环境因素对不同青春期阶段儿童青少年屈光发育的影响因素分析

杨金柳行; 王菁菁; 何鲜桂; 张波; 程天宇; 王悦; 潘臣炜

doi:10.16835/j.cnki.1000-9817.2022.07.004

环境因素对不同青春期阶段儿童青少年屈光发育的影响因素分析

doi: 10.16835/j.cnki.1000-9817.2022.07.004

杨金柳行¹,
王菁菁¹,
何鲜桂^{1, 2},
张波¹,
程天宇²,
王悦³,
潘臣炜^4, ,

1.
上海市眼病防治中心/上海市眼科医院/上海市视觉健康中心(儿童青少年近视防治技术中心), 200040
2.
上海交通大学附属第一人民医院/国家眼部疾病临床医学研究中心/上海市眼底病重点实验室/上海眼视觉与光医学工程技术研究中心
3.
上海市宝山区疾病预防控制中心学校卫生科
4.
苏州大学苏州医学院公共卫生学院

基金项目:

上海市公共卫生优秀学科带头人培养计划项目 GWV-10.2-XD09

国家自然科学基金青年课题项目 81402695

国家自然科学基金青年课题项目 82003562

2019年上海市卫生健康委员会科研课题项目 21094Y0308

详细信息

作者简介:
杨金柳行(1994-)，女，浙江宁波人，硕士，科员，主要从事儿童青少年近视防控工作

通讯作者:
潘臣炜, E-mail：pcwonly@gmail.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R 778.1 G 806 G 478
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- 被引次数: 0
出版历程
- 收稿日期: 2021-11-01
- 修回日期: 2021-12-13
- 网络出版日期: 2022-07-27
- 刊出日期: 2022-07-25

Effects of environmental factors on refractive development of children and adolescents in different pubertal stages

1.
Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai Vision Health Center & Shanghai Children Myopia Institute, Shanghai (200040), China

摘要

摘要: 目的探讨青春期对儿童青少年屈光发育的影响及其与户外活动、近距离用眼和电子产品使用的交互作用，为近视干预策略的制定提供参考。方法采用整群抽样从上海市某所九年一贯制学校选取776名7~13岁的儿童青少年参与研究，随访周期为2年(2015—2017年)。所有参与者每年进行1次睫状肌麻痹下屈光检查和眼轴测量，通过问卷调查和问询获取青春发育表征、日均户外时长、近距离用眼时长、电子产品使用时长等信息。采用广义估计方程分析不同青春期阶段屈光参数的影响因素及其交互效应。结果基线时有634名儿童青少年参与散瞳验光，其中350名近视(55.2%)。不同青春发育阶段眼轴长度进展、日均户外时长、近距离用眼时长和电子产品使用时长差异均有统计学意义(F值分别为4.10，4.25，5.54，9.20，P值均 < 0.05)。青春期阶段与日均户外时长对眼轴长度的影响存在交互作用(β=0.133，P＜0.05)，与近距离用眼时长、电子产品使用时长的交互作用无统计学意义(P值均>0.05)。结论青春期可能在中国儿童青少年户外时间与屈光发育之间的关系中起调节作用。
- 青春期 /
- 环境 /
- 屈光, 眼 /
- 儿童 /
- 青少年
Abstract: Objective To explore the effect of puberty on refractive development of children and adolescents and its interaction with outdoor activities, near work and the use of electronic products, so as to provide a reference for strategies for intervening myopia. Methods Cluster sampling method was used to select 776 students aged 7-13 from a nine-year consistent school in Shanghai to participate and were followed up for 2 years. All participants underwent cycloplegic refraction and ocular axial length measurement once a year, as well as pubertal development, average daily outdoor time, near work time and time of electronic products usage. The influencing factors and interaction effects of refractive parameters in different puberty stages were analyzed by generalized estimation equation. Results At baseline, 634 children participated in cycloplegic refraction, of which 350 were myopic (55.2%). There were significant differences in axial length, average daily outdoor time, near work time and time of using electronic products at different stages of puberty (F=4.10, 4.24, 5.54, 9.20, P < 0.05). There was interaction between puberty and outdoor time on axial length development (β=0.133, P < 0.05), and the interaction between puberty and the time of near work or using electronic products was not statistically significant (P>0.05). Conclusion Puberty may play a regulatory role in the relationship between outdoor time and refractive development among Chinese children and adolescents.
- Puberty /
- Environment /
- Refraction, ocular /
- Child /
- Adolescent
注释:

1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 不同青春发育阶段眼参数和环境因素分析(x±s)

Table 1. Analysis of ocular parameters and environmental factors at different puberty stages(x±s)

初潮或首次遗精	人数	眼轴长度/mm			等效球镜/D			日均户外活动时长/h	日均近距离用眼时长/h	日均电子产品使用时长/h
初潮或首次遗精	人数	基线	2年随访	2年进展	基线	2年随访	2年进展	日均户外活动时长/h	日均近距离用眼时长/h	日均电子产品使用时长/h
未发生组	403	23.87±1.10	24.51±1.21	0.63±0.34	-0.62±1.76	-1.56±2.08	-1.06±0.66	2.01±1.18	3.53±1.34	1.37±1.09
新发生组	143	24.24±0.96	24.79±1.00	0.55±0.30	-1.69±1.98	-2.86±2.16	-1.01±0.59	2.30±1.29	3.83±1.33	1.64±1.25
基线已发生组	83	24.59±1.21	25.15±1.24	0.56±0.32	-2.32±2.35	-3.73±2.44	-1.18±0.72	1.85±1.09	4.01±1.16	1.95±1.43
F值		17.93	11.40	4.10	36.82	29.95	1.06	4.24	5.54	9.20
P值		＜0.01	＜0.01	0.02	＜0.01	＜0.01	0.35	0.02	＜0.01	＜0.01
注：等效球镜在基线与2年随访变化比较P＜0.05。

