上海市杨浦区2022-2024年6~9岁学龄儿童屈光状态分析

Refractive status of school-aged children aged 6-9 years in Yangpu District, Shanghai, 2022-2024: a cohort study

摘要

目的 了解上海市杨浦区2022-2024年6~9岁学龄儿童屈光状态变化特点，分析新发近视的影响因素，为相关部门精准开展近视防控提供科学依据。方法 从上海市杨浦区北部、中部和南部地区各随机抽取一所小学，以3所小学2022年9月一至三年级全体学生为研究对象，收集其2022-2024年屈光检查数据。屈光检查包括裸眼远视力检查、非睫状肌麻痹下电脑验光及眼轴长度(axial length, AL)测量。采用Kolmogorov-Smirnov法检验计量资料的正态性；计数资料以频数描述，组间比较采用χ²检验；采用广义估计方程分析重复测量资料的组间差异及新发近视的影响因素。结果 等效球镜(spherical equivalent, SE)和AL在各随访时期及各基线年龄组的差异均有统计学意义(P<0.05)。不同时期各年龄组间远视、近视前期及近视检出率差异均有统计学意义(P<0.05)。女生(OR=1.608, 95%CI:1.218~2.124)、近视前期(OR=4.447, 95%CI:2.513~7.871)及基线眼轴长度(OR=1.505, 95%CI:1.225~1.850)是新发近视的独立危险因素(P<0.01)。结论 上海市杨浦区6~9岁学龄儿童近视率较高，远视储备不足问题突出。应前移防控关口，加强学龄前儿童屈光监测，并对近视前期儿童实施积极干预。

Abstract

Objective To investigate the characteristics of refractive status changes and analyze the influencing factors of new-onset myopia among school-aged children aged 6-9 years in Yangpu District, Shanghai from 2022 to 2024, so as to provide scientific evidence for precise prevention and control of myopia by relevant government departments. Methods One primary school was randomly selected from each of the northern, central and southern areas of Yangpu District, Shanghai. All students in grades 1 to 3 from these three primary schools in September 2022 were enrolled as study subjects. Refractive examination data from 2022 to 2024 were collected, including uncorrected distance visual acuity test, non-cycloplegic autorefraction and axial length (AL) measurement. Normality of numerical data was tested by Kolmogorov-Smirnov method. Categorical data were described by frequencies, and comparisons between groups were performed using χ² test. Generalized estimating equation was used to analyze differences between groups in repeated measurement data and factors influencing new-onset myopia. Results There were statistically significant differences in spherical equivalent (SE) and AL among different follow-up periods and baseline age groups (P<0.05). The detection rates of hyperopia, pre-myopia and myopia among different age groups at different periods showed statistically significant differences (P<0.05). Girls (OR=1.608, 95%CI: 1.218-2.124), pre-myopia (OR=4.447, 95%CI: 2.513-7.871) and baseline axial length (OR=1.505, 95%CI: 1.225-1.850) were independent risk factors for new-onset myopia (P<0.01). Conclusion The myopia rate among school-aged children aged 6-9 years in Yangpu District, Shanghai is relatively high, with insufficient hyperopia reserve being a prominent issue. The prevention and control checkpoint should be moved forward, refractive monitoring in preschool children should be strengthened, and active interventions should be implemented for children with pre-myopia.

关键词

学龄儿童 / 屈光状态 / 远视储备 / 近视前期 / 近视

Key words

School-age children / Refractive status / Hyperopia reserve / Pre-myopia / Myopia

参考文献

[1] 中华人民共和国教育部, 国家卫生健康委员会, 国家体育总局, 等 . 教育部等八部门关于印发《综合防控儿童青少年近视实施方案》的通知[EB/OL]. (2018-08-31)[2024-10-02]. https://www.gov.cn/gongbao/content/2019/content_5361801.htm

[2] 季成叶 . 现代儿童少年卫生学[M]. 2版 北京: 人民卫生出版社, 2010

[3] Hou W , Norton TT , Hyman L , et al. Axial elongation in myopic children and its association with myopia progression in the correction of myopia evaluation trial[J]. Eye Contact Lens, 2018, 44(4): 248-259. doi: 10.1097/icl.0000000000000505

