北京市通州区中小学生近视肥胖共患综合干预效果评价

杨纲; 杨冬梅; 宋逸; 李晶; 文晗; 车靖岳; 董彦会

doi:10.16835/j.cnki.1000-9817.2025031

北京市通州区中小学生近视肥胖共患综合干预效果评价

doi: 10.16835/j.cnki.1000-9817.2025031

杨纲¹,
杨冬梅¹,
宋逸²,
李晶²,
文晗¹,
车靖岳¹,
董彦会^2, ,

1.
北京市通州区疾病预防控制中心学校卫生科，101100
2.
北京大学儿童青少年卫生研究所

基金项目:

首都卫生发展科研专项重点公关项目首发—1G—4251

详细信息

作者简介:
杨纲(1980-)，男，山东省人，大学本科，副主任医师，主要研究方向为健康教育、学校卫生

通讯作者:
董彦会，E-mail: dongyanhui@bjmu.edu.cn

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 R723.14
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- 被引次数: 0
出版历程
- 收稿日期: 2024-10-28
- 修回日期: 2024-12-16
- 网络出版日期: 2025-01-25
- 刊出日期: 2025-01-25

Evaluation of the effect of integrated interventions on comorbidity of myopia and obesity among primary and secondary school students in Tongzhou District in Beijing

1.
Department of School Health, Tongzhou District Center for Disease Control and Prevention, Beijing(101100), China

摘要

摘要: 目的评价中小学生近视肥胖共患共防干预效果，为制定综合干预措施提供科学依据。方法 2022年9月—2023年9月，采用整群随机抽样方法从北京市通州区抽取6所小学和6所初中，将其随机分配到干预组(干预前914人，干预后754人)和对照组(干预前868人，干预后652人)，干预期为1学年。基于RE-AIM框架，整合家庭、学校、社区、医疗机构资源，开发基于学校的儿童近视肥胖共患共防干预技术包；干预组按照综合干预技术包实施干预，对照组不采取任何干预措施。测量收集基线期和干预后的相关健康指标，采用χ²检验、t检验和Wilcoxon秩和检验进行组间比较。结果干预后，干预组和对照组中小学生的裸眼视力(4.79±0.30，4.77±0.33)较干预前(4.80±0.30，4.90±0.32)均下降(t值分别为-7.00，-5.24)；且干预组下降幅度小于对照组(t=5.33)(P值均＜0.01)。干预后，干预组中小学生的体质量指数、腰围、臀围、体脂率较干预前均有下降，但指标变化均无统计学意义(t/Z值分别为-0.03，-0.36，-0.30，-0.01，P值均＞0.05)；对照组的上述指标与干预前比较均上升，但仅有臀围、体脂率变化有统计学意义(t/Z值分别为2.17，2.62，P值均＜0.05)。干预后，干预组和对照组收缩压和舒张压较干预前均上升(t_干预组值分别为2.16，5.29；t_对照组值分别为6.84，5.07)，且干预组均低于对照组(t值分别为-5.27，-2.08)(P值均＜0.05)。干预后，干预组“进行户外活动可以预防近视”“应该每天吃5份成人拳头大小的蔬菜水果”的认知正确率与对照组(92.48%，69.33%)比较差异均有统计学意义(χ²值分别为6.30, 7.86，P值均＜0.05)；干预组(40.98%)与对照组(35.43%)中小学生“过去7 d每天都没有喝含糖饮料”的比例差异有统计学意义(χ²=4.32，P＜0.05)。干预后，干预组和对照组“上学日学校户外活动时长”“休息日户外活动时长”与干预前比较均增加(t/Z值分别为值分别为-13.32，-9.71；-2.59，-2.69)；干预组(46.68%)和对照组(52.76%)“视力测量频率3个月至少一次”行为率与干预前(36.43%，44.01%)比较均上升，且干预组上升幅度大于对照组(χ²值分别为17.52，11.08)(P值均＜0.05)。结论综合干预措施对于控制儿童近视肥胖共患的发生发展有显著的干预效果。应积极促进家庭、学校、社区、医疗机构的协同配合，减少中小学生近视肥胖共患的发生。
- 近视 /
- 肥胖症 /
- 干预性研究 /
- 共病现象 /
- 学生
Abstract: Objective To evaluate the intervention effectiveness of co-occurrence and prevention for myopia and obesity among primary and secondary school students, so as to provide a scientific basis for the development of comprehensive intervention measures in myopia and obesity. Methods From September 2022 to September 2023, a cluster random sampling method was used to select 6 primary schools and 6 junior high schools from Tongzhou District, Beijing. Participants were randomly assigned to an intervention group (914 before intervention and 754 after intervention) and a control group (868 before intervention and 652 after intervention), with an expected duration of one academic year. Based on the RE-AIM framework, integrate resources from families, schools, communities, and medical institutions to develop a school-based intervention technology packagefor the co-occurrence and prevention of myopia and obesity in children. The intervention group received intervention according to the comprehensive intervention technology package, while the control group did not receive any intervention measures. Relevant health indicators during the baseline period and after intervention were measured and collected, and groups were compared by Chi-quest test, t-test and Wilcoxon rank sum test. Results After intervention, the uncorrected visual acuity of primary and secondary school students in the intervention group (4.79±0.30) and the control group (4.77±0.33) both decreased compared to those before intervention (4.80±0.30, 4.90±0.32) (t=-7.00, -5.24); the decrease in uncorrected visual acuity in the intervention group was smaller than that in the control group(t=5.33)(p < 0.01). After intervention, body mass index, waist circumference, hip circumference, and body fat percentage of primary and secondary school students in the intervention group decreased compared to those before intervention. However, the changes in these indicators were not statistically significant (t/Z=-0.03, - 0.36, - 0.30, - 0.01, P>0.05); the above indicators in the control group increased compared to those before intervention, but only hip circumference and body fat percentage showed statistically significant changes (t/Z=2.17, 2.62, p < 0.05). After intervention, both the intervention group and the control group showed increases in systolic and diastolic blood pressure compared to those before intervention(intervention group: t=2.16, 5.29; control group: t=6.84, 5.07); the intervention group had lower systolic and diastolic blood pressure than the control group(t=-5.27, -2.08)(p < 0.05). After intervention, the intervention and the control groups had statistically significant differences in cognitive accuracy(92.48%, 69.33%) in terms of "outdoor exercise can prevent myopia" and "having 5 servings of adult fist sized vegetables and fruits every day" (χ²=6.30, 7.86, p < 0.05). There was a statistically significant difference in the proportion of primary and secondary school students in the intervention group (40.98%) and the control group (35.43%) for "who did not drink sugary drinks for every day in the past 7 days" (χ²=4.32, p < 0.05). After intervention, the intervention group and the control group showed increases in "school outdoor activity duration on school days" and "outdoor activity duration on rest days" compared to those before intervention (t/Z=-13.32, -9.71;- 2.59, -2.69);the behavior rate of "visual acuity measurement frequency at least once every 3 months" in the intervention group (46.68%) and the control group (52.76%) increased compared to those before intervention (36.43%, 44.01%), and the increases in the intervention group were greater than that in the control group (χ²=17.52, 11.08) (p < 0.05). Conclusions Comprehensive intervention measures have significant intervention effects on controlling the occurrence and development of comorbidity of myopia and obesity in children. It could actively promote collaboration and cooperation among families, schools, communities and medical institutions to reduce the occurrence of myopia and obesity among primary and secondary school students.
- Myopia /
- Obesity /
- Intervention studies /
- Comorbidity /
- Students
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1) 利益冲突声明 所有作者声明无利益冲突。

