成都市高新区儿童青少年屈光状态

辛梅; 张雪梅; 占煜; 刘倩茜; 万雪梅; 聂惠斌; 王晓翔; 田茜溪; 杨杰; 罗洪林; 郭晗; 杨玲; 曾流芝; 罗俊; 陈泽君

doi:10.16835/j.cnki.1000-9817.2022.10.029

成都市高新区儿童青少年屈光状态

doi: 10.16835/j.cnki.1000-9817.2022.10.029

1.
四川省成都市第一人民医院眼科，610095
2.
成都市第一人民医院事业发展部
3.
成都市高新区中和社区卫生服务中心
4.
成都市高新区教育文化和卫生健康局卫生健康处

基金项目:

四川省青年创新科研课题计划 Q21029

成都中医药大学“杏林学者”学科人才科研提升计划医院专项课题项目 YYZX2021013

成都中医药大学“杏林学者”学科人才科研提升计划医院专项课题项目 YYZX2021127

详细信息

作者简介:
辛梅(1985-)，女，四川广汉人，硕士，主治医师，主要从事眼科临床工作

通讯作者:
陈泽君，E-mail：296150738@qq.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: G478 R179 R778.11
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- 被引次数: 0
出版历程
- 收稿日期: 2022-02-14
- 修回日期: 2022-06-22
- 网络出版日期: 2022-10-28
- 刊出日期: 2022-10-25

Refractive status of children and adolescents in Gaoxin District of Chengdu

1.
Department of Ophthalmology, Chengdu First People's Hospital, Chengdu(610095), China

摘要

摘要: 目的了解成都高新区4~18岁儿童青少年的屈光状态，分析屈光参数的流行病学特征。方法于2021年8—9月对成都市高新区4~18岁共82 024名儿童青少年进行调查，分析筛查性近视检出、视力不良、高度近视、屈光状态及眼轴发育情况。结果筛查性近视检出率为40.42%，其中低度近视率为24.51%，中度近视率为13.05%，高度近视率为2.86%。幼儿园筛查性近视检出率为1.81%(233/12 848)，小学为34.44%(17 095/49 644)，初中为79.73%(9 738/12 214)，高中为83.25%(6 092/7 318)。4岁开始视力不良率逐年增加，6~15岁为近视检出率增长最快的时间段；高度近视检出率相邻年龄组间两两比较，9~15岁之间差异有统计学意义(P值均 < 0.035 7)；不同年龄不同性别间比较，5岁、7~17岁男女生筛查性近视检出率差异均有统计学意义(P值均 < 0.05)。4岁时总体屈光度中位数为0.40 D，到18岁时发展为-2.90 D，8~15岁女生的屈光度比男生更高(Z值分别为-2.53，-4.09，-5.67，-8.64，-5.56，-4.97，-2.52，-2.14，P值均 < 0.05)。随年龄增长眼轴逐渐变长，4岁时均值为(22.31±0.59)mm，18岁达到(24.91±1.00)mm。角膜曲率均值随年龄变化不大，均值为(43.19±1.47)D。结论 6~15岁为近视发展关键时期，预防近视应该在6岁前，预防高度近视发生应在10岁前，女生的近视检出率高于男生，近视防控应重点关注女性。
- 屈光, 眼 /
- 近视 /
- 患病率 /
- 儿童 /
- 青少年
Abstract: Objective To investigate the refractive status of children and adolescents aged 4-18 years in Chengdu, and to analyze the epidemiological characteristics of refractive parameters. Methods A cross-sectional survey was conducted among 82 024 children and adolescents aged 4-18 years in Gaoxin District of Chengdu from August to September 2021. The prevalence of screening myopia, low vision rate, high myopia rate, refractive status and axial development were analyzed. Results The prevalence of screening myopia in students aged 4-18 years was 40.42%(33 158/82 024). Low myopia was 24.51%(20 108/82 024), moderate myopia was 13.05%(10 703/82 024) and high myopia was 2.86%(2 347/82 024). The prevalence of screening myopia was 1.81% (233/12 848) in kindergarten, 34.44%(17 095/49 644) in primary school, 79.73%(9 738/12 214) in junior high school and 83.25%(6 092/7 318) in senior high school. The rate of visual impairment increased by year from the age of 4, and the rate of myopia increased most rapidly from 6 to 15 years old, the prevalenct of high myopia was compared between adjacent age groups: there were statistical differences between 9-15 years old were more likely to be nearsighted than boys(P < 0.035 7). Significant differences in screening myopia between 5- and 7-17-year-old groups, and in boys and girls.The median total diopter was 0.40 D at the age of 4 and developed to -2.90 D at the age of 18. The diopter of girls aged 8-15 years was higher than that of boys, and there was statistical significance(Z=-2.53, -4.09, -5.67, -8.64, -5.56, -4.97, -2.52, -2.14, P < 0.05). The axial length gradually increased with age, with the mean value of (22.31±0.59) mm at 4 years old and (24.91±1.00) mm at 18 years old. The mean corneal curvature did not change with age (43.19±1.47)D. Conclusion 6-15 years old is a especially critical period for myopia development. More efforts need to be taken to decrease the prevalence of myopia before 6 years old. Prevention of the development of high myopia should start before the age of 10. The prevalence of myopia in girls is higher than that in boys, more prevention and control of myopia should focus on girls.
- Refraction, ocular /
- Myopia /
- Prevalence /
- 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 不同人口学特征儿童青少年筛查性近视及视力不良检出率比较

