Analysis of myopia related factors among primary and secondary school students in Shanghai
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摘要:
目的 了解上海市学生近视相关因素并探寻轻、中、高度近视可干预的主要行为，为实施家校结合和针对性的干预措施提供依据。 方法 在上海市各区分别抽取6所中小学校(2所小学、2所初中、2所高中)，小学从四年级开始调查，抽到的班级全体学生共24 434名参与视力检测和问卷调查。数据分析组间比较选择χ2检验，不同程度近视与用眼相关行为关联分析采用多分类多因素Logistic回归分析。 结果 白天户外活动时间短、睡眠缺乏、课后读写时间长、读写姿势差、使用移动电子屏时间过长等视力相关的不良行为女生发生率高于男生，而用电脑时间长、阳光下看书/电子屏等行为男生发生率高于女生(P值均 < 0.05)。课后读写时间≥3 h与＜2 h相比，轻度近视模型OR值为1.31(95%CI=1.20~1.44)、中度近视模型OR值为1.78(95%CI=1.62~1.96)、高度近视模型OR值为2.37(95%CI=2.07~2.71)；在中、高度近视的模型中有影响的行为还有读写姿势、近距离用眼休息频次、户外活动时间、看电视时间(P值均 < 0.05)。 结论 中小学生近视的相关不良行为发生率较高，不同行为之间性别差异明显。应严格控制学生课后读写时间，干预的策略和措施应针对不同年龄和性别的特点开展。 Abstract:Objective To analyze myopia related factors among students in Shanghai, to explore associated risky behaviors associated with mild, moderate, high myopia, so as to provide the evidence for the implementation of home and school combination intervention measures. Methods Six primary and secondary schools (2 primary schools, 2 middle schools and 2 high schools) were selected from each district of Shanghai. The primary schools began to investigate from the fourth grade. All the students in the selected classes participated in the vision test and questionnaire survey. Chi square test was used for categorical data analysis. The relationship between myopia and related behaviors was analyzed by multivariate Logistic analysis. Results The prevalence of visual-related risky behaviors such as short outdoor time during the day, lack of sleep, long after-school reading and writing time, poor reading and writing posture, and longtime-using mobile electronic screen was higher in girls than in boys (P < 0.05), boys were more likely than girls to use computer for long time and read books/electronic screen in sunlight (P < 0.05). The group with 3 hours or more than of reading and writing compared with the less than 2 hours, the OR value of mild myopia model was 1.31(1.20-1.44), moderate myopia model was 1.78(1.62-1.96), severe myopia model was 2.37(2.07-2.71). In the model of moderate and high myopia, reading and writing posture, frequency of eye relax, outdoor activity time and watching TV time were also included. Conclusion The prevalence of myopia related behaviors among primary and secondary school students is high, and there are significant gender differences among different behaviors. Students' reading and writing time should be strictly controlled after school. Intervention strategies and measures should be carried out according to the characteristics of different ages and genders. -
Key words:
- Vision, low /
- Myopia /
- Behavior /
- Regression analysis /
- Students
