0.01%阿托品滴眼液对近视青少年近视控制效果及其影响因素分析

毛方超; 朱萍

doi:10.16766/j.cnki.issn.1674-4152.003200

0.01%阿托品滴眼液对近视青少年近视控制效果及其影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.003200

毛方超,
朱萍^,

海宁市人民医院眼科, 浙江海宁 314400

基金项目:

浙江省医药卫生科技计划项目 2023XY182

海宁市科技计划项目 2021065

详细信息

通讯作者:
朱萍, E-mail: 15325739966@189.cn

中图分类号: R778.11
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- 文章访问数: 234
- HTML全文浏览量: 145
- PDF下载量: 17
- 被引次数: 0
出版历程
- 收稿日期: 2023-04-25
- 网络出版日期: 2023-11-23

Effect of 0.01% atropine eye drops on myopia control and its influencing factors in myopic teenagers

MAO Fangchao,
ZHU Ping^,

Department of Ophthalmology, Haining People's Hospital, Haining, Zhejiang 314400, China

摘要

摘要: 目的青少年近视的发病率逐渐增加且M受体参与近视的整体发展过程，阿托品属于典型的M受体阻断剂，故探讨0.01%阿托品滴眼液对青少年近视的控制效果及其影响因素。方法选取2021年3—8月海宁市人民医院收治的98例近视青少年为研究对象，均接受0.01%阿托品治疗。随访观察1年，将完成随访的82例近视青少年根据治疗效果分为有效组(近视年增长量 < 0.25 D或近视年增长量下降≥50%)50例和无效组(近视年增长量≥0.25 D)32例。应用多因素logistic回归模型分析影响0.01%阿托品治疗效果的相关因素并绘制ROC曲线评估预测价值。结果 2组年龄、基线等效球镜度SE、裸眼视力比较差异有统计学意义(均P < 0.05)；多因素logistic回归分析显示年龄(OR=1.395，95% CI：1.023~1.901)、裸眼视力(OR=2.134，95% CI：1.087~4.187)、等效球镜度SE(OR=0.349，95% CI：0.183~0.666)为近视0.01%阿托品治疗效果的影响因素(均P < 0.05)；ROC曲线显示，年龄、基线等效球镜度SE、裸眼视力预测0.01%阿托品治疗效果的AUC分别为0.708(95% CI: 0.597~0.803)、0.799(95% CI: 0.696~0.879)、0.714(95% CI: 0.603~0.808)。结论 0.01%阿托品治疗近视青少年效果显著，年龄小、基线等效球镜度SE高、裸眼视力低更能从0.01%阿托品治疗中获益。
- 近视 /
- 青少年 /
- 阿托品 /
- 治疗效果
Abstract: Objective The incidence of myopia in teenagers is gradually increasing, and the M receptor is involved in the whole process of myopia development. Atropine is a typical M receptor blocker. Therefore, the effect of 0.01% atropine eye drops on myopia control in adolescents with myopia and its influencing factors are discussed. Methods A total of 98 myopic adolescents admitted to Haining People's Hospital from March to August 2021 were selected as the research objects, and all received 0.01% atropine treatment. The 82 patients were followed up for 1 year. According to the treatment effect, they were divided into an effective group (50 cases, annual increase of myopia < 0.25 D or decrease of myopia ≥50%) and an ineffective group (32 cases, annual increase of myopia ≥0.25 D). A multivariate logistic regression model was used to analyze the related factors affecting the treatment effect of 0.01% atropine, and a ROC curve was drawn to evaluate the predictive value. Results There were significant differences in age, baseline equivalent spherical mirror SE and naked eye visual acuity between the two groups (all P < 0.05). Multivariate logistic regression analysis showed that age (OR=1.395, 95% CI: 1.023-1.901), naked eye visual acuity (OR=2.134, 95% CI: 1.087-4.187), equivalent spheroscope SE (OR=0.349, 95% CI: 0.183-0.666) were the factors influencing the therapeutic effect of 0.01% atropine (all P < 0.05). The ROC curve showed that the AUCs of age, baseline equivalent spheroscope SE and naked eye visual acuity in predicting the effect of 0.01% atropine were 0.708 (95% CI: 0.597-0.803), 0.799(95% CI: 0.696-0.879) and 0.714 (95% CI: 0.603-0.808), respectively. Conclusion The effect of 0.01% atropine in the treatment of myopic adolescents is significant. Younger age, higher baseline spherical equivalent SE and lower naked eye visual acuity are more likely to benefit from 0.01% atropine.
- Myopia /
- Teenagers /
- Atropine /
- Treatment effect