Table 1. Comparison of screening myopia prevalence and poor vision rate among different demographic characteristics

人口学指标	选项	人数	统计值	近视	低度近视	中度近视	高度近视	视力不良
学段	幼儿园	12 848		233(1.81)	188(1.46)	36(0.28)	9(0.07)	3 797(29.55)
	小学	49 644		17 095(34.44)	13 249(26.69)	3 522(7.09)	324(0.65)	17 432(35.11)
	初中	12 214		9 738(79.73)	4 561(37.34)	4 298(35.19)	879(7.20)	9 430(77.21)
	高中	7 318		6 092(83.25)	2 110(28.83)	2 847(38.90)	1 135(15.51)	6 017(82.22)
			χ²值	12 103.28	4 975.83	12 986.16	4 015.24	12 426.35
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
性别	男	42 399		16 432(38.76)	9 931(23.42)	5 258(12.40)	1 243(2.93)	18 041(42.55)
	女	39 625		16 726(42.21)	10 177(25.68)	5 445(13.74)	1 104(2.79)	18 635(47.03)
			χ²值	101.53	56.56	32.42	1.56	166.14
			P值	< 0.01	< 0.01	< 0.01	0.21	< 0.01
年龄/岁	4	6 699		127(1.90)	106(1.58)	15(0.22)	6(0.09)	1 691(25.24)
	5	5 767		72(1.25)^*	55(0.95)^*	14(0.24)	3(0.05)	1 960(33.99)^*
	6	8 981		812(9.04)^*	739(8.23)^*	58(0.65)^*	15(0.17)	1 434(15.97)^*
	7	10 116		1 740(17.20)^*	1 597(15.79)^*	125(1.24)^*	18(0.18)	1 921(18.99)^*
	8	8 563		2 673(31.22)^*	2 322(27.12)^*	325(3.80)^*	26(0.30)	2 667(31.15)^*
	9	8 824		3 715(42.10)^*	2 998(33.98)^*	675(7.65)^*	42(0.48)	3 679(41.69)^*
	10	6 772		3 778(55.79)^*	2 750(40.61)^*	957(14.13)^*	71(1.05)^*	3 624(53.51)^*
	11	6 032		3 930(65.15)^*	2 558(42.41)	1 238(20.52)^*	134(2.22)^*	3 785(62.75)^*
	12	4 618		3 391(73.43)^*	1 900(41.14)	1 307(28.30)^*	184(3.98)^*	3 244(70.25)^*
	13	4 185		3 346(79.95)^*	1 591(38.02)^*	1 459(34.86)^*	296(7.07)^*	3 246(77.56)^*
	14	3 766		3 180(84.44)^*	1 269(33.70)^*	1 535(40.76)^*	376(9.98)^*	3 106(82.47)^*
	15	2 965		2 504(84.45)	855(28.84)^*	1 229(41.45)	420(14.17)^*	2 463(83.07)
	16	2 304		1 918(83.25)	686(29.77)	861(37.37)^*	371(16.10)	1 893(82.16)
	17	1 983		1 625(81.95)	549(27.69)	747(37.67)	329(16.59)	1 614(81.39)
	18	449		347(77.28)	133(29.62)	158(35.19)	56(12.47)	349(77.73)
			χ²值	30 525.30	9 142.40	15 257.20	6 602.60	18 247.51
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
注：*代表与上一相邻年龄组间两两比较，P < 0.00 357；()内数字为检出率/%。