[4] Chua SYL , Sabanayagam C , Cheung YB , et al. Age of onset of myopia predicts risk of high myopia in later childhood in myopic Singapore children[J]. Ophthalmic Physiol Opt, 2016, 36(4): 388-394. doi: 10.1111/opo.12305

[5] Haarman AEG , Enthoven CA , Tideman JWL , et al. The complications of myopia: a review and meta-analysis[J]. Invest Ophthalmol Vis Sci, 2020, 61(4): 49. doi: 10.1167/iovs.61.4.49

[6] Jong M , Jonas JB , Wolffsohn JS , et al. IMI 2021 yearly digest[J]. Invest Ophthalmol Vis Sci, 2021, 62(5): 7. doi: 10.1167/iovs.62.5.7

[7] 国家卫生健康委办公厅 . 国家卫生健康委办公厅关于开展第二批儿童青少年近视防控适宜技术试点工作的通知[EB/OL]. (2021-10-09)[2025-03-03]. http://www.nhc.gov.cn/jkj/s7934td/202110/0fc8a001d42345d9ac9b38842b295fe7.shtml

[8] Flitcroft DI , He MG , Jonas JB , et al. IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): M20. doi: 10.1167/iovs.18-25957

[9] 杨彦帆 . 儿童青少年近视防控取得实效[N]. 人民日报, 2021-07-14(013)

[10] 程天宇, 何鲜桂, 汪玲 . 青少年屈光发育与青春期生长发育的研究进展[J]. 上海预防医学, 2019, 31(5): 338-343. doi: 10.19428/j.cnki.sjpm.2019.19344

[11] CHENG Tianyu , HE Xianguai , WANG Ling . Advances in research of adolescent refraction development during puberty[J]. Shanghai Journal of Preventive Medicine, 2019, 31(5): 338-343. doi: 10.19428/j.cnki.sjpm.2019.19344

[12] 何鲜桂, 张欣, 许迅 . 有序推进儿童青少年近视筛查建档和防控闭环管理[J]. 中华预防医学杂志, 2021, 55(4): 551-555. doi: 10.3760/cma.j.cn112150-20201208-01435

[13] HE Xianguai , ZHANG Xin , XU Xun . Orderly promoting myopia screening, refractive archives establishment, and the closed-loop management of myopia prevention and control for children and adolescents[J]. Chinese Journal of Preventive Medicine, 2021, 55(4): 551-555. doi: 10.3760/cma.j.cn112150-20201208-01435

[14] 中华人民共和国国家卫生健康委员会 . 《儿童青少年近视防控适宜技术指南(更新版)》及解读[EB/OL]. (2021-10-13)[2025-03-02]. https://www.gov.cn/xinwen/2021-10/13/content_5642345.htm

[15] 孙祖贤, 冯彦清, 王宏, 等 . 上海市杨浦区学龄前儿童视力的分析[J]. 上海预防医学, 2020, 32(2): 181-184. doi: 10.19428/j.cnki.sjpm.2020.19043

[16] SUN Zuxian , FENG Yanqing , WANG Hong , et al. Visual acuity in preschool children of Yangpu District in Shanghai[J]. Shanghai Journal of Preventive Medicine, 2020, 32(2): 181-184. doi: 10.19428/j.cnki.sjpm.2020.19043

[17] 冯建秀, 姜敏敏, 冯彦清, 等 . 上海市杨浦区3~6岁学龄前儿童屈光状态调查[J]. 中国初级卫生保健, 2023, 37(9): 27-30. doi: 10.3969/j.issn.1001-568X.2023.09.0008

[18] FENG Jianxiu , JIANG Minmin , FENG Yanqing , et al. Refraction of preschool children aged 3 to 6 years in Yangpu district of Shanghai[J]. Chinese Primary Health Care, 2023, 37(9): 27-30. doi: 10.3969/j.issn.1001-568X.2023.09.0008