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图 1 近视青少年0.01%阿托品治疗效果相关因素预测ROC曲线

Figure 1. ROC curve for predicting the factors related to the treatment effectiveness of 0.01% atropine in myopic adolescents

下载: 全尺寸图片幻灯片

表 1 近视青少年0.01%阿托品治疗效果单因素分析

Table 1. Univariate analysis of the therapeutic effect of 0.01% atropine in myopic adolescents

项目	有效组(n=50)	无效组(n=32)	统计量	P值
性别(例)			0.065^a	0.799
男性	28	17
女性	22	15
年龄(x±s，岁)	12.20±1.97	13.65±1.69	3.550^b	0.001
家族史[例(%)]	3(6.00)	3(9.38)	0.019^a	0.890
户外活动时间[例(%)]			0.178^a	0.674
＜2 h/d	18(36.00)	13(40.63)
≥2 h/d	32(64.00)	19(59.37)
睡眠时间[例(%)]			0.019^a	0.891
＜9 h/d	18(36.00)	12(37.50)
≥9 h/d	32(64.00)	20(62.50)
完成作业及看书时长[例(%)]			1.149^a	0.284
≥3 h/d	19(38.00)	16(50.00)
＜3 h/d	31(62.00)	16(50.00)
使用移动设备时间(x±s，h/d)	1.88±0.35	2.01±0.37	1.585^b	0.118
基线等效球镜度SE(x±s，D)	-2.15±0.90	-3.21±0.90	5.203^b	< 0.001
AL(x±s，mm)	24.26±1.21	24.31±1.24	0.180^b	0.858
IOP(x±s，mmHg)	16.98±2.30	17.02±2.19	0.079^b	0.937
瞳孔直径(x±s，mm)	3.85±0.58	3.87±0.61	0.148^b	0.883
AMP(x±s，D)	14.28±4.11	14.21±4.22	0.074^b	0.941
最平坦角膜曲率(x±s，D)	42.26±1.25	42.22±1.27	0.140^b	0.889
最陡峭角膜曲率(x±s，D)	44.25±1.63	44.31±1.59	0.165^b	0.869
裸眼视力(x±s，LogMAR)	0.36±0.12	0.46±0.11	3.875^b	< 0.001
注：^a为χ²值，^b为t值。

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表 2 近视青少年0.01%阿托品治疗效果多因素logistic回归分析

Table 2. Multivariable logistic regression analysis of the therapeutic effect of 0.01% atropine in myopic adolescents

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.333	0.158	4.428	0.035	1.395	1.023~1.901
等效球镜度SE	-1.053	0.330	10.201	0.001	0.349	0.183~0.666
裸眼视力	0.758	0.344	4.854	0.028	2.134	1.087~4.187

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参考文献(16)

