云南地区中小学生眼轴变化及影响因素分析

肖洁; 苏梅慧; 李佩谦; 黄达峰; 李茜茜; 马子雪; 罗筱; 陈茂森; 黄莹

doi:10.16835/j.cnki.1000-9817.2024024

云南地区中小学生眼轴变化及影响因素分析

doi: 10.16835/j.cnki.1000-9817.2024024

1.
昆明医科大学公共卫生学院, 云南 650500
2.
西双版纳傣族自治州勐海县疾病预防控制中心
3.
云南省疾病预防控制中心学校卫生所

基金项目:

国家自然科学基金项目 81960593

详细信息

作者简介:
肖洁(1993-), 女, 江西吉安人, 在读硕士, 主要研究方向为儿童青少年疾病预防与保健

通讯作者:
黄莹, E-mail: huangying02@163.com

利益冲突声明 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: 2023-07-31
- 修回日期: 2023-12-20
- 网络出版日期: 2024-02-01
- 刊出日期: 2024-01-25

Changes of axial length in primary and secondary school students in Yunnan and associated factors

1.
School of Public Health, Kunming Medical University, Kinming(650500), Yunnan Province, China

摘要

摘要: 目的探讨云南地区中小学生眼轴长度与角膜曲率半径比值(AL/CR)变化规律及其影响因素, 为早期近视干预控制提供科学依据。方法采用多阶段分层整群随机抽样方法, 于2020年抽取云南省2个市/县二、三年级和七年级共685名学生分别于2021年10月、2023年3月进行随访, 调查内容包括近视相关因素问卷调查、裸眼远视力、屈光参数测量, 分析AL/CR在不同学段不同组别间的分布及变化, 采用广义线性模型探索AL/CR累积进展量的影响因素。结果小学生基线AL/CR值为(2.95±0.09), 第1次随访增加至(2.99±0.11), 第2次随访增加至(3.04±0.12)。中学生基线AL/CR值为(3.08±0.13), 第1次随访增加至(3.12±0.15), 第2次随访增加至(3.15±0.14)。广义线性模型结果显示控制环境因素后, 小学生中白族(β=-0.017)、等效球境度数(SE)累积进展量(β=-0.027)影响AL/CR变化; 中学生AL/CR变化与基线AL(β=-0.005)、基线CR(β=0.032)及SE累积进展量(β=-0.035)相关(P值均＜0.05)。结论云南地区中小学生AL/CR可用于判断不同屈光状态类型, 其变化量除与SE进展有关, 还受民族、基线眼生物学参数的影响。AL/CR应用于评估近视进展方面的价值需进一步证实。
- 眼轴长度 /
- 角膜曲率半径 /
- 因素分析, 统计学 /
- 学生
Abstract: Objective To explore the pattern of change of axial length/curvatrue radius ratio (AL/CR) and associated factors in primary and secondary school students in Yunnan, so as to provide scientific basis and prospective guidance for early myopia intervention and control. Methods A total of 685 students from grades 2 to 3 and grade 7 in 2 cities/counties in Yunnan Province were selected by multi-stage stratified random cluster sampling method in 2020. All the participants were followed up twice with questionnaire of myopia related factors, uncorrected distance visual acuity, and refractive parameter measurement from October, 2021 and March, 2023, respectivelty. The distribution and change of AL/CR in different classes and groups were analyzed, and the influencing factos of AL/CR cumulative progression were explored using generalized linear model. Results AL/CR ratio in primary school students was (2.95±0.09) at baseline, increased to (2.99±0.11) at the first follow-up and (3.04±0.12) at the second follow-up. AL/CR ratio in middle school students(3.08±0.13) at baseline, increased to (3.12±0.15) at the first follow-up and (3.15±0.14) at the second follow-up. The generalized linear model showed that after controlling for environmental factors, ethnicity (β=-0.017), cumulative progression of the SE (β=-0.027) influenced the changes of AL/CR ratio among the primary school students, whereas the changes of AL/CR ratio were associated with baseline AL (β=-0.005), baseline corneal curvatrue radius (β=0.032) and cumulative progression of SE(β=-0.035) among middle school students (P＜0.05). Conclusions The AL/CR ratio of primary and secondary school students in Yunnan can be used to judge different refractive status types, but its variation is not only related to SE progression, but also affected by different ethnic groups and baseline ocular biological parameters. so the value of AL/CR application in assessing the progression of myopia needs to be further confirmed.
- Ocular axial length /
- Corneal curvature radius /
- Factor analysis, statistical /
- Students
注释:

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表 1 不同组别学龄儿童AL/CR累积变化情况比较

Table 1. Comparison of cumulative changes of AL/CR ratio among school-aged children in different groups

组别	选项	统计值	小学				中学
组别	选项	统计值	人数	第1次随访	第2次随访	累积	人数	第1次随访	第2次随访	累积
性别	男		139	0.03(0.02, 0.05)	0.04(0.02, 0.07)	0.07(0.04, 0.11)	204	0.03(0.01, 0.05)	0.03(0.01, 0.05)	0.06(0.03, 0.10)
	女		157	0.03(0.02, 0.07)	0.05(0.03, 0.08)	0.08(0.05, 0.14)	185	0.03(0.02, 0.04)	0.03(0.02, 0.05)	0.06(0.04, 0.10)
		Z值		-0.84	-1.51	-1.52		-0.30	-1.19	-1.20
		P值		0.40	0.13	0.13		0.76	0.24	0.23
民族	汉族		133	0.03(0.02, 0.05)	0.05(0.02, 0.08)	0.09(0.05, 0.15)	127	0.03(0.02, 0.04)	0.03(0.01, 0.05)	0.06(0.04, 0.09)
	白族		68	0.03(0.02, 0.05)	0.04(0.02, 0.06)	0.06(0.05, 0.10)	94	0.03(0.01, 0.05)	0.03(0.10, 0.05)	0.06(0.03, 0.09)
	纳西族		65	0.03(0.02, 0.05)	0.05(0.02, 0.08)	0.08(0.04, 0.14)	139	0.03(0.01, 0.05)	0.04(0.02, 0.06)	0.07(0.04, 0.10)
	其他		30	0.03(0.02, 0.05)	0.03(0.02, 0.07)	0.06(0.04, 0.10)	29	0.03(0.01, 0.04)	0.03(0.01, 0.05)	0.05(0.03, 0.09)
		H值		1.87	8.58	8.25		1.29	13.31	8.67
		P值		0.60	0.04	0.04		0.73	＜0.01	0.03
父母近视	均不近视		141	0.03(0.02, 0.05)	0.04(0.02, 0.07)	0.06(0.04, 0.11)	234	0.03(0.01, 0.05)	0.04(0.02, 0.06)	0.07(0.04, 0.10)
	一方近视		110	0.04(0.02, 0.06)	0.05(0.03, 0.08)	0.09(0.05, 0.13)	107	0.03(0.02, 0.05)	0.03(0.01, 0.05)	0.06(0.03, 0.09)
	均近视		45	0.03(0.02, 0.07)	0.05(0.03, 0.08)	0.10(0.05, 0.16)	48	0.03(0.02, 0.04)	0.03(0.01, 0.05)	0.06(0.03, 0.09)
		H值		3.77	2.84	13.50		2.62	6.10	1.48
		P值		0.15	0.18	＜0.01		0.27	0.04	0.48
基线屈光状态	无		214	0.03(0.02, 0.04)	0.04(0.02, 0.07)	0.06(0.04, 0.10)	127	0.02(0.01, 0.03)	0.03(0.02, 0.05)	0.05(0.03, 0.08)
	低度		75	0.06(0.03, 0.09)	0.06(0.03, 0.09)	0.11(0.07, 0.16)	136	0.03(0.02, 0.05)	0.04(0.02, 0.06)	0.07(0.04, 0.10)
	中高度		7	0.07(0.05, 0.09)	0.07(0.06, 0.11)	0.16(0.13, 0.19)	126	0.03(0.02.0.05)	0.03(0.01.0.05)	0.06(0.04, 0.08)
		H值		44.25	15.01	33.62		29.30	12.02	14.01
		P值		＜0.01	＜0.01	＜0.01		＜0.01	＜0.01	＜0.01
屈光状态变化类型	非近视		150	0.02(0.02, 0.03)	0.03(0.02, 0.04)	0.05(0.04, 0.07)	69	0.01(0.01, 0.02)	0.02(0.01, 0.03)	0.04(0.02, 0.05)
	新增近视		72	0.04(0.03, 0.05)	0.07(0.04, 0.10)	0.12(0.09, 0.16)	60	0.03(0.01, 0.05)	0.05(0.03, 0.07)	0.08(0.04, 0.11)
	持续性近视		74	0.06(0.04, 0.09)	0.07(0.04, 0.09)	0.13(0.09, 0.17)	260	0.03(0.02, 0.05)	0.03(0.02, 0.05)	0.07(0.04, 0.10)
		H值		84.02	75.79	109.83		49.77	31.42	49.30
		P值		＜0.01	＜0.01	＜0.01		＜0.01	＜0.01	＜0.01