[19] YIN Y , LI L , WANG T , et al. Establishment of noncycloplegic methods for screening myopia and pre-myopia in preschool children[J]. Frontiers in Medicine, 2023, 10: 1291387. doi: 10.3389/fmed.2023.1291387

[20] Yu MK , Hu YY , Han M , et al. Global risk factor analysis of myopia onset in children: a systematic review and meta-analysis[J]. PLoS One, 2023, 18(9): e0291470. doi: 10.1371/journal.pone.0291470

[21] 胡学敏, 周炼红, 金小琴, 等 . 6~12岁儿童眼轴长度、角膜曲率半径及其比值与等效球镜的关系[J]. 中国斜视与小儿眼科杂志, 2021, 29(2): 8-11. doi: 10.3969/J.ISSN.1005-328X.2021.02.003

[22] HU Xuemin , ZHOU Lianhong , JIN Xiaoqin , et al. Relationship between axial length, corneal curvature radius, AL/CR ratio and refractive errors in children aged 6-12 years[J]. Chinese Journal of Strabismus & Pediatric Ophthalmology, 2021, 29(2): 8-11. doi: 10.3969/J.ISSN.1005-328X.2021.02.003

[23] Peñaloza-Barbosa MI , Martinez-Perez C , Andreu-Vázquez C , et al. Spherical equivalent percentile curves in a Portuguese school-aged population[J]. J Clin Med, 2025, 14(20): 7262. doi: 10.3390/jcm14207262

[24] Tao LX , Wang CX , Peng YY , et al. Correlation between increase of axial length and height growth in Chinese school-age children[J]. Front Public Health, 2022, 9: 817882. doi: 10.3389/fpubh.2021.817882

[25] 马铭绅, 关文英, 李文萱, 等 . 呼和浩特6~12岁儿童屈光状态特点及父母屈光状态对其的影响[J]. 中国临床医生杂志, 2021, 49(8): 995-998. doi: 10.3969/j.issn.2095-8552.2021.08.036

[26] MA Mingshen , GUAN Wenying , LI Wenxuan , et al. Characteristics of refractive status of children aged 6-12 in Hohhot and the influence of parents' refractive status on them[J]. Chinese Journal for Clinicians, 2021, 49(8): 995-998. doi: 10.3969/j.issn.2095-8552.2021.08.036

[27] 茶健美, 闫芳冰, 张扬, 等 . 7~12岁儿童屈光发育参数特点及对屈光状态的影响[J]. 昆明医科大学学报, 2025, 46(1): 87-92. doi: 10.12259/j.issn.2095-610X.S20250111

[28] CHA Jianmei , YAN Fangbing , ZHANG Yang , et al. Characteristics of refractive development parameters and their effects on refractive status in children aged 7-12 years[J]. Journal of Kunming Medical University, 2025, 46(1): 87-92. doi: 10.12259/j.issn.2095-610X.S20250111

[29] 魏聪, 刘佳, 卢亚梅 . 3~15岁儿童青少年眼轴与屈光状态变化分析[J]. 中国斜视与小儿眼科杂志, 2021, 29(4): 31-32. doi: 10.3969/J.ISSN.1005-328X.2021.04.010

[30] WEI Cong , LIU Jia , LU Yamei . Analysis of changes in the eye axis and refractive status of children and adolescents aged 3-15[J]. Chinese Journal of Strabismus & Pediatric Ophthalmology, 2021, 29(4): 31-32. doi: 10.3969/J.ISSN.1005-328X.2021.04.010

[31] 中华预防医学会公共卫生眼科分会 . 中国学龄儿童眼球远视储备、眼轴长度、角膜曲率参考区间及相关遗传因素专家共识(2022年)[J]. 中华眼科杂志, 2022, 58(2): 96-102. doi: 10.3760/cma.j.cn112142-20210603-00267

[32] 邵洁, 黄蛟灵, 陈金枝, 等 . 上海市3~16岁儿童屈光进展的时间与空间差异研究[J]. 中华全科医学, 2025, 23(1): 89-93. doi: 10.16766/j.cnki.issn.1674-4152.003842

