Analysis of factors influencing insufficient hyperopia reserve and refractive parameters in preschool children in Hefei
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摘要:
目的 了解合肥市3~6岁学龄前儿童屈光及远视储备不足现状并分析其影响因素，为制定针对性的防控政策、开展综合干预提供科学依据。 方法 2022年5月，采用分层整群随机抽样方法从合肥市包河区、瑶海区、蜀山区、经开区4个区8所幼儿园抽取897名学龄前儿童，采用《儿童视力保健相关行为评估量表》收集相关个人信息及环境影响因素，通过睫状肌麻痹前后屈光度检测获取学龄前儿童的远视储备不足和屈光发育水平。组间比较采用χ2检验、t检验或方差分析。采用多因素回归分析影响学龄前儿童远视储备、眼轴长度和等效球镜度数(SE)发育的主要相关因素。 结果 学龄前儿童远视检出率为6.8%，近视为1.6%，散光为11.1%，其中男童(2.3%)近视率高于女童(0.7%)(χ2=3.88，P < 0.05)。学龄前儿童远视储备不足检出率为8.8%。多因素回归分析结果显示，父亲高度近视、母亲高度近视、日均近距离用眼时间越长、日均使用电子产品时间越长的学龄前儿童眼轴增长(β值分别为0.12，0.09，0.15，0.11)，SE降低(β值分别为-0.10，-0.07，-0.18，-0.13)、远视储备不足(OR值分别为1.87，2.22，1.40，1.28)的风险增加；睡眠时间越长、日均户外活动时间越长的学龄前儿童眼轴增长(β值分别为-0.11，-0.10)，SE降低(β值分别为0.39，0.51)、远视储备不足(OR值分别为0.54，0.51)的风险降低(P值均 < 0.05)。 结论 合肥市学龄前儿童屈光异常及远视储备不足率较低，且影响因素较多。家长、幼儿园和相关部门应对学龄前儿童进行早期视力监测及干预，培养学龄前儿童科学的用眼习惯。 Abstract:Objective To investigate the current status of refractive errors and insufficient hyperopia reserve in preschool children aged 3-6 years in Hefei and to analyze influencing factors, so as to provide a scientific basis for formulating targeted myopia prevention policies and comprehensive interventions. Methods In May 2022, a stratified cluster random sampling method was used to select 897 preschool children from 8 kindergartens across four districts (Baohe, Yaohai, Shushan, and Economic and Technological Development Zone) in Hefei, and Children's Visual Health-related Behavior Assessment Scale was used to collect personal information and environmental factors. Pre- and post-cycloplegic refraction tests were conducted to assess insufficient hyperopic reserve and refractive development levels. Group comparisons were conducted using χ2 test, t-test or analysis of variance. Multivariate regression analysis was performed to identify key factors influencing hyperopic reserve, axial length and spherical equivalent in preschool children. Results The detection rates of refractive errors among preschool children were 6.8% for hyperopia, 1.6% for myopia, and 11.1% for astigmatism. Notably, the prevalence of myopia was significantly higher in boys (2.3%) than in girls (0.7%) (χ2=3.88, P < 0.05). Additionally, 8.8% of the children exhibited insufficient hyperopic reserve. The results of multiple regression analysis showed that preschool children with high myopia in the father, high myopia in the mother, longer daily duration of near work, and longer daily electronic product use time had increased risks of axial growth (β=0.12, 0.09, 0.15, 0.11), SE reduction (β=-0.10, -0.07, -0.18, -0.13), and insufficient hyperopic reserve (OR=1.87, 2.22, 1.40, 1.28) (P < 0.05). While, preschool children with longer sleep time and daily outdoor activity duration had lower risks of axial growth (β=-0.11, -0.10), SE reduction (β=0.39, 0.51), and insufficient hyperopia reserve (OR=0.54, 0.51) in preschool children (P < 0.05). Conclusions The rates of refractive errors and insufficient hyperopia reserve in preschool children in Hefei are relatively low, which are influenced by many factors. Parents, kindergartens and relevant departments should implement early vision monitoring and intervention for preschool children, and cultivate their scientific eye-use habits. -