[1]	中华医学会眼科学分会眼视光学组, 中国医师协会眼科医师分会眼视光专业委员会. 低浓度阿托品滴眼液在儿童青少年近视防控中的应用专家共识(2022)[J]. 中华眼视光学与视觉科学杂志, 2022, 24(6): 401-409. Chinese Optometric Association of Chinese Ophthalmological Society, Optometry Committee of Chinese Ophthalmologists Association. Expert consensus on application of low-concentration atropine eye drops in the prevention and control of myopia in children and adolescents (2022)[J]. Chinese Journal Of Optometry Ophthalmology And Visual Science, 2022, 24(6): 401-409.
[2]	索倩, 张德勇, 蔡文茜, 等. 视力低常学龄前儿童屈光不正的分布特征分析[J]. 中华全科医学, 2020, 18(11): 1869-1871. doi: 10.16766/j.cnki.issn.1674-4152.001641 SUO Q, ZHANG D Y, CAI W Q, et al. Analysis of distribution characteristics of refractive error in preschoolers with low vision[J]. Chinese Journal of General Practice, 2020, 18(11): 1869-1871. doi: 10.16766/j.cnki.issn.1674-4152.001641
[3]	LEE S, MACKEY D A, LINGHAM G, et al. Western australia atropine for the treatment of myopia (WA-ATOM) study: rationale, methodology and participant baseline characteristics[J]. Clin Exp Ophthalmol, 2020, 48(5): 569-579. doi: 10.1111/ceo.13736
[4]	YAM J C, LI F F, ZHANG X J, et al. Two-year clinical trial of the low-concentration atropine for myopia progression (LAMP) study: phase 2 report[J]. Ophthalmology, 2020, 127(7): 910-919. doi: 10.1016/j.ophtha.2019.12.011
[5]	李凤鸣, 谢立信, 朱秀安. 中华眼科学[M]. 北京: 人民卫生出版社, 2014. LI F M, XIE L X, ZHU X A. Chinese Ophthalmology[M]. Beijing: People's Medical Publishing House, 2014.
[6]	中华人民共和国国家卫生和计划生育委员会. 近视防治指南[J]. 中国实用乡村医生杂志, 2018, 25(8): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-FJJY201918015.htm National Health and Family Planning Commission of the PRC. Guidelines for myopia prevention and treatment[J]. Chinese Practical Journal of Rural Doctor, 2018, 25(8): 1-4. https://www.cnki.com.cn/Article/CJFDTOTAL-FJJY201918015.htm
[7]	FOO L L, HTOON H, FAROOQUI S Z, et al. Part-time use of 1% atropine eye drops for prevention of myopia progression in children[J]. Int Ophthalmol, 2020, 40(7): 1857-1862. doi: 10.1007/s10792-020-01356-x
[8]	LENINA O A, PETROV K A. Balanced modulation of neuromuscular synaptic transmission via M1 and M2 muscarinic receptors during inhibition of cholinesterases[J]. Sci Rep, 2022, 12(1): 1688. doi: 10.1038/s41598-022-05730-w
[9]	MORICHE-CARRETERO M, REVILLA-AMORES R, DIAZ-VALLE D, et al. Myopia progression and axial elongation in spanish children: efficacy of atropine 0.01% eye-drops[J]. J Fr Ophtalmol, 2021, 44(10): 1499-1504. doi: 10.1016/j.jfo.2021.07.005
[10]	HA A, KIM S J, SHIM S R, et al. Efficacy and safety of 8 atropine concentrations for myopia control in children: a network meta-analysis[J]. Ophthalmology, 2022, 129(3): 322-333. doi: 10.1016/j.ophtha.2021.10.016
[11]	SUN W Y, HASEBE S. Efficacy of 0.01% atropine eye drops in controlling myopia progression and axial elongation in children: a meta-analysis based on randomized controlled trials[J]. Acta Med Okayama, 2022, 76(4): 457-463.
[12]	HIEDA O, HIRAOKA T, FUJIKADO T, et al. Efficacy and safety of 0.01% atropine for prevention of childhood myopia in a 2-year randomized placebo-controlled study[J]. Jpn J Ophthalmol, 2021, 65(3): 315-325. doi: 10.1007/s10384-021-00822-y
[13]	李萍, 刘婷, 孙先桃. 角膜塑形镜联合0.01%硫酸阿托品眼用凝胶对小儿近视的疗效及影响因素分析[J]. 国际眼科杂志, 2021, 21(4): 698-701. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK202104032.htm LI P, LIU T, SUN X T. Effect of orthokeratology combined with 0.01%Atropine Sulfate Ophthalmic Gel on curative effect and analysis influencing factors on children's myopia[J]. International Eye Science, 2021, 21(4): 698-701. https://www.cnki.com.cn/Article/CJFDTOTAL-GJYK202104032.htm
[14]	LI F F, ZHANG Y Z, ZHANG X J, et al. Age effect on treatment responses to 0.05%, 0.025%, and 0.01% atropine: low-concentration atropine for myopia progression study[J]. Ophthalmology, 2021, 128(8): 1180-1187.
[15]	李双莲. 低浓度阿托品滴眼液延缓儿童青少年不同程度近视的有效性和安全性研究[D]. 南昌: 南昌大学, 2020. LI S L. Efficacy and safety of low concentration atropine eye drops in delaying myopia of different degrees in children and adolescents[D]. Nanchang: Nanchang University, 2020.
[16]	朱显丰, 周晓伟. 低浓度阿托品控制不同程度近视疗效分析[J]. 浙江临床医学, 2019, 21(6): 806-808. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202108042.htm ZHU X F, ZHOU X W. Analysis of the effect of low concentration atropine on the control of different degrees of myopia[J]. Zhejiang Clinical Medical Journal, 2019, 21(6): 806-808. https://www.cnki.com.cn/Article/CJFDTOTAL-ZWYY202108042.htm