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表 1 中小学生用眼相关行为性别间分布比较
Table 1. Comparison of eye use related behaviors among primary and secondary school students by gender
行为 分类 男生(n=12 375) 女生(n=12 059) 合计(n=24 434) χ2值 P值 白天户外活动时间/(h·d-1) ＜1 3 129(26.3) 3 217(27.9) 6 346(27.1) -5.00 ＜0.01 1~＜2 4 723(39.8) 4 772(41.3) 9 495(40.5) 2~＜3 1 923(16.2) 1 795(15.5) 3 718(15.9) ≥3 2 106(17.7) 1 761(15.3) 3 867(16.5) 睡眠缺乏时间/(h·d-1) ≥2 1 332(10.9) 1 413(11.9) 2 745(11.4) -8.17 ＜0.01 1~＜2 3 515(28.7) 3 824(32.1) 7 339(30.4) ＜1 4 910(40.1) 4 705(39.5) 9 615(39.8) 0 2 474(20.2) 1 981(16.6) 4 455(18.4) 课后读写时间/(h·d-1) ＜2 4 131(34.2) 3 444(29.2) 7 575(31.7) -8.51 ＜0.01 2~＜3 4 386(36.3) 4 476(37.9) 8 862(37.1) ≥3 3 572(29.5) 3 880(32.9) 7 452(31.2) 读写姿势 好 3 372(27.3) 2 686(22.3) 6 058(24.8) -6.82 ＜0.01 中 5 194(42.0) 5 458(45.3) 10 652(43.7) 差 3 791(30.7) 3 901(32.4) 7 692(31.5) 用电脑时间/(h·d-1) 0 5 028(40.7) 4 954(41.1) 9 982(40.9) -5.80 ＜0.01 ＜1 4 240(34.3) 4 820(40.0) 9 060(37.1) ≥1 3 096(25.0) 2 274(18.9) 5 370(22.0) 用移动电子设备时间/(h·d-1) 0 2 520(20.4) 1 822(15.1) 4 342(17.8) 6.55 ＜0.01 ＜1 3 322(26.9) 3 537(29.4) 6 859(28.1) 1~＜2 3 330(27.0) 3 413(28.4) 6 743(27.7) ≥2 3 182(25.8) 3 260(27.1) 6 442(26.4) 阳光下看书/电子屏 否 7 712(62.3) 7 304(60.6) 15 016(61.5) 7.63 0.01 是 4 658(37.7) 4 744(39.4) 9 402(38.5) 天黑后看电子屏幕关灯 否 7 505(60.7) 6 673(55.4) 14 178(58.1) 70.00 ＜0.01 是 4 864(39.3) 5 374(44.6) 10 238(41.9) 躺着或趴着看书/电子屏幕 否 5 023(40.6) 4 316(35.8) 9 339(38.3) 59.12 ＜0.01 是 7 340(59.4) 7 725(64.2) 15 065(61.7) 走路或乘车看书/电子屏幕 否 6 809(55.1) 5 745(47.7) 12 554(51.5) 132.14 ＜0.01 是 5 551(44.9) 6 291(52.3) 11 842(48.5) 天黑时读书写字灯光 同时使用台、顶灯 7 973(64.9) 8 265(68.8) 16 238(66.8) 40.81 ＜0.01 仅使用台灯 1 827(14.9) 1 582(13.2) 3 409(14.0) 仅使用屋顶灯 2 478(20.2) 2 168(18.0) 4 647(19.1) 近距离用眼多久休息一次/min ＜15 2 458(19.9) 2 261(18.8) 4 719(19.3) -0.97 0.33 15~＜30 2 129(17.2) 2 104(17.5) 4 233(17.3) 30~＜60 2 972(24.0) 2 920(24.2) 5 892(24.1) 60~＜120 2 700(21.8) 2 821(23.4) 5 521(22.6) ≥120 2 108(17.0) 1 941(16.1) 4 049(16.6) 注：()内数字为构成比/%，部分项目的应答存在缺失值。 
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表 2 中小学生不同程度近视影响因素分析(n=24 434)
Table 2. Associated factors for different degrees of myopia in primary and middle school students (n=24 434)
近视程度 自变量 选项 β值 标准误 P值 OR值(OR值95%CI) 轻度近视 课后读写时间/(h·d-1) 2~＜3 0.16 0.04 0.00 1.17(1.08~1.27) ≥3 0.27 0.05 0.00 1.31(1.20~1.44) 中度近视 看电视时间/(h·d-1) ＜1 -0.25 0.05 0.00 0.78(0.71~0.86) 1~＜2 -0.45 0.06 0.00 0.64(0.57~0.71) ≥2 -0.59 0.07 0.00 0.56(0.49~0.63) 读写姿势 中 0.30 0.05 0.00 1.35(1.23~1.48) 差 0.31 0.05 0.00 1.36(1.23~1.50) 近距离用眼多久休息一次/min 15~＜30 0.06 0.06 0.38 1.06(0.94~1.19) 30~＜60 0.19 0.06 0.00 1.20(1.08~1.35) 60~＜120 0.38 0.06 0.00 1.46(1.30~1.64) ≥120 0.46 0.07 0.00 1.58(1.39~1.79) 课后读写时间 2~＜3 0.38 0.05 