摘要
目的:探讨郑州市小学生近视眼进展的情况及其影响因素。方法:采用随机分层整群抽样的方法，选择2021年3月至2021年4月郑州市领航学校、郑州市实验小学及郑州市思存路小学等3所小学1～4年级学生共3167人(6334只眼)进行研究。其中，男生1674人(3348只眼)，女生1493人(2986只眼)。年龄6～14岁，平均(8.7±1.2)岁。至2023年4月对这批学生随访2年，完成2次数据收集。2023年有效随访2748人(5496只眼)，男生1452人(2904只眼)，女生1296人(2592只眼)。年龄8～16岁，平均(10.6±1.1)岁。按等效球镜屈光度(SE)值分为近视眼和非近视眼。其中，近视眼又进一步分为轻度近视眼、中度近视眼及高度近视眼。对不同性别、年级的近视眼患病情况以频数和率表示，组间比较采用卡方检验；SE年进展量符合正态分布以±s表示，同一性别中不同年级的比较采用单因素方差分析，同一年级不同性别的比较采用独立样本t检验；应用Logistic回归模型分析非近视眼学生中不同级别SE发生近视眼的风险。结果:郑州市3所小学1～4年级学生2021年基线期近视眼总患病率为51.88%，2年后为67.03%，差异有统计学意义(χ2＝186.29，P<0.05)。2021年基线期1年级、2年级、3年级及4年级近视眼患病率分别为33.26%、51.79%、59.28%及70.13%，随访2年后分别为54.84%、68.34%、71.61%及84.16%，差异有统计学意义(χ2＝85.33，46.50，24.29，25.46；P<0.05)，且近视眼患病率随年级增长也逐渐升高，差异有统计学意义(χ趋势2＝228.58，118.05；P趋势<0.05)。2021～2023年郑州市3所小学1～4年级学生中，近视眼的平均年发病率为23.26%。1年级、2年级、3年级及4年级学生的近视眼平均年发病率分别22.34%、25.26%、21.48%及25.96%，不同年级间的平均年发病率差异无统计学意义(χ2＝5.91，P>0.05)。Logistic回归模型分析显示，以SE≥＋0.50 D为参照，在男生中，0 D≤SE<＋0.50 D级别发展为近视眼的风险升高了3.21(2.206，4.674)倍，－0.50 D<SE<0 D级别发展为近视眼的风险升高了7.226(4.641，11.253)倍。在女生中，0 D≤SE<＋0.50 D级别发展为近视眼的风险升高了4.554(2.967，6.991)倍，－0.50 D≤SE≤0 D级别发展为近视眼的风险升高了4.554(2.967，6.991)倍。结论:2021～2023年，郑州市3所小学1～4年级学生近视眼发病率高，患病率增长速度快。现阶段应更加重视儿童青少年近视眼防控，并重点关注女生群体和远视储备不足的儿童青少年。
Abstract
Objective:To explore the progression of myopia among primary school students in Zhengzhou city and its influencing factors.Methods:Using a random stratified cluster sampling method, a total of 3167 primary school students (6334 eyes) from grades 1 to 4 in Navigation School, Experimental Primary School, and Sicun Road Primary School in Zhengzhou City from March 2021 to April 2021 were selected. Among them, there are 1674 male students (3348 eyes) and 1493 female students (2986 eyes) with an average of (8.7±1.2) years old (ranged from 6 to 14 years old). By April 2023, these students have be followed up for 2 years and collected data twice. In 2023, 2748 individuals (5496 eyes) were effectively followed up, with 1452 males (2904 eyes) and 1296 females (2592 eyes) with an average of (10.6±1.1) years old (ranged from 8 to 16 years old). According to the spherical equivalent (SE), vision was divided into myopia and non-myopia, and myopia was further divided into mild, moderate, and high myopia. The incidence of myopia in different genders and grades was expressed in terms of frequency and percentage, and compared by chi square test for inter group. The annual progress of SE followed a normal distribution, was expressed as ±s, and compared by one-way ANOVA between different grades within the same gender, and independent sample t-test between different genders within the same grade. The logistic regression model was used to analyze the risk of myopia among non-myopic students with different levels of SE.Results:The overall prevalence of myopia among primary school students in grades 1 to 4 in Zhengzhou City in 2021 was 51.88% during the baseline period, and 67.03% after 2 years, with a statistically significant difference (χ2= 186.29, P<0.05). The incidence rates of myopia in grades 1 to 4 during the baseline period in 2021 were 33.26%, 51.79%, 59.28%, and 70.13%, respectively. After followup for 2 years, the incidence rates were 54.84%, 68.34%, 71.61%, and 84.16%, respectively, with statistically significant differences (χ2= 85.33, 46.50, 24.29, 25.46; P<0.05), and the incidence of myopia gradually increased with grade, with a statistically significant difference (χtrend2=228.58, 118.05; Ptrend<0.05). The average annual incidence rate of myopia among primary school students in grades 1 to 4 from 2021 to 2023 was 23.26%. The average annual incidence rate of myopia among pupils in grades 1 to 4 were 22.34%, 25.26%, 21.48% and 25.96%, respectively. There was no significant difference in the average annual incidence rate among different grades (χ2= 5.91, P>0.05). Logistic regression model analysis showed that, with SE ≥+ 0.50 D as a reference, the risk of developing myopia at the 0 D ≤ SE <+ 0.50 D level was 3.21 (2.206, 4.674) times higher in males, and the risk of developing myopia at the -0.50 D < SE <0 D level was 7.226 (4.641, 11.253) times higher. Among girls, the risk of developing myopia at 0 D ≤ SE <+ 0.50 D level increased by 4.554 (2.967, 6.991) times, and the risk of developing myopia at -0.50 D ≤ SE ≤0 D level increased by 4.554 (2.967, 6.991) times.Conclusions:From 2021 to 2023, the incidence rate of myopia among primary school students in grades 1 to 4 in Zhengzhou is high, and the prevalence rate is growing rapidly. At present, more attention should be paid to the prevention and control of myopia in children and adolescents, with a focus on the female population and children and adolescents with insufficient foresight reserves.
基金项目
国家自然科学基金资助项目(82071000)
郑州市科技惠民计划项目(2021KJHM0009)
北京市杰出青年科学基金项目(JQ20029)
万方数据