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表 1 中小学生干预前后肥胖相关指标比较(x±s)

Table 1. Comparison of obesity related indicators before and after intervention among primary and secondary school students(x±s)

干预前后	组别	人数	统计值	BMI/(kg·m^-2)	腰围/cm	臀围/cm	体脂率/%	脂肪重量/kg^a	去脂体重/kg	肌肉重量/kg	水分百分比/%	收缩压/mmHg	舒张压/mmHg
干预前	干预组	914		18.99±4.14	63.17±11.98	77.40±11.76	22.14±11.40	6.80(3.80, 13.20)	29.05±7.89	27.28±7.40	21.26±5.79	103.07±11.36	65.32±8.88
	对照组	868		18.55±4.11	62.09±12.56	76.38±12.07	20.64±11.13	5.70(3.40, 11.80)	28.93±8.09	27.31±7.62	21.33±6.24	102.91±12.00	65.82±8.42
			t/Z值	1.96	1.65	1.52	3.08	-2.80	0.40	-0.08	-0.89	0.25	-1.06
			P值	0.05	0.10	0.13	0.02	＜0.01	0.69	0.94	0.37	0.80	0.29
干预后	干预组	754		18.98±4.18	62.95±11.66	77.18±12.00	22.10±11.63	7.50(4.00, 14.20)	30.98±8.70^*	29.06±8.12^*	22.68±6.37^*	104.29±12.15^*	67.88±9.51^*
	对照组	652		18.92±4.17	63.24±10.91	77.77±11.03^*	22.05±11.77^*	7.40(3.90, 14.40)^*	30.87±8.56^*	29.20±8.07^*	22.57±6.29^*	107.53±13.26^*	69.22±14.22^*
			t/Z值	0.28	-0.47	-0.98	0.13	-0.18	0.87	-0.92	0.88	-5.27	-2.08
			P值	0.78	0.64	0.33	0.90	0.86	0.39	0.41	0.38	＜0.01	0.04
注： 1 mmHg=0.133 kPa；^a不符合正态分布，用M(P₂₅，P₇₅)描述；^*与干预前进行组间比较，p＜0.05。

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表 2 中小学生干预前后预防近视和膳食相关知识与行为正确率比较