0.00 1.46(1.34~1.60) ≥3 0.58 0.05 0.00 1.78(1.62~1.96) 高度近视 看电视时间 ＜1 -0.40 0.07 0.00 0.67(0.59~0.76) 1~＜2 -0.55 0.08 0.00 0.58(0.50~0.67) ≥2 -0.92 0.09 0.00 0.40(0.33~0.48) 读写姿势 中 0.26 0.07 0.00 1.30(1.14~1.47) 差 0.31 0.07 0.00 1.37(1.19~1.57) 白天户外活动时间/(h·d-1) ＜1 0.37 0.08 0.00 1.44(1.23~1.69) 1~＜2 0.34 0.08 0.00 1.40(1.20~1.63) 2~＜3 0.39 0.09 0.00 1.48(1.24~1.77) 近距离用眼多久休息一次/min 15~＜30 0.11 0.09 0.25 1.11(0.93~1.33) 30~＜60 0.28 0.08 0.00 1.32(1.12~1.55) 60~＜120 0.54 0.08 0.00 1.72(1.46~2.02) ≥120 0.54 0.09 0.00 1.72(1.45~2.05) 课后读写时间/(h·d-1) 2~＜3 0.54 0.07 0.00 1.72(1.51~1.95) ≥3 0.86 0.07 0.00 2.37(2.07~2.71) 注：课后读写时间、看电视时间、读写姿势、近距离用眼多久休息一次、白天户外活动时间分别以 < 2 h/d，0 h/d，好， < 15 min，≥3 h/d为对照。
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[1] 上海市眼病防治中心/上海市眼科医院. 2019爱眼日, 这些动作是预防孩子近视的关键[EB/OL]. [2019-10-22]. http://www.shsyf.com/Content/News/1380.Shanghai Eye Diseases Prevention & Treatment Center/Shanghai Eye Hospital. On Eye Day 2019, these actions are key to preventing myopia in children[EB/OL]. [2019-10-22]. http://www.shsyf.com/Content/News/1380. [2] HOLDEN B A, FRICKE T R, WILSON D A, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050[J]. Ophthalmology (Rochester, Minn), 2016, 123(5): 1036-1042. doi: 10.1016/j.ophtha.2016.01.006 [3] 方晖, 林芳宇, 韩伟. 近视眼遗传机制的研究现状与展望[J]. 医学分子生物学杂志, 2014, 11(2): 119-124. doi: 10.3870/j.issn.1672-8009.2014.02.012FANG H, LIN F Y, HAN W. Research status and prospects of myopia genetics[J]. J Med Molecul Biol, 2014, 11(2): 119-124. doi: 10.3870/j.issn.1672-8009.2014.02.012 [4] 王军良, 龚莹莹, 辜臻晟. 环境和遗传因素对近视眼的影响[J]. 国际眼科纵览, 2015, 39(2): 134-139. doi: 10.3760/cma.j.issn.1673-5803.2015.02.014WANG J L, GONG Y Y, GU Z S. Effects of environmental and genetic factors on myopia[J]. Int Rev Ophthalmol, 2015, 39(2): 134-139. doi: 10.3760/cma.j.issn.1673-5803.2015.02.014 [5] 金涵, 罗荣, 陈娟, 等. 高度近视的分子遗传学研究进展[J]. 江西医药, 2020, 55(4): 491-492. doi: 10.3969/j.issn.1006-2238.2020.04.044JIN H, LUO R, CHEN J, et al. Recent advances in molecular genetic study on high myopia[J]. Jiangxi Med J, 2020, 55(4): 491-492. doi: 10.3969/j.issn.1006-2238.2020.04.044 [6] 国家卫生和计划生育委员会. 标准对数视力表GB/T 11533—2011[S]. 2011.National Health and Family Planning Commission. standard for logarithmic visual acuity charts GB/T 11533-2011[S]. 2011. [7] 国家卫生和计划生育委员会. 学生健康检查技术规范GB/T 26343—2010[S]. 2011.National Health and Family Planning Commission. Technical standard for physical examination for students GB/T 26343-2010[S]. 2011. [8] 疾病预防控制局. 