Key words:
- Myopia /
- Refraction, ocular /
- Regression analysis /
- Child, preschool
1) 第二十七届中国科协年会学术论文2) 利益冲突声明 所有作者声明无利益冲突。3) 张博林与张珊珊为共同第一作者。 -
表 1 不同组别学龄前儿童屈光不正和远视储备不足检出率比较
Table 1. Comparison of detection rates for refractive errors and insufficient hyperopia reserve in preschool children of different groups
组别 选项 人数 统计值 屈光不正 远视储备不足 远视 近视 散光 性别 男 474 35(7.4) 11(2.3) 48(10.1) 33(7.0) 女 423 26(6.1) 3(0.7) 52(12.3) 46(10.9) χ2值 0.60 3.88 1.06 4.26 P值 0.26 0.05 0.18 0.05 年龄/岁 3~ < 4 86 6(7.0) 1(1.2) 8(9.3) 6(7.0) 4~ < 5 200 12(6.0) 2(1.0) 25(12.5) 15(7.5) 5~6 611 43(7.0) 11(1.8) 67(11.0) 58(9.5) χ2值 0.26 0.75 0.69 1.14 P值 0.88 0.69 0.71 0.57 注： ()内数字为检出率/%。 
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表 2 不同组别学龄前儿童眼轴及等效球镜度数的单因素分析(x ±s)
Table 2. Univariate analysis of axial length and spherical equivalent refraction among preschool children in different groups(x ±s)
组别 选项 人数 统计值 眼轴/mm 等效球镜/D 组别 选项 人数 统计值 眼轴/mm 等效球镜/D 性别 男 474 23.85±1.34 1.30±1.36 日均户外活动 < 2 79 22.71±0.71 1.30±1.36 女 423 22.57±0.06 1.35±1.42 时间/h ≥2 818 22.55±1.06 1.69±1.78 t值 3.85 0.41 t值 4.79 5.70 P值 0.02 0.52 P值 0.03 0.02 年龄/岁 3~ < 4 286 22.54±0.82 1.43±1.66 日均近距离用眼 < 1 305 22.51±0.74 1.44±1.42 4~ < 5 334 22.61±0.75 1.33±1.66 时间/h 1~2 434 22.57±0.72 1.39±1.36 5~6 277 22.65±0.74 1.27±1.33 >2 158 22.71±0.81 1.27±1.83 F值 2.24 3.15 t值 3.33 3.24 P值 0.05 0.02 P值 0.04 0.04 父亲高度近视 是 57 23.22±0.74 1.32±1.41 日均使用电子产品 < 1 549 22.50±1.18 1.42±1.37 否 840 22.44±0.65 1.68±1.76 时间/h 1~2 269 22.64±0.72 1.37±1.30 t值 2.63 4.10 >2 79 22.72±0.91 1.19±1.75 P值 0.05 0.04 t值 3.72 3.92 母亲高度近视 是 74 22.59±0.75 1.32±1.42 P值 0.03 0.05 否 823 22.35±0.67 1.71±1.74 日均睡眠时间/h < 9 330 22.64±0.75 1.27±1.53 t值 4.70 4.79 ≥9 567 22.53±0.74 1.42±1.41 P值 0.03 0.03 t值 4.37 4.07 出生时有缺氧史 是 23 22.90±1.06 1.06±2.11 P值 0.04 0.04 否 874 22.56±0.74 1.35±1.38 母乳喂养 是 801 22.56±0.76 1.36±1.42 t值 3.23 4.12 否 96 22.67±0.64 1.08±1.12 P值 0.04 0.02 t值 1.72 3.15 父亲文化程度 大专及以上 790 22.59±0.73 1.31±1.36 P值 0.19 0.08 大专以下 107 22.32±0.73 1.54±1.44 早产儿 是 56 22.40±0.68 1.74±2.24 t值 5.22 3.96 否 841 22.58±0.75 1.37±1.37 P值 0.02 0.04 t值 2.67 3.23 母亲文化程度 大专及以上 753 22.60±0.73 1.36±1.44 P值 0.10 0.07 大专以下 144 22.31±0.80 1.59±1.43 是否独生子女 是 615 22.59±0.71 1.35±1.29 t值 8.38 3.88 否 282 22.49±1.53 1.49±1.73 P值 0.00 0.05 t值 5.78 5.90 P值 < 0.01 < 0.01
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表 3 学龄前儿童远视储备不足、眼轴长度和等效球镜度数与环境因素的多元回归分析(n=897)
Table 3. Multiple regression analysis of insufficient hyperopia reserve, axial length, and spherical equivalent refraction in relation to environmental factors in preschool children(n=897)
自变量 远视储备不足 眼轴长度 等效球镜度数 OR值(95%CI) P值 β值(95%CI) P值 β值(95%CI) P值 父亲高度近视 1.87(1.03~3.39) 0.04 0.12(0.07~0.70) 0.02 -0.10(-1.18~-0.00) 0.05 母亲高度近视 2.22(1.05~4.72) 0.04 0.09(0.07~0.51) 0.01 -0.07(-0.84~-0.01) 0.05 睡眠时间 0.54(0.32~0.90) 0.02 -0.11(-0.21~-0.01) 0.04 0.39(0.04~0.75) 0.03 日均户外活动时长 0.51(0.29~0.89) 0.02 -0.10(-0.20~-0.02) 0.05 0.51(0.43~1.64) < 0.01 日均近距离用眼时长 1.40(1.13~1.75) < 0.01 0.15(0.00~0.20) 0.05 -0.18(-0.33~-0.05) 0.01 日均使用电子产品时长 1.28(1.05~1.55) 0.01 0.11(0.01~0.11) 0.02 -0.13(-0.26~-0.03) 0.02 注：自变量父母高度近视以父母不高度近视为参照，睡眠时间、日均户外活动时长、日均近距离用眼时长、日均使用电子产品时长为连续型变量。
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