6岁儿童线性生长及BMI轨迹与屈光不正关联队列研究

  目的   描述0~6岁儿童线性生长及体质量指数(BMI)生长轨迹，探讨不同类型生长轨迹模式与学龄前儿童屈光不正的关联。  方法  研究对象源自马鞍山优生优育队列(MABC)，MABC建立于2013年5月至2014年9月，2 037名活产儿在出生后42 d至72月龄共随访15次，测量儿童身长、体重，问卷调查喂养情况、代养人等数据信息, 并于儿童(72±6)月龄时由马鞍山市妇幼保健院专业眼科医生测量其裸眼视力，视力不良者行睫状肌麻痹扩瞳验光诊断近视和远视。运用潜变量增长模型拟合0~6岁儿童身高及BMI生长轨迹。采用多项式Logistic回归模型分析不同生长轨迹与6岁儿童屈光不正的关联。  结果  根据潜变量增长模型，线性生长轨迹可将儿童的身高发育轨迹划分为3类:较慢身高生长轨迹(302名)、适宜身高生长轨迹(1 162名)和较快身高生长轨迹(573名)。BMI Z生长轨迹可将儿童的发育轨迹划分为3类:较慢BMI Z生长轨迹(630名)、适宜BMI Z生长轨迹(1 058名)和较快BMI Z生长轨迹(349名)。多因素Logistic回归分析显示，缓慢身高生长模式与6岁儿童远视呈正相关OR值(95%CI)=1.80(1.09~2.98)，P < 0.05]，而与近视关联无统计学意义；快速和缓慢BMI Z生长轨迹模式与6岁儿童近视、远视关联均无统计学意义(P值均>0.05)。  结论  线性生长轨迹中较慢身高生长模式与6岁儿童远视相关。应密切关注学龄前儿童身高增长模式，定期检查体格发育指标以及远视力，有助于预防学龄前儿童屈光不正的发生发展。

A cohort study of the association between linear growth and BMI trajectories with ametropia among 6-year-old children

  Objective   To describe the linear growth trajectory and BMI growth trajectory of children aged 0-6 years, and to investigate the relationship between different growth trajectory patterns and refractive error of preschool children.  Methods  The participants were selected from Ma'anshan Birth Cohort Study (MABC), which was established from May 2013 to September 2014. In this study, 15 follow-up interviews were conducted among 2 037 live births between 42 days after birth and 72 months of age to collect the data of body length and body weight. And at the age of (72±6) months, data of the naked eye visual acuity was measured by professional ophthalmologist in Ma'anshan Maternal and Child Health Hospital. The latent class growth model was conducted to identify distinct linear growth trajectory and BMI Z-score trajectories of 0 to 6 year old infants and young children. Multinomial Logistic regression model was used for analyzing the relationship between distinct growth trajectories and ametropia in 6-year-old children.  Results  According to the latent class growth model, children showed three obvious linear growth trajectories: slow growth trajectory (n=302), normal growth trajectory (n=1 162), and fast growth trajectory (n=573). And BMI growth trajectory were also divided into three patterns: slow growth trajectory (n=630), normal growth trajectory (n=1 058), and fast growth trajectory (n=349). Multinomial Logistic regression analysis showed that linear slow growth trajectory was a risk factor for hyperopia in 6-year-old children (OR=1.80, 95%CI=1.09-2.98, P < 0.05). But it was not significantly associated with myopia. There was no significant correlation between fast growth BMI pattern and slow growth BMI pattern with myopia and hyperopia in 6-year-old children.  Conclusion  Slower growth patterns in linear growth trajectories were associated with hyperopia in 6-year-old children.It should pay close attention to the height growth pattern of preschool children. Regular examination of physical development indicators and distance vision can help prevent the occurrence and development of ametropia in preschool children.