北京市2023年幼儿和小学生近视辅助筛查方法研究

秦冉; 赵金辉; 李婷; 张京舒; 王一凡; 郭欣

doi:10.16835/j.cnki.1000-9817.2024205

北京市2023年幼儿和小学生近视辅助筛查方法研究

doi: 10.16835/j.cnki.1000-9817.2024205

秦冉^{1, 2},
赵金辉^1, ,,
李婷¹,
张京舒¹,
王一凡¹,
郭欣^1, ,

1.
北京市疾病预防控制中心学校卫生所，100013
2.
北京大学公共卫生学院/生育健康研究所

基金项目:

国家重点研发计划项目 2021YFC2702102

北京市卫生健康委员会高层次公共卫生技术人才建设项目领军人才-01-09

详细信息

作者简介:
秦冉(1991-)，男，江苏徐州人，在读博士，主管医师，主要研究方向为学校卫生

通讯作者:
赵金辉，E-mail: jinhuizhao@sina.com

郭欣，E-mail: gguoxin2000@126.com

利益冲突 所有作者声明无利益冲突。
中图分类号: R179 R778.1⁺¹ R770.42⁺¹
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- 被引次数: 0
出版历程
- 收稿日期: 2024-05-15
- 修回日期: 2024-05-28
- 网络出版日期: 2024-07-27
- 刊出日期: 2024-07-25

Auxiliary screening for myopia in kindergarten and primary school students in Beijing, 2023

QIN Ran^{1, 2},
ZHAO Jinhui^{1
, ,},
LI Ting¹,
ZHANG Jingshu¹,
WANG Yifan¹,
GUO Xin^{1
, ,}

1.
School Health Department, Beijing Center for Disease Prevention and Control, Beijing (100013), China

摘要

摘要: 目的分析2023年北京市幼儿和小学生散瞳验光等眼视光检查数据，为科学选择学生人群近视辅助筛查方法提供参考。方法 2023年春季学期，在北京市1个城区和1个郊区，采用多阶段整群随机抽样的方法抽取幼儿园和小学，城区选取2所幼儿园和2所小学，使用0.5%复方托吡卡胺滴眼液散瞳后验光1 191名学生；郊区选取66所幼儿园和6所小学，散瞳验光3 555名学生。检查项目包括散瞳前后验光、眼轴长度、角膜曲率、身高等。结果在各个学段，幼儿和小学生轴率比的ROC曲线下面积(幼儿园：AUC=0.89，小学低年级：AUC=0.91，小学高年级：AUC=0.89)均高于筛查性近视(幼儿园：0.87，小学低年级：0.90，小学高年级：0.89)，但差异均无统计学意义(P值均>0.05)；眼轴长度的AUC值均最低(0.74，0.82，0.83)，均低于轴率比AUC值，差异有统计学意义(χ²值分别为22.43，59.04，20.13，P值均 < 0.05)。裸眼视力加上轴率比后，幼儿园幼儿AUC值由0.83(95%CI=0.78~0.88)增加至0.93(95%CI=0.89~0.97)，小学低年级学生AUC值由0.89(95%CI=0.86~0.91)增加至0.96(95%CI=0.95~0.97)，小学高年级学生AUC值由0.91(95%CI=0.89~0.92)增加至0.96(95%CI=0.95~0.97)，前后置信区间均无交叉，差异均有统计学意义(P值均 < 0.05)。结论轴率比对幼儿和小学生近视辅助筛查有重要意义，应重视轴率比在相关人群近视辅助筛查中的应用。
- 近视 /
- 眼轴长度 /
- 曲线下面积 /
- 学生
Abstract: Objective To analyze cycloplegic refraction data of kindergarten and primary school students in Beijing in 2023, so as to provide scientific reference for selecting auxiliary methods for students myopia screening. Methods In the spring semester of 2023, a multi-stage cluster sampling method was used to select kindergartens and primary schools in one urban and one suburban district of Beijing. Two kindergartens and two primary schools were selected in the urban district, with 1 191 students undergoing cycloplegic refraction examination. And the suburban district included 66 kindergartens and 6 primary schools, with 3 555 students undergoing cycloplegic refraction examination. The examination items included pre- and post- cycloplegia optometry, axial length (AL), corneal curvature and height. Results In each academic stage, the area under the ROC curve (AUC) for the axial length/corneal radius of curvature (AL/CR) (Kindergarten: AUC=0.89, Lower primary school students: AUC=0.91, Upper primary school students: AUC=0.89) were higher than that of screening myopia, but the difference were not statistically significant (P>0.05). The AUC for axial length was the lowest (0.74, 0.82, 0.83) and lower than that for AL/CR with statistically significant difference (χ²=22.43, 59.04, 20.13, P < 0.05). After combining naked eye vision and AL/CR, kindergarten students showed an increased AUC from 0.83 (95%CI=0.78-0.88) to 0.93 (95%CI=0.89-0.97), and lower primary school students exhibited an increase from 0.89 (95%CI=0.86-0.91) to 0.96 (95%CI=0.95-0.97). In higher primary school students, AUC increased from 0.91 (95%CI=0.89-0.92) to 0.96 (95%CI=0.95-0.97). There was no overlap in the confidence intervals before and after combinations, and the differences were statistically significant (P < 0.05). Conclusion AL/CR plays a significant role in assisting with myopia screening among kindergarten and primary school students. Attention should be paid to the application of AL/CR in assisting myopia screening in kindergarten and primary school students.
- Myopia /
- Ocular axial length /
- Area under curve /
- Students
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表 1 北京市幼儿和小学生散瞳近视预测模型构建(n=4 746)

