上海地区4~14岁儿童1年屈光进展及影响因素分析

  目的  了解不同年龄和屈光状态儿童屈光进展情况及其影响因素,为近视防控方案制定和工作实践提供参考。  方法  基于已有队列分层整群抽取上海嘉定区和松江区共20所幼儿园和中小学校,收集1 510名4~14岁儿童2015年基线及2016年1年随访数据,包括睫状肌麻痹等效球镜(SER)、眼轴长度(AL)和角膜曲率等,分析SER和AL在不同年龄、屈光状态儿童中的分布和进展,采用多元线性回归探索SER进展量的影响因素。  结果  4~5岁儿童ΔSER保持相对稳定(平均-0.08~-0.07 D/年),6岁以上各年龄段SER均向近视方向明显漂移(平均-0.50~-0.31 D/年),11岁后回落至-0.44~-0.33 D/年;ΔAL在4~10岁组为0.27~0.35 mm/年,11~14岁组降低为0.15~0.22 mm/年。新发近视者的ΔSER和ΔAL最大[(-0.90±0.05)D,(0.51±0.02)mm],其次是低度近视组[(-0.68±0.04)D,(0.36±0.02)mm],中高度近视组[(-0.49±0.06)D,(0.23±0.03)mm]再次之,远视组[(-0.21±0.02)D,(0.26±0.01)mm]最低,差异均有统计学意义(P值均 < 0.05)。年龄(β=-0.07)、基线SER(β=0.05)和ΔAL(β=-0.78)是4~10岁组屈光进展的独立影响因素,ΔAL(β=-1.55)是11~14岁组屈光进展的独立影响因素(P值均 < 0.05)。  结论  学龄前阶段儿童眼轴多为生理性增长,应通过增加户外活动等防止其超越生理性范围增长引起屈光近视化进展。小学阶段、近视前期和低度近视对象是近视防控重点动态监控和干预人群。

Refractive progression among students aged 4-14 in Shanghai and associated factors

  Objective  To investigate the refractive progression and associated factors of children of different ages and refractive status, and to provide guidance on myopia prevention and control program formulation and work practice.  Methods  A total of 20 kindergartens, primary schools, and secondary schools in 2 districts of Shanghai were selected based on the existing cohort, and baseline data in 2015 and one-year follow-up data in 2016 were collected from 1 510 children aged 4 to 14, including cycloplegic spherical equivalent refraction (SER), axial length (AL), and corneal curvature. The distribution and progression of SER and AL in children of different ages and refractive status were analyzed, and the influencing factors of SER progression (ΔSER) were explored using multiple linear regression.  Results  ΔSER remained relatively stable at age 4 and 5 (average -0.08 to -0.07 D/year), and SER drifted significantly towards myopia (average -0.50 to -0.31 D/year) in all groups older than 6 years, dropping back to -0.44 to -0.33 D/year after age 11; Elongation of AL (ΔAL) was 0.27 to 0.35 mm/year in 4 to 10 years group, and decreased to 0.15 to 0.22 mm/year in 11 to 14 years group. The ΔSER and ΔAL were greatest in the new-onset myopes [(-0.90±0.05)D, (0.51±0.02)mm], followed by the low myopia group [(-0.68±0.04)D, (0.36±0.02)mm], then followed by the moderate to high myopia group[(-0.49±0.06)D, (0.23±0.03)mm] and the lowest in the hyperopia group[(-0.21±0.02)D, (0.26±0.01)mm], with a statistically significant difference among these groups (P < 0.05). Age (β=-0.07), baseline SER (β=0.05) and ΔAL (β=-0.78) were independent influencing factors for refractive progression in the 4 to 10 years old group, while ΔAL(β=-1.55) was the only independent influencing factor in the 11 to 14 years old group (P < 0.05).  Conclusion  The elongation of AL in preschoolers is mostly physiologically and should be prevented from growing beyond the physiological range by increasing outdoor activities. The primary students, as well as students with pre-myopia or low myopia are the priority groups for dynamic monitoring and intervention in myopia prevention and control.