环境因素对不同青春期阶段儿童青少年屈光发育的影响因素分析

  目的  探讨青春期对儿童青少年屈光发育的影响及其与户外活动、近距离用眼和电子产品使用的交互作用，为近视干预策略的制定提供参考。  方法  采用整群抽样从上海市某所九年一贯制学校选取776名7~13岁的儿童青少年参与研究，随访周期为2年(2015—2017年)。所有参与者每年进行1次睫状肌麻痹下屈光检查和眼轴测量，通过问卷调查和问询获取青春发育表征、日均户外时长、近距离用眼时长、电子产品使用时长等信息。采用广义估计方程分析不同青春期阶段屈光参数的影响因素及其交互效应。  结果  基线时有634名儿童青少年参与散瞳验光，其中350名近视(55.2%)。不同青春发育阶段眼轴长度进展、日均户外时长、近距离用眼时长和电子产品使用时长差异均有统计学意义(F值分别为4.10，4.25，5.54，9.20，P值均 < 0.05)。青春期阶段与日均户外时长对眼轴长度的影响存在交互作用(β=0.133，P＜0.05)，与近距离用眼时长、电子产品使用时长的交互作用无统计学意义(P值均>0.05)。  结论  青春期可能在中国儿童青少年户外时间与屈光发育之间的关系中起调节作用。

Effects of environmental factors on refractive development of children and adolescents in different pubertal stages

  Objective  To explore the effect of puberty on refractive development of children and adolescents and its interaction with outdoor activities, near work and the use of electronic products, so as to provide a reference for strategies for intervening myopia.  Methods  Cluster sampling method was used to select 776 students aged 7-13 from a nine-year consistent school in Shanghai to participate and were followed up for 2 years. All participants underwent cycloplegic refraction and ocular axial length measurement once a year, as well as pubertal development, average daily outdoor time, near work time and time of electronic products usage. The influencing factors and interaction effects of refractive parameters in different puberty stages were analyzed by generalized estimation equation.  Results  At baseline, 634 children participated in cycloplegic refraction, of which 350 were myopic (55.2%). There were significant differences in axial length, average daily outdoor time, near work time and time of using electronic products at different stages of puberty (F=4.10, 4.24, 5.54, 9.20, P < 0.05). There was interaction between puberty and outdoor time on axial length development (β=0.133, P < 0.05), and the interaction between puberty and the time of near work or using electronic products was not statistically significant (P>0.05).  Conclusion  Puberty may play a regulatory role in the relationship between outdoor time and refractive development among Chinese children and adolescents.