儿童和青少年近视患儿用眼行为的现状调查及健康教育的近视防控效果

张暹梅; 辛延峰; 陈静; 刘淑美

doi:10.16766/j.cnki.issn.1674-4152.004174

儿童和青少年近视患儿用眼行为的现状调查及健康教育的近视防控效果

doi: 10.16766/j.cnki.issn.1674-4152.004174

1.
杭州师范大学附属医院眼科，浙江杭州 310015
2.
杭州师范大学经亨颐教育学院，浙江省哲学社会科学培育实验室“杭州师范大学婴幼儿发展与托育实验室”，浙江杭州 310015

基金项目:

国家社会科学基金“十四五”规划项目 BLA220233

杭州市生物医药和健康产业发展扶持科技项目 2022WJC149

详细信息

通讯作者:
刘淑美，E-mail：liushumei@hznu.edu.cn

中图分类号: R778.11
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出版历程
- 收稿日期: 2024-08-18
- 网络出版日期: 2025-11-17

Survey on the current status of eye behavior of children and adolescents with myopia and the effect of health education on myopia prevention and control

1.
Department of Ophthalmology, Affiliated Hospital of Hangzhou Normal University, Hangzhou, Zhejiang 310015, China

摘要

摘要: 目的调查儿童和青少年近视患儿的用眼行为现状，并分析其影响因素及健康教育的近视防控效果。方法横断面调查2021年5月—2022年12月杭州师范大学附属医院就诊的近视儿童、青少年96例(191眼)作为近视组，首诊时接受配戴单光框架眼镜和健康教育。另选择同期体检的视力正常儿童、青少年117例(233眼)作为对照组, 不戴眼镜。收集并对比近视组和对照组的临床资料，将其中有差异的项目代入logistic回归方程中计算，得到儿童、青少年近视患儿用眼行为的影响因素。基于此，制定近视健康教育的防控措施，比较对照组和近视组随访18个月后的屈光度、眼轴、平均等效球镜增长及平均眼轴增长量。结果首诊时评估2组的学业繁忙程度、读写姿势、睡眠时间、户外运动时间、使用电子产品时间、用眼行为评分差异均有统计学意义(P < 0.05), 且上述指标均为影响眼健康行为的相关因素。随访18个月后，近视组屈光度大于对照组，眼轴大于对照组(P＜0.05)，但平均等效球镜增长、平均眼轴增长量均与对照组相比差异无统计学意义(P＞0.05)。结论儿童、青少年近视患儿用眼行为情况不容乐观，近视进展程度与多种因素有关，而健康教育的近视防控效果较好，可有效延缓近视进展，对预防高度近视的发生具有重要的临床意义。
- 儿童 /
- 青少年 /
- 近视 /
- 健康教育 /
- 防控措施 /
- 屈光度
Abstract: Objective To investigate the current status of eye behavior in children and adolescents with myopia, and to analyze the influencing factors and the effect of health education on myopia prevention and control. Methods Across-sectional survey from May 2021 to December 2022, 96 myopic children and adolescents (191 eyes) in the Affiliated Hospital of Hangzhou Normal University were selected as the myopia group, Single vision glasses and health education were accepted at the first visit.and 117 children and adolescents (233 eyes) with normal vision were selected as the control group, without wearing glasses. The clinical data of the myopia group and the control group were collected and compared, and the items with differences were substituted into the logistic regression equation to obtain the influencing factors of the eye behavior of children and adolescents with myopia. Based on this, the prevention and control measures of myopia health education were formulated, and the diopter, axial length, average equivalent spherical lens growth and average axial length growth of the control group and the myopia group were compared after 18 months of follow-up. Results There were statistically significant differences in the scores of academic busyness, reading and writing posture, sleep time, outdoor exercise time, time of using electronic products and eye behavior between the two groups at the first visit (P < 0.05), and the above indicators were related factors affecting eye health behavior. After 18 months of follow-up, the diopter of the myopia group was greater than that of the control group, and the axial length was larger than that of the control group (P < 0.05), but there was no significant difference in the average equivalent spherical lens growth and the average axial length growth between the myopia group and the control group (P>0.05). Conclusion The current state of eye behavior among children and adolescents with myopia is a matter of concern. The progression of myopia is influenced by a number of factors, Health education programs that focus on the prevention and control of myopia can effectively delay its progression. These programs are of great clinical significance in prevention of high myopia.
- Children /
- Adolescents /
- Myopia /
- Health education /
- Preventive and control measures /
- Refractive error