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表 2 儿童青少年户外时间、青春期与眼轴长度和等效球镜的广义估计方程分析(n=776)

Table 2. Analysis of generalized estimation equations among outdoor time, puberty and axial length/spherical equivalence(n=776)

自变量	选项	眼轴长度/mm		等效球镜/D
自变量	选项	β值(β值95%CI)	P值	β值(β值95%CI)	P值
年龄		0.217(0.152~0.281)	＜0.01	-0.424(-0.543~-0.304)	＜0.01
性别	女	-0.643(-0.794~-0.491)	＜0.01	0.028(-0.278~0.333)	0.86
身高		0.011(0.002~0.020)	0.02	-0.011(-0.025~0.003)	0.12
父母近视	双方均近视	0.599(0.392~0.806)	＜0.01	-1.202(-1.625~-0.780)	＜0.01
	一方近视	0.193(0.026~0.361)	0.02	-0.430(-0.763~-0.097)	0.01
日均户外活动时长/h		-0.279(-0.352~-0.206)	＜0.01	0.483(0.350~0.616)	＜0.01
日均近距离用眼时长/h		0.045(-0.014~0.103)	0.14	-0.122(-0.242~-0.002)	0.05
日均电子产品使用时长/h		0.009(-0.061~0.080)	0.80	-0.010(-0.155~0.135)	0.89
是否发生初潮或首次遗精	是	-0.193(-0.530~0.143)	0.26	0.050(-0.666~0.765)	0.89
户外活动时长与青春发育交互作用		0.133(0.003~0.264)	＜0.05	-0.241(-0.517~0.036)	0.09

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表 3 近距离用眼时长、青春期与眼轴长度和等效球镜的广义估计方程分析(n=776)

Table 3. Analysis of generalized estimation equations among near work time, puberty and axial length/spherical equivalence(n=776)

自变量	选项	眼轴长度/mm		等效球镜/D
自变量	选项	β值(β值95%CI)	P值	β值(β值95%CI)	P值
年龄		0.216(0.152~0.281)	＜0.01	-0.422(-0.542~-0.301)	＜0.01
性别	女	-0.650(-0.801~-0.499)	＜0.01	0.033(-0.271~0.338)	0.83
身高		0.011(0.002~0.020)	0.02	-0.011(-0.025~0.003)	0.11
父母近视	双方均近视	0.601(0.393~0.808)	＜0.01	-1.215(-1.638~-0.792)	＜0.01
	一方近视	0.198(0.030~0.367)	0.02	-0.447(-0.783~-0.110)	0.01
日均户外活动时长/h		-0.248(-0.315~-0.181)	＜0.01	0.434(0.300~0.569)	＜0.01
日均近距离用眼时长/h		0.043(-0.021~0.107)	0.19	-0.130(-0.260~0.000)	0.05
日均电子产品使用时长/h		0.006(-0.065~0.077)	0.87	-0.007(-0.153~0.139)	0.92
是否发生初潮或首次遗精	是	0.087(-0.407~0.581)	0.73	-0.661(-1.711~0.388)	0.22
近距离用眼时长与青春发育交互作用		0.000(-0.118~0.117)	0.99	0.055(-0.188~0.298)	0.66

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表 4 电子产品使用时长、青春期与眼轴长度和等效球镜的广义估计方程分析(n=776)

Table 4. Analysis of generalized estimation equations among time of using electronic products, puberty and axial length/spherical equivalence(n=776)

自变量	选项	眼轴长度/mm		等效球镜/D
自变量	选项	β值(β值95%CI)	P值	β值(β值95%CI)	P值
年龄		0.217(0.153~0.282)	＜0.01	-0.419(-0.539~-0.298)	＜0.01
性别	女	-0.651(-0.802~-0.500)	＜0.01	0.030(-0.273~0.333)	0.85
身高		0.011(0.002~0.020)	0.02	-0.011(-0.025~0.003)	0.11
父母近视	双方均近视	0.600(0.392~0.808)	＜0.01	-1.212(-1.632~-0.791)	＜0.01
	一方近视	0.197(0.028~0.365)	0.02	-0.448(-0.783~-0.113)	0.01
日均户外活动时长/h		-0.247(-0.314~-0.179)	＜0.01	0.438(0.302~0.574)	＜0.01
日均近距离用眼时长/h		0.043(-0.017~0.102)	0.16	-0.116(-0.235~0.004)	0.06
日均电子产品使用时长/h		-0.008(-0.090~0.075)	0.86	-0.074(-0.230~0.083)	0.36
是否发生初潮或首次遗精	是	0.016(-0.236~0.268)	0.90	-0.810(-1.382~-0.238)	0.01
电子产品使用时长与青春发育交互作用		0.040(-0.066~0.145)	0.46	0.211(-0.029~0.451)	0.09

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