Table 1. Construction of a prediction model for cycloplegic myopia in kindergarten and primary school students in Beijing(n=4 746)

常数项与自变量	β值	标准误	Wald χ²值	P值	OR值(95%CI)
常数项	4.40	0.53	68.27	< 0.01
筛查性近视
是					1.00
否	-3.55	0.44	64.22	< 0.01	0.03(0.01~0.07)
学段
幼儿园	-2.43	0.26	89.54	< 0.01	0.09(0.05~0.15)
小学低年级					1.00
小学高年级	2.31	0.20	133.62	< 0.01	10.04(6.79~14.84)
轴率比
< P₁₀	-3.65	0.80	21.02	< 0.01	0.03(0.01~0.12)
P₁₀~ < P₂₅	-2.36	0.34	48.35	< 0.01	0.10(0.05~0.18)
P₂₅~ < P₅₀	-1.24	0.22	31.47	< 0.01	0.29(0.19~0.45)
P₅₀~ < P₇₅					1.00
P₇₅~ < P₉₀	0.80	0.22	13.77	< 0.01	2.23(1.46~3.41)
≥P₉₀	2.86	0.28	102.13	< 0.01	17.40(10.00~30.28)
裸眼视力
正常	-0.10	0.45	0.04	0.83	0.91(0.38~2.20)
轻度视力不良	-1.56	0.22	49.80	< 0.01	0.21(0.14~0.33)
中度视力不良					1.00
重度视力不良	0.96	0.37	6.98	0.01	2.62(1.28~5.34)
眼轴长度
< P₁₀	-1.30	0.43	9.14	< 0.01	0.27(0.12~0.63)
P₁₀~ < P₂₅	-0.81	0.27	9.07	< 0.01	0.45(0.26~0.75)
P₂₅~ < P₅₀	-0.85	0.21	16.27	< 0.01	0.43(0.28~0.65)
P₅₀~ < P₇₅					1.00
P₇₅~ < P₉₀	0.28	0.22	1.61	0.21	1.33(0.86~2.06)
≥P₉₀	0.79	0.26	8.95	< 0.01	2.20(1.31~3.68)

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表 2 不同方法用于近视辅助筛查真实性比较

Table 2. Comparison of the authenticity of different methods used for myopia assisted screening

学段	方法	AUC值(95%CI)	与轴率比AUC差值(95%CI)	χ²值	P值
幼儿园 (n=1 985)	筛查性近视	0.87(0.83~0.92)	-0.02(-0.07~0.03)	0.66	0.42
	裸眼视力	0.83(0.78~0.88)	-0.06(-0.11~-0.01)	5.78	0.02
	眼轴长度	0.74(0.68~0.80)	-0.15(-0.21~-0.09)	22.43	< 0.01
	轴率比	0.89(0.85~0.93)
小学低年级 (n=1 753)	筛查性近视	0.90(0.88~0.92)	-0.02(-0.04~0.01)	2.03	0.15
	裸眼视力	0.89(0.86~0.91)	-0.03(-0.05~-0.00)	5.00	0.03
	眼轴长度	0.82(0.79~0.84)	-0.10(-0.12~-0.07)	59.04	< 0.01
	轴率比	0.91(0.90~0.93)
小学高年级 (n=1 008)	筛查性近视	0.89(0.87~0.91)	-0.00(-0.03~0.02)	0.11	0.74
	裸眼视力	0.91(0.89~0.92)	0.01(-0.01~0.04)	1.44	0.23
	眼轴长度	0.83(0.80~0.85)	-0.06(-0.09~-0.04)	20.13	< 0.01
	轴率比	0.89(0.87~0.91)

下载: 导出CSV

表 3 不同方法组合用于各学段近视辅助筛查的真实性比较[AUC值(95%CI)]

Table 3. Comparison of the authenticity of different method combinations used for myopia assisted screening in each academic stage [AUC(95%CI)]

方法组合	幼儿园(n=1 985)	小学低年级(n=1 753)	小学高年级(n=1 008)
筛查性近视+轴率比	0.94(0.90~0.98)	0.97(0.96~0.98)	0.95(0.94~0.97)
筛查性近视+眼轴长度	0.93(0.89~0.96)	0.94(0.92~0.95)	0.94(0.93~0.95)
筛查性近视+轴率比+眼轴长度	0.95(0.92~0.98)	0.97(0.96~0.98)	0.96(0.96~0.97)
裸眼视力+轴率比	0.93(0.89~0.97)	0.96(0.95~0.97)	0.96(0.95~0.97)
裸眼视力+眼轴长度	0.88(0.83~0.93)	0.93(0.91~0.94)	0.94(0.93~0.95)
裸眼视力+轴率比+眼轴长度	0.94(0.90~0.98)	0.97(0.96~0.98)	0.97(0.96~0.97)
轴率比+眼轴长度	0.91(0.86~0.95)	0.94(0.92~0.95)	0.93(0.92~0.94)

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