国家卫生健康委办公厅关于印发2019年全国学生常见病和健康影响因素监测与干预工作方案的通知[EB/OL]. [2019-10-10]. http://www.nhc.gov.cn/jkj/s5898bm/201903/1bcbac21e1864377ad24984fac014c7d.shtml.Agency for Disease Control and Prevention. The Office of the National Health and Wellness Commission has issued a notice on the 2019 National Programme for monitoring and intervention of common student diseases and health effects[EB/OL]. [2019-10-10]. http://www.nhc.gov.cn/jkj/s5898bm/201903/1bcbac21e1864377ad24984fac014c7d.shtml. [9] 中国国家标准化管理委员会. 中小学生一日学习时间卫生要求GB/T 17223—2012[S]. 2012-12-31.China National Standardization Management Committee. Health requirements of daily learning time for secondary and elementary school students GB/T 17223-2012[S]. 2012-12-31. [10] 王幼生, 廖瑞瑞, 刘泉, 等. 现代眼视光学[M]. 广州: 广东科技出版社, 2004.WANG Y S, LIAO R R, LIU Q, et al. Modern optometry[M]. Guangzhou: Guangdong Science and Technology Press, 2004. [11] 亓祥顺, 周广英, 王艳. 关于视疲劳诊断、病因及其治疗方法的探讨[J]. 临床医药文献电子杂志, 2017, 4(29): 5733-5736. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX201729150.htmYU X S, ZHOU G Y, WANG Y. Discussion on the diagnosis, causes and treatment of visual fatigue[J]. J Clin Med Literat (Electronic Edition), 2017, 4(29): 5733-5736. https://www.cnki.com.cn/Article/CJFDTOTAL-LCWX201729150.htm [12] 王立书, 陈如利, 吴飞. 青少年看近视疲劳的检查、分析与处理[J]. 中国眼镜科技杂志, 2019, 317(7): 98-102. https://www.cnki.com.cn/Article/CJFDTOTAL-YJKJ201907041.htmWANG L S, CHEN L R, WU F. Examination, analysis and treatment of youth myopia fatigue[J]. J China Opt Technol, 2019, 317(7): 98-102. https://www.cnki.com.cn/Article/CJFDTOTAL-YJKJ201907041.htm [13] FRENCH A N, MORGAN I G, MITCHELL P, et al. Risk factors for incident myopia in Australian school children[J]. Ophthalmology, 2013, 120(10): 2100-2108. doi: 10.1016/j.ophtha.2013.02.035 [14] JONES-JORDAN L A, MITCHELL G L, COTTER S A, et al. Visual activity before and after the onset of juvenile myopia[J]. Invest Ophthalmol Vis Sci, 2011, 52(3): 1841-1850. doi: 10.1167/iovs.09-4997 [15] MUHAMEDAGIC L, MUHAMEDAGIC B, HALILOVIC E A, et al. Relation between near work and myopia progression in student population[J]. Materia Socio Med, 2014, 26(2): 100-103. doi: 10.5455/msm.2014.26.100-103 [16] 吕敏之, 何鲜桂, 王明进. 学生读写姿势研究进展[J]. 中国学校卫生, 2017, 38(5): 795-798. http://2269799.s21d-2.faiusrd.com/61/ABUIABA9GAAg0MjlyAUo74PasAY.pdfLYU M Z, HE X G, WANG M J. Recent advances in students' reading and writing posture[J]. Chin J Sch Health, 2017, 38(5): 795-798. http://2269799.s21d-2.faiusrd.com/61/ABUIABA9GAAg0MjlyAUo74PasAY.pdf [17] YOU Q S, WU L J, DUAN J L, et al. Factors associated with myopia in school children in China: the beijing childhood eye study[J]. PLoS One, 2012, 7(12): e52668. http://pubmedcentralcanada.ca/pmcc/articles/PMC3531363/ [18] WU L, WANG Y, YOU Q, et al. Risk factors of myopic shift among primary school children in Beijing, China: a prospective study[J]. Int J Med Sci, 2015, 12(8): 633-638. doi: 10.7150/ijms.12133 [19] 黄剑辉, 段佳丽, 宋玉珍, 等. 北京市9~22岁学生视力不良影响因素分析[J]. 