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表 2 不同性别各年龄组儿童青少年筛查性近视检出率比较

Table 2. Comparison of screening myopia prevalence among different ages and genders

性别	4岁	5岁	6岁	7岁	8岁	9岁	10岁	11岁
男	70(2.00)	49(1.64)	423(9.21)	797(15.73)	1 318(29.73)	1 835(39.82)	1 889(53.53)	1 864(59.97)
女	57(1.78)	23(0.83)	389(8.87)	943(18.68)	1 355(32.81)	1 880(44.59)	1 889(58.25)	2 066(70.66)
χ²值	0.42	7.72	0.31	15.43	9.43	20.55	15.27	75.72
P值	0.53	0.01	0.58	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

性别	12岁	13岁	14岁	15岁	16岁	17岁	18岁
男	1 687(69.37)	1 605(76.39)	1 570(81.52)	1 278(82.08)	976(81.47)	880(80.07)	191(74.61)
女	1 704(77.95)	1 741(83.54)	1 610(87.50)	1 226(87.07)	942(85.17)	745(84.28)	156(80.83)
χ²值	43.48	33.36	25.65	14.04	5.65	5.85	2.43
P值	< 0.01	< 0.01	< 0.01	< 0.01	0.02	0.02	0.14
注：()内数字为检出率/%。

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表 3 不同性别各年龄组儿童青少年屈光度比较[D, M(P₂₅，P₇₅)]

Table 3. Comparison of diopter of children and adolescents of different ages and genders[D, M(P₂₅, P₇₅)]

性别	人数	4岁	5岁	6岁	7岁	8岁	9岁	10岁	11岁
男	42 399	0.40(-0.40, 0.60)	0.40(-0.40, 0.60)	0.40(-0.30, 0.80)	0.30(-0.50, 0.60)	-0.40(-1.10, 0.40)	-0.50(-1.60, 0.30)	-1.00(-2.30, -0.10)	-1.40(-2.80, -0.40)
女	39 625	0.40(-0.40, 0.80)	0.40(-0.30, 0.80)	0.40(-0.30, 0.80)	0.10(-0.60, 0.60)	-0.40(-1.30, 0.40)	-0.80(-1.80, 0.30)	-1.30(-2.50, -0.40)	-1.90(-3.10, -0.80)
总体	82 024	0.40(-0.40, 0.60)	0.40(-0.30, 0.80)	0.40(-0.30, 0.80)	0.10(-0.60, 0.60)	-0.40(-1.10, 0.40)	-0.60(-1.80, 0.30)	-1.10(-2.40, -0.30)	-1.60(-2.90, -0.50)
Z值		-2.73	-4.57	-2.41	-1.93	-2.53	-4.09	-5.67	-8.64
P值		0.01	< 0.01	0.02	0.05	0.01	< 0.01	< 0.01	< 0.01

性别	人数	12岁	13岁	14岁	15岁	16岁	17岁	18岁
男	42 399	-1.90(-3.50, -0.80)	-2.50(-4.00, -1.10)	-3.00(-4.80, -1.50)	-3.40(-5.10, -1.60)	-3.40(-5.10, -1.60)	-3.40(-5.30, -1.50)	-2.80(-4.58, -1.10)
女	39 625	-2.30(-3.60, -1.10)	-2.80(-4.30, -1.50)	-3.10(-4.80, -1.90)	-3.50(-5.08, -2.00)	-3.30(-5.00, -1.80)	-3.40(-5.10, -1.65)	-3.30(-4.70, -1.20)
总体	82 024	-2.10(-3.60, -0.90)	-2.60(-4.10, -1.30)	-3.10(-4.80, -1.60)	-3.50(-5.10, -1.80)	-3.40(-5.10, -1.60)	-3.40(-5.30, -1.60)	-2.90(-4.60, -1.10)
Z值		-5.56	-4.97	-2.52	-2.14	-0.29	-0.29	-1.10
P值		< 0.01	< 0.01	0.01	0.03	0.77	0.77	0.27