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表 1 近视组和对照组儿童、青少年的临床资料比较

Table 1. Comparison of clinical data between children and adolescents between the myopia group and the control group

项目	例数	近视组(n=96)	对照组(n=117)	统计量	P值
性别[例(%)]				0.366^a	0.545
男	118	51	67
女	95	45	50
年龄(x±s, 岁)	213	9.36±2.14	9.52±2.36	0.513^b	0.608
首诊屈光度(x±s, DS)	213	-2.76±2.25	-2.78±2.25	0.065^b	0.949
居住地[例(%)]				0.226^a	0.635
城镇	128	56	72
农村	85	40	45
家庭月收入[例(%)]				0.655^a	0.418
＞5 000元	120	57	63
≤5 000元	93	39	54
家长是否近视[例(%)]				1.057^a	0.304
是	79	32	47
否	134	64	70
家长文化程度[例(%)]				0.341^a	0.559
初中及以下	71	30	41
高中及以上	142	66	76
读写姿势[例(%)]				22.836^a	＜0.001
正确	116	35	81
错误	97	61	36
睡眠时间[例(%)]				11.684^a	0.001
达标	114	39	75
不达标	99	57	42
学习场所照明情况[例(%)]				2.493^a	0.114
光线充足	130	53	77
光线昏暗	83	43	40
学业繁忙程度[例(%)]				13.999^a	＜0.001
繁忙	103	60	43
轻松	110	36	74
户外运动时间[M(P₂₅, P₇₅), h/d]	213	1.38(1.10, 1.70)	2.57(1.90, 3.10)	-9.838^c	＜0.001
使用电子产品时间[M(P₂₅, P₇₅), h/d]	213	2.81(2.20, 3.20)	0.98(0.70, 1.20)	-11.536^c	＜0.001
用眼行为评分(x±s，分)	213	43.59±5.36	58.67±6.01	19.123^b	< 0.001
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 影响儿童、青少年眼健康行为的相关因素分析

Table 2. Analysis of relevant factors affecting eye health behaviors of children and adolescents

变量	B	SE	Waldχ²	P值	OR值	95% CI
读写姿势	1.366	0.292	21.944	＜0.001	3.921	2.214~6.946
睡眠时间	0.959	0.283	11.456	＜0.001	2.610	1.498~4.549
学业繁忙程度	1.009	0.284	12.621	＜0.001	2.744	1.572~4.789
户外运动时间	-2.803	0.386	52.703	＜0.001	0.061	0.028~0.129
使用电子产品时间	4.955	0.808	37.576	＜0.001	141.922	29.104~692.059
用眼行为评分	-0.463	0.069	44.442	＜0.001	0.630	0.550~0.721
首诊等效球镜	1.370	0.210	42.360	＜0.001	3.935	2.605~5.944
注：各变量赋值如下，读写姿势正确=0，错误=1；睡眠时间达标=0，不达标=1；学业繁忙程度，轻松=0，繁忙=1；户外运动时间、使用电子产品及首诊等效球镜均以实际值赋值。

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表 3 近视组和对照组干预后眼部检查指标比较(x ±s)

Table 3. Comparison of ocular examination indicators between the myopia group and the control group after intervention(x ±s)

组别	例数	等效球镜(D)	等效球镜增长(D)	眼轴(mm)	眼轴增长(mm)
近视组	96	-3.27±1.79	-0.60±0.15	25.00±1.08	0.29±0.18
对照组	117	0.31±0.60	-0.58±0.12	23.01±1.11	0.27±0.15
t值		18.751	1.081	13.178	0.885
P值		＜0.001	0.281	＜0.001	0.377

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参考文献(22)