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表 2 环境因素评分与中小学生AL/CR累积变化量的相关性(r值，n=685)

Table 2. Correlation between environmental factor scores and cumulative changes of AL/CR ratio in primary and secondery school students(r, n=685)

环境评分	小学	中学
校内用眼环境	0.10	-0.06
校外用眼环境	-0.04	0.06
读写姿势	0.01	0.00
电子屏幕使用时间	0.20^**	0.05
近距离用眼	0.00	-0.07
户外活动	0.00	-0.05
睡眠情况	0.06	-0.03
饮食情况	0.04	0.00
注：**P＜0.01。

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表 3 不同学段学龄儿童AL/CR累积变化量的广义线性模型分析

Table 3. Generalized linear model analysis of cumulative changes of AL/CR ratio among school-aged children in different classes

自变量	选项	小学(n=296)			初中(n=389)
自变量	选项	β值(95%CI)	标准误	P值	β值(95%CI)	标准误	P值
年龄		-0.008(-0.018~0.001)	0.005	0.09	-0.004(-0.010~0.002)	0.003	0.20
性别	男	1.000			1.000
	女	0.002(-0.010~0.015)	0.007	0.73	-0.003(-0.011~0.005)	0.004	0.45
民族	汉族	1.000			1.000
	白族	-0.017(-0.033~-0.001)	0.082	0.04	-0.006(-0.016~0.004)	0.005	0.25
	纳西族	-0.003(-0.019~0.013)	0.082	0.70	0.004(-0.006~0.013)	0.005	0.46
	其他民族	-0.016(-0.037~0.005)	0.011	0.13	-0.007(-0.022~0.008)	0.008	0.34
父母近视	无近视	1.000			1.000
	一方近视	0.003(-0.010~0.016)	0.007	0.64	-0.002(-0.011~0.007)	0.006	0.63
	均近视	0.009(-0.009~0.027)	0.009	0.32	-0.001(-0.013~0.011)	0.005	0.84
基线AL		0.007(-0.004~0.018)	0.006	0.23	-0.005(-0.010~0.000)	0.002	0.03
基线CR		-0.019(-0.053~0.016)	0.020	0.29	0.032(0.014~0.051)	0.009	＜0.01
基线前房深度		0.002(-0.018~0.021)	0.010	0.86	-0.003(-0.018~0.012)	0.008	0.69
基线角膜直径		-0.010(-0.027~0.006)	0.009	0.22	-0.005(-0.013~0.004)	0.004	0.27
SE累积进展量		-0.027(-0.032~-0.022)	0.003	＜0.01	-0.035(-0.039~-0.030)	0.002	＜0.01

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