[33] SHAO Jie , HUANG Jiaoling , CHEN Jinzhi , et al. A study on the temporal and spatial differences in refractive progression among children aged 3-16 in Shanghai[J]. Chinese Journal of General Practice, 2025, 23(1): 89-93. doi: 10.16766/j.cnki.issn.1674-4152.003842

[34] Li YZ , Guo L , Zhang JY , et al. Trajectories of spherical equivalent refraction from grades 1 to 4 in Chinese children[J]. BMC Public Health, 2023, 23(1): 2500. doi: 10.1186/s12889-023-17420-x

[35] 《眼轴长度在近视防控管理中的应用专家共识(2023)》专家组 . 眼轴长度在近视防控管理中的应用专家共识(2023). 中华实验眼科杂志, 2024, 42(1): 1-11. doi: 10.3760/cma.j.cn115989-20231010-00121

[36] 刘凌, 张美霞 . 近视的药物治疗[J]. 山东大学耳鼻喉眼学报, 2021, 35(4): 123-128. doi: 10.6040/j.issn.1673-3770.0.2020.313

[37] LIU Ling , ZHANG Meixia . Drug therapy for myopia[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2021, 35(4): 123-128. doi: 10.6040/j.issn.1673-3770.0.2020.313

[38] Flitcroft DI , He MG , Jonas JB , et al. IMI-defining and classifying myopia: a proposed set of standards for clinical and epidemiologic studies[J]. Invest Ophthalmol Vis Sci, 2019, 60(3): M20. doi: 10.1167/iovs.18-25957

[39] 项凯迪, 王菁菁, 潘臣炜, 等 . 上海地区4~14岁儿童1年屈光进展及影响因素分析[J]. 中国学校卫生, 2022, 43(9): 1309-1313, 1318. doi: 10.16835/j.cnki.1000-9817.2022.09.008

[40] XIANG Kaidi , WANG Jingjing , PAN Chenwei , et al. Refractive progression among students aged 4-14 in Shanghai and associated factors[J]. Chinese Journal of School Health, 2022, 43(9): 1309-1313, 1318. doi: 10.16835/j.cnki.1000-9817.2022.09.008

[41] Rozema J , Dankert S , Iribarren R , et al. Axial growth and lens power loss at myopia onset in Singaporean children[J]. Invest Ophthalmol Vis Sci, 2019, 60(8): 3091-3099. doi: 10.1167/iovs.18-26247

[42] Castagno VD , Fassa AG , Carret MLV , et al. Hyperopia: a meta-analysis of prevalence and a review of associated factors among school-aged children[J]. BMC Ophthalmol, 2014, 14: 163. doi: 10.1186/1471-2415-14-163

[43] 刘盛鑫, 杜蓓, 于军, 等 . 天津市北辰区24930名7~12岁儿童屈光不正现况调查[J]. 现代疾病预防控制, 2023, 34(12): 933-936. doi: 10.13515/j.cnki.hnjpm.1006-8414.2023.12.013

[44] LIU Shengxin , DU Bei , YU Jun , et al. A cross-sectional survey on refractive errors in children aged 7-12 years in Beichen district of Tianjin[J]. Modern Disease Control and Prevention, 2023, 34(12): 933-936. doi: 10.13515/j.cnki.hnjpm.1006-8414.2023.12.013

[45] Tang Y , Chen AM , Zou MJ , et al. Prevalence and time trends of refractive error in Chinese children: a systematic review and meta-analysis[J]. J Glob Health, 2021, 11: 08006. doi: 10.7189/jogh.11.08006

[46] Williams SM , Sanderson GF , Share DL , et al. Refractive error, IQ and reading ability: a longitudinal study from ages seven to 11[J]. Dev Med Child Neurol, 1988, 30(6): 735-742. doi: 10.1111/j.1469-8749.1988.tb14635.x

[47] Dong W , Li YB , Liu CF , et al. A study on the status of myopia and pre-myopia among primary school students in different regions of Shaanxi Province, China[J]. Front Pediatr, 2025, 13: 1596389. doi: 10.3389/fped.2025.1596389