[1]	张亚, 苏鸣, 梁玲玲, 等. 身体发育、用眼行为及环境对学龄儿童近视的影响[J]. 实用临床医药杂志, 2023, 27(18): 59-64, 69. ZHANG Y, SU M, LIANG L L, et al. Influence of physical development, eye-using behavior and environment on myopia in school-age children[J]. Journal of Clinical Medicine in Practice, 2023, 27(18): 59-64, 69.
[2]	黄睿, 金银铃, 郑金华. 低中度近视青少年配戴角膜塑形镜1月内角膜生物力学参数检测[J]. 贵州医科大学学报, 2024, 49(5): 710-715. HUANG R, JIN Y L, ZHENG J H. Changes of corneal biomechanics after wearing orthokeratology for one month in adolescents with low to moderate myopia[J]. Journal of Guizhou Medical University, 2024, 49(5): 710-715.
[3]	中华预防医学会公共卫生眼科分会. 儿童青少年近视防控公共卫生策略分期专家共识(2022)[J]. 中华预防医学杂志, 2023, 57(6): 806-814. Chinese Journal of Preventive Medicine. Expert consensus on stages of public health strategies for myopia prevention and control in children and adolescents[J]. Chinese Journal of Preventive Medicine, 2023, 57(6): 806-814.
[4]	吴泽勇, 陈哲, 杨亚新, 等. 新疆阿克苏地区6~11岁儿童近视状况及影响因素分析[J]. 中华全科医学, 2020, 18(8): 1320-1323. doi: 10.16766/j.cnki.issn.1674-4152.001497 WU Z Y, CHEN Z, YANG Y X, et al. Analysis of myopia and influencing factors in children aged 6-11 in Aksu area of Xinjiang[J]. Chinese Journal of General Practice, 2020, 18(8): 1320-1323. doi: 10.16766/j.cnki.issn.1674-4152.001497
[5]	刘姣, 潘婧, 汪婧媛. 近视健康教育在青少年近视防控中的作用及其可行性探讨[J]. 江西医药, 2023, 58(3): 357-359. LIU J, PAN J, WANG J Y. The role of myopia health education in the prevention and control of myopia in adolescents and its feasibility[J]. Jiangxi Medical Journal, 2023, 58(3): 357-359.
[6]	陈晓希, 赵姣, 韩瑾, 等. 近视健康教育在青少年近视防控中的作用及其可行性探讨[J]. 实用医院临床杂志, 2019, 16(5): 78-80. CHEN X X, ZHAO J, HAN J, et al. The role and feasibility of myopia health education in prevention and control of juvenile myopia[J]. Practical Journal of Clinical Medicine, 2019, 16(5): 78-80.
[7]	中华预防医学会公共卫生眼科分会, 北京预防医学会公共卫生眼科学专委会. 关于加强儿童青少年近视防控用眼行为干预的倡议及实施方法共识(2023)[J]. 中华实验眼科杂志, 2023, 41(4): 297-302. Public Health Ophthalmology Branch of Chinese Preventive Medicine Association, Public Health Ophthalmology Specialty Committee of Beijing Preventive Medicine Association. Consensus on enhancing eye-use behavior interventions for myopia prevention and control of children and adolescents(2023)[J]. Chinese Journal of Experimental Ophthalmology, 2023, 41(4): 297-302.
[8]	国家卫生健康委疾病预防控制局. 《儿童青少年近视防控适宜技术指南(更新版)》解读[J]. 实用防盲技术, 2022, 17(2): 封2, 封4.
[9]	范奕, 陈婷, 陈福辉, 等. 江西省儿童青少年近视流行现状及影响因素[J]. 中国学校卫生, 2020, 41(9): 1413-1416. FAN Y, CHEN T, CHEN F H, et al. The current prevalence and influencing factors of myopia among children and adolescents in Jiangxi Province[J]. Chinese Journal of School Health, 2020, 41(9): 1413-1416.
[10]	熊雪薇, 周炼红, 曾彩琼, 等. 湖北省1~3年级小学生近视眼进展及影响因素的纵向研究[J]. 中华眼科杂志, 2021, 57(10): 749-756. XIONG X W, ZHOU L H, ZENG C Q, et al. A longitudinal study on the progression and influencing factors of myopia in primary school students from grade one to grade three in Hubei Province[J]. Chinese Journal of Ophthalmology, 2021, 57(10): 749-756.
[11]	蔡佳玉, 邢怡桥, 周炼红, 等. 湖北省孝感市小学生视力调查及近视相关因素分析[J]. 中华眼视光学与视觉科学杂志, 2020, 22(3): 198-199. CAI J Y, XING Y Q, ZHOU L H, et al. Prevalence and Associated Factors of Myopia among Primary School Students in Xiaogan, Hubei Province[J]. Chinese Journal Of Optometry Ophthalmology And Visual Science, 2020, 22(3): 198-199.