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表 4 不同性别各年龄组儿童青少年眼轴长度比较(x ±s，mm)

Table 4. Comparison of axial length in children and adolescents of different ages and genders(x ±s, mm)

性别	人数	4岁	5岁	6岁	7岁	8岁	9岁	10岁	11岁
男	42 399	22.34±0.57	22.76±0.58	22.94±0.63	23.25±0.69	23.57±0.78	23.83±0.83	24.04±0.87	24.20±0.88
女	39 625	22.27±0.60	22.41±0.57	22.54±0.59	22.81±0.67	23.09±0.76	23.39±0.81	23.65±0.88	23.87±0.91
总体	82 024	22.31±0.59	22.59±0.60	22.74±0.64	23.03±0.71	23.34±0.81	23.62±0.85	23.85±0.90	24.04±0.91
t值		3.62	16.80	23.98	27.99	28.08	26.12	20.29	16.21
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

性别	人数	12岁	13岁	14岁	15岁	16岁	17岁	18岁
男	42 399	24.31±0.90	24.37±0.92	24.41±0.94	24.56±0.96	24.78±0.96	24.80±0.98	25.00±0.99
女	39 625	24.04±0.93	24.17±0.93	24.24±0.92	24.37±0.96	24.56±0.99	24.67±0.98	24.78±1.01
总体	82 024	24.18±0.92	24.27±0.93	24.33±0.93	24.47±0.96	24.67±0.98	24.74±0.98	24.91±1.00
t值		11.59	8.19	6.60	6.54	6.68	3.64	2.92
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

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表 5 不同性别各年龄组儿童青少年角膜曲率比较(x ±s，D)

Table 5. Comparison of corneal curvature in children and adolescents of different ages and genders(x ±s, D)

性别	人数	4岁	5岁	6岁	7岁	8岁	9岁	10岁	11岁
男	42 399	43.10±1.57	43.13±1.65	42.87±1.36	42.83±1.34	42.81±1.36	42.76±1.38	42.74±1.41	42.72±1.43
女	39 625	43.84±1.56	43.90±1.60	43.59±1.35	43.54±1.36	43.53±1.37	43.43±1.39	43.42±1.40	43.44±1.40
总体	82 024	43.45±1.61	43.50±1.67	43.22±1.40	43.18±1.40	43.16±1.41	43.08±1.42	43.07±1.45	43.07±1.46
t值		-21.32	-20.59	-24.03	-25.16	-23.46	-22.15	-19.70	-19.69
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

性别	人数	12岁	13岁	14岁	15岁	16岁	17岁	18岁
男	42 399	42.71±1.38	42.74±1.36	42.79±1.43	42.79±1.43	42.75±1.40	42.76±1.40	42.84±1.32
女	39 625	43.36±1.40	43.40±1.44	43.48±1.33	43.46±1.47	43.48±1.43	43.39±1.47	43.47±1.78
总体	82 024	43.02±1.43	43.07±1.44	43.13±1.42	43.11±1.49	43.10±1.46	43.04±1.47	43.11±1.56
t值		-15.54	-15.04	-14.91	-12.84	-12.34	-9.83	-4.66
P值		< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

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参考文献(16)

