2(0,6.25)d](P=0.015,0.025).The incidence of hyaluronic membrane disease,bronchopulmonary dysplasia and sepsis are higher than those in the non-ROP group [60%(12/20)vs 25%(5/20),25%(5/20)vs 0%(0/20),45%(9/20)vs10%(2/20)](P=0.025,0.017,0.013);The rate of cesarean delivery is lower [40%(8/20)vs.90%(18/20)](P=0.001).In the hemogram indexes,statistical results showed P >0.05.Logistic regression analysis showed that cesarean delivery was a protective factor for ROP(P=0.003).(2)The oxygen inhalation time and mechanical ventilation time in severe ROP group are longer than those in mild ROP group [21.5(16,38.75)d vs.4(0,9.25)d,12.5(5.25,32.25)d vs.2.5(0.5,7.5)d](P=0.002,0.046);The incidence of bronchopulmonary dysplasia is higher than the incidence of mild ROP group [41.6%(5/12)vs.0%(0/8)](P=0.035);The rate of cesarean delivery is higher than that in the mild ROP group [58%(7/12)vs.12.5%(1/8)](P=0.040).The levels of PDW and EO in severe ROP group are significantly higher than those in mild ROP group [(13.88±2.46)FL vs.(11.84±1.61)FL,(0.38±0.16)109/L vs.(0.26±0.07)109/L],(P=0.038,0.049);Significantly decreased on MCHC[(329.08±10.09)g/L vs.(341.50±10.16)g/L](P=0.015);There is no significant difference in the residual blood indexs(P > 0.05).(3)The levels of PDW and NEUT at 1 week after intravitreal injection anti-VEGF drug are lower than those before the surgery [(11.98±2.01)FL vs.(13.88±2.46)FL,(1.30±0.42)109/L vs.(1.77±0.89)109/L].The levels of RDW-SD,RDW-CV and PLR at 4 weeks after surgery are lower than those before surgery [(45.19±4.36)vs.(52.03±6.36),(0.14±0.01)vs.(0.16±0.02),(61.88±33.70)vs.(79.87±37.58)].At 8weeks after surgery,the levels of RDW-SD and RDW-CV are lower than those before surgery [(39.68±4.78)vs(52.03±6.36),(0.13±0.01)vs(0.16±0.02)],and the level of LMR is higher[(15.59±5.39)vs(9.22±4.31)].The levels of RDW-SD and RDW-CV at12 weeks after surgery are lower than those before surgery [(37.12±3.45)vs.(52.03±6.36),(0.12±0.01)vs.(0.16±0.02)],and there were statistically significant differences(P<0.05).Conclusion:1.Factors affecting the occurrence of ROP include oxygen inhalation time,mechanical ventilation time,hyaline membrane disease,bronchopulmonary dysplasia,sepsis,and cesarean delivery,and cesarean delivery is a protective factor of ROP;2.Factors affecting the occurrence of severe ROP include oxygen inhalation time,mechanical ventilation time,cesarean delivery,bronchopulmonary dysplasia,MCHC,PDW and EO;3.The treatment of intravitreal injection anti-VEGF drug has an effect on the blood image system,and the effect starts from the platelet system,PDW decreases first,and then affects the red blood cell system,resulting in a decrease in RDW;4.Although no injection-related complications were found in the intravitreal anti-VEGF drug treatment for ROP,the influence of the blood image changes after treatment could last up to 12 weeks.