[48] 邓益斌, 王晓银, 王惠敏, 等 . 学龄前儿童近视临床前期相关因素分析[J]. 中国学校卫生, 2023, 44(6): 893-896. doi: 10.16835/j.cnki.1000-9817.2023.06.022

[49] DENG Yibin , WANG Xiaoyin , WANG Huimin , et al. Risk factors associated with pre-myopia among preschool children[J]. Chinese Journal of School Health, 2023, 44(6): 893-896. doi: 10.16835/j.cnki.1000-9817.2023.06.022

[50] Shi ZW , Yang LH , Xu T , et al. Development of a risk score for myopia: a cohort study conducted among school-aged children in China[J]. Indian J Ophthalmol, 2024, 72(Suppl 2): S265-S272. doi: 10.4103/ijo.ijo_2077_23

[51] 戚紫怡, 何鲜桂, 潘臣炜, 等 . 上海地区6~8岁儿童近视前期流行病学调查[J]. 中国学校卫生, 2022, 43(9): 1314-1318. doi: 10.16835/j.cnki.1000-9817.2022.09.009

[52] QI Ziyi , HE Xianguai , PAN Chenwei , et al. Epidemiology of premyopia among children aged 6-8 in Shanghai[J]. Chinese Journal of School Health, 2022, 43(9): 1314-1318. doi: 10.16835/j.cnki.1000-9817.2022.09.009

[53] 李玉兰, 童浩杰, 董鑫宇, 等 . 2019年中国6~18岁汉族学生近视流行病学特征分析[J]. 中国校医, 2023, 37(7): 485-488

[54] LI Yulan , TONG Haojie , DONG Xinyu , et al. Epidemiological characteristics of myopia among Han Chinese students aged 6-18 years in China in 2019[J]. Chinese Journal of School Doctor, 2023, 37(7): 485-488. doi: 10.20161/j.cnki.32-1199/r.2023.07.003

[55] Liu LJ , Jiang DD , Li CC , et al. Relationship between myopia progression and school entrance age: a 2.5-year longitudinal study[J]. J Ophthalmol, 2021, 2021: 7430576. doi: 10.1155/2021/7430576

[56] 廖娅, 陈鸿雁, 董磊, 等 . 宿迁市2020年学龄儿童新发近视情况分析[J]. 国际眼科杂志, 2021, 21(11): 2001-2004. doi: 10.3980/j.issn.1672-5123.2021.11.34

[57] LIAO Ya , CHEN Hongyan , DONG Lei , et al. Analysis of new myopia among school-age children in Suqian City in 2020[J]. International Eye Science, 2021, 21(11): 2001-2004. doi: 10.3980/j.issn.1672-5123.2021.11.34

[58] 雍政, 孙林, 张天薇, 等 . 2545名初中生新发近视情况及其影响因素研究[J]. 中国校医, 2022, 36(4): 256-259

[59] YONG Zheng , SUN Lin , ZHANG Tianwei , et al. Study on new-onset myopia and its influencing factors in 2545 junior middle school students[J]. Chinese Journal of School Doctor, 2022, 36(4): 256-259

[60] 王艳姣, 王菁菁, 倪梓涵, 等 . 上海市儿童青少年周末户外活动水平及其与近视的关联[J]. 中国学校卫生, 2025, 46(1): 18-23. doi: 10.16835/j.cnki.1000-9817.2025012

[61] WANG Yanjiao , WANG Jingjing , NI Zihan , et al. Association of outdoor activity level on weekends and myopia among children and adolescents in Shanghai[J]. Chinese Journal of School Health, 2025, 46(1): 18-23. doi: 10.16835/j.cnki.1000-9817.2025012

基金资助

上海市加强公共卫生体系建设三年行动计划学科建设项目(GWVI-11.1-30)

上海市杨浦区科技和经济委员会，上海市杨浦区卫生健康委员会科研项目(YPQ202404)

健康杨浦专项(2022-2024)