Table 2. Comparison of accuracy rates of knowledge and behavior in preventing myopia and diet among primary and secondary school students before and after intervention

知识与行为	干预前			干预后
知识与行为	干预组 (n=914)	对照组 (n=868)	χ²值	干预组 (n=754)	对照组 (n=652)	χ²值
预防近视
认为每天应该坚持2 h户外活动	666(72.87)	649(74.77)	0.74	609(80.77)^a	502(76.99)	2.78
进行户外活动可以预防近视	839(91.79)	786(90.55)	0.71	722(95.76)^a	603(92.48)	6.30^*
每天视屏不宜过久	868(94.97)	819(94.35)	0.22	723(95.89)	626(96.01)	0.00
过去7 d每天使用电子产品＜1 h	193(21.12)	177(20.39)	0.10	177(23.47)	139(21.32)	0.81
使用电脑时眼睛距离电脑屏幕≥66 cm或不用电脑	628(68.71)	582(67.05)	0.49	629(83.42)^a	550(84.36)^a	0.16
膳食
应该每天吃5份成人拳头大小的蔬菜水果	492(53.83)	489(56.34)	1.03	574(76.13)^a	452(69.33)^a	7.86^**
应该每天吃优质蛋白	481(52.63)	397(45.74)	8.18^**	404(53.58)	349(53.53)^a	0.00
过去7 d每天能够吃5份蔬菜水果、1份优质蛋白	233(25.49)	223(25.69)	0.01	228(30.24)^a	206(31.60)^a	0.24
过去7 d每天都没有喝含糖饮料	254(27.79)	229(26.38)	0.38	309(40.98)^a	231(35.43)^a	4.32^*
注： ()内数字为正确率/%；^a与干预前进行组间比较，p＜0.05；^* p＜0.05，^**p＜0.01。

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表 3 中小学生干预前后不同类型活动时长比较(x±s，h/d)

Table 3. Comparison of the activity duration of different types among primary and secondary school students before and after intervention (x±s, h/d)

干预前后	组别	人数	统计值	上学日在家时长	上学日小区户外活动时长^a	上学日教室内时长	上学日学校户外活动时长^a	休息日在家活动时长	休息日户外活动时长^a
干预前	干预组	914		10.14±4.84	1.00(1.00, 2.00)	6.54±2.78	1.00(1.00, 2.00)	13.81±6.94	2.00(1.00, 4.00)
	对照组	868		10.48±4.65	1.00(1.00, 2.00)	6.47±2.57	1.00(1.00, 2.00)	14.36±6.90	3.00(2.00, 4.00)
			t/Z值	-2.81	-2.50	-1.06	-2.81	-3.10	-1.65
			P值	0.05	0.01	0.29	＜0.01	0.02	0.10
干预后	干预组	754		9.95±4.60	2.00(0.50, 2.00)^*	8.04±2.66^*	2.00(2.00, 2.00)^*	15.53±6.54^*	2.50(1.00，4.50)^*
	对照组	652		10.50±4.70	2.00(0.50, 2.00)	8.35±3.16^*	2.00(2.00, 2.00)^*	15.70±6.65	2.50(1.00，4.50)^*
			t/Z值	-4.70	-0.45	-4.16	-0.04	-0.98	-1.43
			P值	＜0.01	0.66	＜0.01	0.97	0.33	0.15
注： ^a不符合正态分布，用M(P₂₅，P₇₅)描述；^*与干预前进行组间比较，p＜0.05。

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表 4 中小学生干预前后学校和家庭健康促进行为率比较

Table 4. Comparison of the rates of school and family health promotion behaviors among primary and secondary school students before and after intervention

知识与行为	干预前			干预后
知识与行为	干预组(n=914)	对照组(n=868)	χ²值	干预组(n=754)	对照组(n=652)	χ²值
老师允许零食带入教室	51(5.58)	56(6.45)	0.45	78(10.34)^a	57(8.74)	0.86
学校小卖部能买到含糖饮料	81(8.86)	71(8.18)	0.19	95(12.60)^a	121(18.56)^a	9.10^**
小学生每天睡10 h，初中生每天睡9 h	714(78.12)	771(88.82)	35.98^**	601(79.71)	545(83.59)^a	3.24
父母、老师提醒学生参加体育运动	772(84.46)	839(96.66)	74.92^**	664(88.06)^a	594(91.10)^a	3.12
学校开展近视、肥胖相关健康教育活动	684(74.84)	667(76.84)	0.87	445(59.02)^a	499(76.53)	47.83^**
体重测量频率每周1次以上	268(29.32)	286(32.95)	2.57	295(39.12)^a	266(40.80)^a	0.34
视力测量频率3个月至少一次	333(36.43)	382(44.01)	10.32^**	352(46.68)^a	344(52.76)^a	4.92^*
注： ()内数字为行为率/%；^a与干预前进行组间比较，p＜0.05；^* p＜0.05，^** p＜0.01。

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