中国学校卫生, 2016, 37(7): 1019-1021. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201607018.htmHUANG J H, DUAN J L, SONG Y Z, et al. Influencing factors of myopia among students aged 9-22 in Beijing[J]. Chin J Sch Health, 2016, 37(7): 1019-1021. https://www.cnki.com.cn/Article/CJFDTOTAL-XIWS201607018.htm [20] HEALTH D O A A, AIDS N C F H, HEPATITIS V, et al. Trends in the prevalence of physical activity and sedentary behaviors National YRBS: 1991-2019[EB/OL]. [2020-10-10]. https://www.cdc.gov/healthyyouth/data/yrbs/factsheets/2019_physical_trend_yrbs.htm. [21] 罗冬梅, 闫晓晋, 雷园婷, 等. 1953—2010年中国10~24岁青少年全死因死亡率趋势和地区差异分析[J]. 中华流行病学杂志, 2020, 41(2): 184-189. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zhlxbx202002009LUO D M, YAN X J, LEI Y T, et al. Secular trends and geographic disparities of all-cause mortality among Chinese adolescents aged 10-24 years, between 1953 and 2010[J]. Chin J Epidemiol, 2020, 41(2): 184-189. http://med.wanfangdata.com.cn/Paper/Detail?id=PeriodicalPaper_zhlxbx202002009 [22] 徐荣彬, 温勃, 宋逸, 等. 1990—2016年中国青少年死亡率及主要死因变化[J]. 中华预防医学杂志, 2018, 52(8): 802-808. doi: 10.3760/cma.j.issn.0253-9624.2018.08.006XU R B, WEN B, SONG Y, et al. The change in mortality and major causes of death among Chinese adolescents from 1990 to 2016[J]. Chin J Prev Med, 2018, 52(8): 802-808. doi: 10.3760/cma.j.issn.0253-9624.2018.08.006 [23] 郭玲, 宋逸, 马军. 1991—2010年中国5个少数民族7~18岁学生肥胖率动态变化分析[J]. 中国儿童保健杂志, 2017, 25(4): 338-341. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201704005.htmGUO L, SONG Y, MA J. Secular trend on prevalence of obesity among students aged 7-18 years old of 5 minorities in china from 1991 to 2010[J]. Chin J Child Heal Care, 2017, 25(4): 338-341. https://www.cnki.com.cn/Article/CJFDTOTAL-ERTO201704005.htm [24] 陈露. 上海市少年儿童屈光发育现状及进展的纵向调查研究[D]. 上海: 复旦大学, 2012.CHEN L. The study of refractive development status and longitudinal changes of children and juveniles in Shanghai[D]. Shanghai: Fudan University, 2012. [25] 宋逸, 胡佩瑾, 董彦会, 等. 2014年全国各省、自治区、直辖市汉族学生视力不良现况分析[J]. 北京大学学报(医学版), 2017, 49(3): 433-438. doi: 10.3969/j.issn.1671-167X.2017.03.010SONG Y, HU P J, DONG Y H, et al. Prevalence of reduced visual acuity among Chinese Han students in 2014[J]. J Peking University(Health Sci), 2017, 49(3): 433-438. doi: 10.3969/j.issn.1671-167X.2017.03.010 [26] 宋超, 郭海军, 宫伟彦, 等. 2010—2012年中国中小学生闲暇静态活动[J]. 卫生研究, 2017, 46(5): 705-709. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ201705006.htmSONG C, GUO H J, GONG W Y, er al. Status of sedentary activities in the leisure time in Chinese pupils in 2010-2012[J]. J Hyg Res, 2017, 46(5): 705-709. https://www.cnki.com.cn/Article/CJFDTOTAL-WSYJ201705006.htm -
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