日本未熟児新生児学会雑誌　第24巻第2号　107～114頁（2012年）

日本未熟児新生児学会雑誌　24(2)：319-326；2012　

受付日：平成24．01．12

受理日：平成24．04．10

未熟児網膜症と血清総ビリルビン値との関連についての検討

Total Serum Bilirubin Levels and Severe Retinopathy of Prematurity in Preterm Infants

愛知県厚生連海南病院　小児科

Department of Pediatrics, Kainan Hospital Aichi Prefectural Welfare Federation of Agricultural Cooperatives

山田崇春・浜田実邦・小久保　稔・一木　貴

Takaharu YAMADA，Miho HAMADA，Minoru KOKUBO，Takashi ICHIKI

Key Words：retinopathy of prematurity，total serum bilirubin，oxidative stress，antioxidant，preterm infant

　早産児において，血清総ビリルビン（TSB）値が未熟児網膜症（ROP）の重症化と関連するかを後方視的に検討した。ROPを発症した在胎28週以下の早産児50例を対象に，レーザー光凝固施行群（PC群）と非レーザー光凝固施行群（非PC群）に分類し，日齢0～7の日齢毎のTSB値，日齢0～7の平均TSB値，日齢14のTSB値，入院中の最高TSB値，周産期因子について比較検討した。単変量解析では，非PC 群と比べてPC群で日齢2～7の日齢毎のTSB値，日齢0～7の平均TSB値，入院中の最高TSB値が有意に低値を示した。ROP重症化についての多変量分析では，人工換気日数のみ有意な相関を示した。今回の検討では，TSB 値とROP 重症化との関連性は認められなかった。

　Oxidative injury may contribute to the development of retinopathy of prematurity（ROP），and bilirubin may be a physiologically important antioxidant. Therefore we retrospectively evaluated the relationship of severe ROP to total serum bilirubin（TSB）levels in 50 infants with gestational age ≦28 weeks, admitted to our neonatal intensive care unit from June 2003 to September 2011. 27 patients who received photocoagulation therapy（PC group）and 23 patients who did not receive PC（non-PC group）were analyzed the daily mean TSB levels, the mean TSB levels of the first week, and the peak TSB levels for each infant. A similar analysis was also performed on the two groups with perinatal factors.
　When analysed using the unpaired t-test, the daily mean TSB levels from day two to seven, the mean TSB levels of the first week, and the peak TSB levels were lower in the PC group compared with those in the non-PC group. Using multivariate logistic regression, we found number of ventilation days were an independent risk factor for severity of ROP （adjusted odds ratio 1.150, 95%CI 1.024〜1.291；p=0.018）．　We found no definite association between TSB levels and severity of ROP.