[1]	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, 2016, 123(5): 1036-1042. doi: 10.1016/j.ophtha.2016.01.006
[2]	张欣. 重视儿童青少年近视环境危险因素的防控[J]. 中国学校卫生, 2018, 39(1): 6-8, 12. doi: 10.16835/j.cnki.1000-9817.2018.01.002 ZHANG X. Environmental factors and myopia: prospects for prevention[J]. Chin J Sch Health, 2018, 39(1): 6-8, 12. (in Chinese) doi: 10.16835/j.cnki.1000-9817.2018.01.002
[3]	教育部, 国家卫生健康委员会, 国家体育总局, 等. 教育部等八部门关于印发《综合防控儿童青少年近视实施方案》的通知[J]. 中华人民共和国国务院公报, 2019(3): 29-34. https://www.cnki.com.cn/Article/CJFDTOTAL-GWYB201903010.htm Ministry of Education of the PRC, National Health Commission of the PRC, General Administration of Sport of China, et al. Notice of the Ministry of Education and other eight departments on issuing the Implementation Plan of Comprehensive Prevention and Control of Myopia in Children and Adolescents[J]. Bull State Council PRC, 2019(3): 29-34. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-GWYB201903010.htm
[4]	国家卫生健康委员会. 《儿童青少年近视防控适宜技术指南(更新版)》及解读[EB/OL]. (2021-10-13)[2022-02-13]. http://www.gov.cn/xinwen/2021-10/13/content_5642345.htm. National Health Commission of the PRC. Appropriate Technical Guidelines for Prevention and Control of Myopia in Children and Adolescents(Updated) and interpretation[EB/OL]. (2021-10-13)[2022-02-13]. http://www.gov.cn/xinwen/2021-10/13/content_5642345.htm. (in Chinese)
[5]	国家卫生健康委员会宣传司. 国家卫生健康委员会2021年7月13日新闻发布会文字实录[EB/OL]. (2021-07-13)[2022-02-13]. http://www.nhc.gov.cn/xcs/s3574/202107/2fef24a3b77246fc9 fb36dc8943af700.shtml. Department of Publicity, National Health Commission of the PRC. Transcript of the press conference held by the National Health Commission on July 13, 2021[EB/OL]. (2021-07-13)[2022-02-13]. http://www.nhc.gov.cn/xcs/s3574/202107/2fef24a3b77246fc9fb 36dc8943af700.shtml. (in Chinese)
[6]	曾婕, 周亮, 陈剑宇, 等. 2018年四川省中小学生近视现况调查[J]. 职业卫生与病伤, 2021, 36(5): 296-300. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWB202105008.htm ZENG J, ZHOU L, CHEN J Y, et al. Prevalence of myopia among children and adolescents in Sichuan Province[J]. Occup Health Inj, 2021, 36(5): 296-300. (in Chinese) https://www.cnki.com.cn/Article/CJFDTOTAL-ZYWB202105008.htm
[7]	XU L, ZHUANG Y, ZHANG G, et al. Design, methodology, and baseline of whole city-million scale children and adolescents myopia survey(CAMS) in Wenzhou, China[J]. Eye Vis(Lond), 2021, 8(1): 31.
[8]	LI Y, LIU J, QI P. The increasing prevalence of myopia in junior high school students in the Haidian District of Beijing, China: a 10-year population-based survey[J]. BMC Ophthalmol, 2017, 17(1): 1-9. doi: 10.1186/s12886-016-0396-9
[9]	THORN F, CHEN J, LI C, et al. Refractive status and prevalence of myopia among Chinese primary school students[J]. Clin Exp Optom, 2020, 103(2): 177-183. doi: 10.1111/cxo.12980
[10]	WANG J, LIU J, MA W, et al. Prevalence of myopia in 3-14-year-old Chinese children: a school-based cross-sectional study in Chengdu[J]. BMC Ophthalmol, 2021, 21(1): 318. doi: 10.1186/s12886-021-02071-6
[11]	XIE Z, LONG Y, WANG J, et al. Prevalence of myopia and associated risk factors among primary students in Chongqing: multilevel modeling[J]. BMC Ophthalmol, 2020, 20(1): 146. doi: 10.1186/s12886-020-01410-3
[12]	葛坚, 王宁利. 眼科学[M]. 3版. 北京: 人民卫生出版社, 2020: 407-408. GE J, WANG N L. Ophthalmology[M]. 3 ed. Beijing: People's Medical Publishing House, 2020: 407-408. (in Chinese)
[13]	SAW S M, CARKEET A, CHIA K S, et al. Component dependent risk factors for ocular parameters in Singapore Chinese children[J]. Ophthalmology, 2002, 109(11): 2065-2071.
[14]	DIEZ P S, YANG L H, LU M X, et al. Growth curves of myopia-related parameters to clinically monitor the refractive development in Chinese schoolchildren[J]. Graefes Arch Clin Exp Ophthalmol, 2019, 257(5): 1045-1053.
[15]	LU T L, WU J F, YE X, et al. Axial length and associated factors in children: the Shandong children eye study[J]. Ophthalmologica, 2016, 235(2): 78-86.
[16]	SCHEIMAN M, GWIAZDA J, ZHANG Q, et al. Longitudinal changes in corneal curvature and its relationship to axial length in the Correction of Myopia Evaluation Trial(COMET) cohort[J]. J Optom, 2015, 9(1): 13-21.