Longitudinal analysis of myopia and refractive errors screening results in adolescents in a community in Shanghai
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摘要:
目的 了解上海市郊区某镇青少年近视屈光不正筛查中屈光度的纵向变化及影响因素，为针对性采取预防和控制近视流行的措施提供依据。 方法 采用整群抽样方法，抽取上海市郊区某镇2所小学1 346名学生，从上海市青少年屈光发育档案获取学生2017和2020年裸眼视力、非睫状肌麻痹下屈光检查参数和体格发育指标。评估青少年屈光度的指标等效球镜(SE)纵向变化情况。使用线性回归模型检查SE的变化率与学生特征之间的关系。 结果 筛查性近视年平均发病率为16.36%，3年时间持续近视组学生左右眼SE度数均降低225度。女生(Z右眼=-4.33，Z左眼=-3.75，P值均 < 0.01)、新发近视状态和持续近视状态(Z右眼=634.45，Z左眼=638.85，P值均 < 0.01)是屈光度下降较快的关键因素。 结论 学生重度视力不良比例较高，持续近视的学生纵向屈光度中度负移。有关部门应结合屈光度变化情况制定有效的防控方案来延缓青少年近视发展。 Abstract:Objective To understand the longitudinal changes of refractive errors in adolescent myopia screening in the suburb of Shanghai, and to provide reference for targeted measures of myopia prevention and intervention. Methods By using the cluster sampling method, 1 346 students were selected from two primary schools in a town in the suburb of Shanghai. Physical development indicators and refractive examination parameters of non-ciliary muscle paralysis, and uncorrected visual acuity in 2017 and 2020 were collected from the Shanghai adolescent refractive development file. Longitudinal change of spherical equivalent (SE) refractive were assessed. A linear regression model was used to examine the relationship between the rate of SE change with characteristics of the students. Results The average annual incidence of myopia was 16.36%, and the SE degrees of the left and right eyes of myopia students decreased by 225 degrees for three years. Girls (right eye Z=-4.33; left eye Z=-3.75, P < 0.01), newly-onset myopia and persistent myopia (right eye Z=634.45; left eye Z=638.85, P < 0.01) was a key for the rapid progress of refractive power. Conclusion The proportion of students with severe low vision is relatively high, and the apparent shifts toward more hyperopia in myopia students call for effective prevention and control programs based on changes in refractive to slow the progression of adolescent myopia. -
Key words:
- Myopia /
- Refractive errors /
- Regression analysis /
- Adolescent
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表 1 不同年份学生远视力筛查视力不良程度分布(n=1 346)
Table 1. Distribution of the degree of poor vision among students in distance vision screening in 2017 and 2020(n=1 346)
裸眼 年份 正常 轻度 中度 重度 右眼 2017 963(71.55) 189(14.04) 137(10.18) 57(4.23) 2020 622(46.21) 114(8.47) 250(18.57) 360(26.75) 左眼 2017 944(70.13) 189(14.04) 162(12.04) 51(3.79) 2020 612(45.47) 126(9.36) 268(19.91) 340(25.26) 注：()内数字为构成比/%。 
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表 2 不同年份远视力筛查不同基线年级学生屈光度
Table 2. Diopter of pupils of different grades in distance vision screening in different years
裸眼 年份 一年级 二年级 三年级 四年级 五年级 左眼 2017 0.50 0.25 0.13 0 -0.50 2020 -0.25 -1.00 -0.88 -1.00 -2.00 右眼 2017 0.50 0.25 0.13 0 -0.50 2020 -0.38 -1.00 -1.13 -1.31 -2.00
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表 3 不同组别学生2017年与2020年眼球等效球镜变化量比较/D
Table 3. Comparison of the amount of change of the student's eyeball equivalent SE between different variable types in 2017 and 2020/D
组别 类别 人数 右眼 左眼 M值(M值95%CI) Z值 P值 M值(M值95%CI) Z值 P值 性别 女 657 -1.38(-1.50~-1.25) -4.33 ＜0.01 -1.25(-1.25~-1.13) -3.75 ＜0.01 男 689 -1.00(-1.13~-0.88) -0.88(-1.00~-0.75) 地区 上海 525 -1.25(-1.38~-1.13) 5.96 0.55 -1.13(-1.25~-1.00) 7.70 0.36 东北 9 -0.63(-2.76~-0.02) -0.50(-1.24~0.22) 华东 579 -1.13(-1.25~-1.00) -1.00(-1.13~-0.88) 华北 14 -1.44(-2.06~-0.98) -1.50(-2.33~-0.73) 华中 124 -0.94(-1.23~-0.63) -0.75(-1.13~-0.63) 华南 8 -1.06(-2.35~-0.17) -1.06(-2.65~-0.46) 西南 66 -1.19(-1.56~-0.63) -1.00(-1.37~-0.69) 西北 21 -1.00(-2.02~-0.43) -1.13(-1.96~-0.54) 近视状态 不近视 644 -0.50(-0.63~-0.50) 634.45 ＜0.01 -0.50(-0.63~-0.50) 638.85 ＜0.01 新发近视 403 -2.00(-2.13~-1.88) -2.00(-2.13~-1.88) 持续近视 224 -2.25(-2.38~-2.00) -2.13(-2.25~-1.88) 近视扭转 75 -0.25(-0.50~0.00) -0.13(-0.37~-0.01) 基线学校 学校1 867 -1.13(-1.25~-1.13) 0.18 0.85 -1.00(-1.13~-1.00) 0.40 0.69 学校2 479 -1.13(-1.25~-1.00) -1.13(-1.25~-0.88) 注：华东组不包括上海。
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表 4 视力筛查后学生屈光度3年变化情况多因素线性回归分析(n=1 346)
Table 4. Multi-factor linear regression analysis of changes in students' refractive power in 3 years after vision screening (n=1 346)
裸眼 自变量与常数项 B值(B值95%CI) 标准误 t值 P值 右眼 近视状态 -0.48(-0.55~-0.40) 0.04 -12.98 ＜0.01 性别 0.22(0.09~0.35) 0.07 3.38 ＜0.01 籍贯地区 0.01(-0.02~0.05) 0.02 0.77 0.44 基线学校 -0.13(-0.27~0.00) 0.07 -1.92 0.06 基线年级 0.00(-0.05~0.05) 0.03 0.02 0.98 常数项 -0.89(-1.15~-0.63) 0.13 -6.68 ＜0.01 左眼 近视状态 -0.42(-0.50~-0.35) 0.04 -10.87 ＜0.01 性别 0.22(0.09~0.36) 0.07 3.19 ＜0.01 籍贯地区 0.01(-0.03~0.05) 0.02 0.26 0.79 基线学校 -0.18(-0.32~-0.03) 0.07 -2.41 0.02 基线年级 0.02(-0.03~0.07) 0.03 0.81 0.42 常数项 -0.84(-1.11~-0.56) 0.14 -5.93 ＜0.01
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表 5 不同性别学生SE 3年变化量与发育指标相关性(r值，n=1 346)
Table 5. Correlation between the three-year change of equivalent SE and developmental indicators for students of different genders(r, n=1 346)
性别 裸眼 身高 体重 体质量指数 基线年龄 基线 增长量 基线 增长量 基线 增长量 女 右 -0.10* -0.05 -0.08* -0.07 -0.02 -0.03 -0.10 左 -0.05 -0.03 -0.05 -0.04 -0.02 -0.01 -0.05 男 右 -0.07 -0.05 -0.07 -0.02 -0.06 0.03 -0.07 左 -0.04 -0.06 -0.06 -0.05 -0.06 -0.02 -0.04 注：*P＜0.05。
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