[12]	莫想换, 谭艺青, 黄雪华, 等. 东莞市中小学生视力不良现况及其影响因素分析[J]. 华南预防医学, 2023, 49(2): 192-194. MO X H, TAN Y Q, HUANG X H, et al. Analysis of the Current Situation of Poor Eyesight among Primary and Secondary School Students in Dongguan City and Its Influencing Factors[J]. South China Journal of Preventive Medicine, 2023, 49(2): 192-194.
[13]	陈敏锋, 刘新婷, 张芬, 等. 儿童配戴角膜塑形镜后近视眼控制效果的影响因素分析[J]. 中华眼科杂志, 2022, 58(4): 259-264. CHEN M F, LIU X T, ZHANG F, et al. The influencing factors and the effect of myopia control in children treated with orthokeratology[J]. Chinese Journal of Ophthalmology, 2022, 58(4): 259-264.
[14]	王天坤, 王明博, 赵文, 等. 近视防控视频科普干预对重庆市小学生的效果评价[J]. 现代预防医学, 2022, 49(18): 3351-3356. WANG T K, WANG M B, ZHAO W, et al. Evaluation of the effectiveness of intervention through science popularization video for myopia prevention and control on primary school students in Chongqing[J]. Modern Preventive Medicine, 2022, 49(18): 3351-3356.
[15]	魏雪辉, 吴敏方, 姚美琴, 等. 上海市金山区儿童青少年家庭近视防控现况调查[J]. 职业与健康, 2021, 37(16): 2251-2256. WEI X H, WU M F, YAO M Q, et al. Current situation investigation on family prevention and control of myopia among children and adolescents in Jinshan District of Shanghai[J]. Occupation and Health, 2021, 37(16): 2251-2256.
[16]	张琴, 朱琰泓, 彭谦, 等. 学生重点常见病干预项目对小学生近视相关行为的影响[J]. 中国初级卫生保健, 2022, 36(10): 103-106. ZHANG Q, ZHU Y H, PENG Q, et al. Effect of Intervention Program for Key Common Diseases on Myopia Related Behavior of Primary School Students[J]. Chinese Primary Health Care, 2022, 36(10): 103-106.
[17]	史千惠, 刘琳, 何晴, 等. 近视防控门诊7~14岁儿童干眼的患病率及危险因素分析[J]. 国际眼科杂志, 2023, 23(2): 339-344. SHI Q H, LIU L, HE Q, et al. Prevalence and risk factors of dry eye in children aged 7-14 years in myopia prevention and control clinic[J]. International Eye Science, 2023, 23(2): 339-344.
[18]	黄志浩, 邹淼, 陈继艳, 等. 东营市东营区中小学生不同近视程度影响因素分析[J]. 职业与健康, 2021, 37(23): 3259-3264. HUANG Z H, ZOU M, CHEN J Y, et al. Analysis on influencing factors of different myopia level among primary and secondary school students in Dongying District of Dongying City[J]. Occupation and Health, 2021, 37(23): 3259-3264.
[19]	苗城塬, 韩璐鸾, 班晓蕾, 等. 河南省9~22岁大、中、小学生不同睡眠指标与近视的关系[J]. 郑州大学学报(医学版), 2024, 59(4): 480-483. MIAO C Y, HAN L L, BAN X L, et al. Relationship between different sleep indicators and myopia in 9 to 22 years old students at different stages of learning in Henan Province[J]. Journal of Zhengzhou University(Medical Sciences), 2024, 59(4): 480-483.
[20]	金楠, 杜蓓, 宋德胜, 等. 天津市中小学生日常用眼行为调查及近视相关影响因素研究[J]. 眼科新进展, 2024, 44(4): 302-305, 310. JIN N, DU B, SONG D S, et al. A survey of common eye behaviors and influencing factors of myopia in primary and secondary school students in Tianjin[J]. Recent Advances in Ophthalmology, 2024, 44(4): 302-305, 310.
[21]	陈丽云, 唐丹, 吕岫葳, 等. 近视儿童家长近视防控认知-行为-需求的现况调查[J]. 中华现代护理杂志, 2023, 29(15): 2069-2072. CHEN L Y, TANG D, LYU X W, et al. A survey of cognitive-behavior-demand for myopia prevention and control among parents of myopic children[J]. Chinese Journal of Modern Nursing, 2023, 29(15): 2069-2072.
[22]	李嘉妍, 奴比娅·阿马尔江, 李梦龙, 等. 2022年北京市小学生户外活动和电子产品使用与近视发生的交互作用[J]. 实用预防医学, 2024, 31(5): 513-517. LI J Y, Nubiya·Amaerjiang, LI M L, et al. Interactions of outdoor activities and use of electronic products with the occurrence of myopia among primary school students in Beijing, 2022[J]. Practical Preventive Medicine, 2024, 31(5): 513-517.