广州市荔湾区学龄儿童屈光不正患病率的现况调查

Population-based survey of refractive error in school-aged children in Liwan District, Guangzhou

目的探讨广州市荔湾区5～15岁儿童的屈光不正患病率情况。方法采用人群为基础的横断面调查方法。在2002年10月至2003年1月期间，中山大学中山眼科中心对广州市荔湾区居住的全部5～15岁儿童，通过随机整群抽样和逐户登记确定样本与受检对象，在71个学校和19个社区检查点进行检查，眼部检查包括视力、眼球运动、散瞳检影验光、自动验光、外眼、眼前段、屈光间质及眼底检查。屈光不正与儿童的年龄、性别及家长教育程度的关系采用多元回归模型进行分析。结果在登记的5053名儿童中，实际检查4364人，受检率为86．4％。以等效球镜-0．50 D以下作为界定，近视的患病率为35．1％（95％可信区间：33．2％～36．9％），患病率从5岁的3．3％增加到15岁时的73．1％（根据检影验光）；女性儿童具有较高的患病率，调整比数比为1．29（95％可信区间：1．11～1．51）；以等效球镜＋2．00D以上作为界定，远视患病率为5．8％（95％可信区间：5．3％～6．3％），从5岁时16．7％减少到15岁时低于1．0％。散光（柱镜屈光度≥0．75D）的患病率在视网膜检影法为33．6％，而在自动验光法为42．7％。Logistic回归模型显示近视与年龄（OR=1．52，95％可信区间：1．48～1．56）、女性（OR=1．29，95％可信区间：1．11～1．51）和父母教育程度（OR=1．22，95％可信区间：1．05～1．42）有关。结论广州市荔湾区学龄儿童具有较高的近视患病率，近视已经成为重要的公共卫生问题，提高儿童屈光矫正的覆盖率和质量是当前的主要挑战。

Objective To estimate the prevalence of refractive error in school-aged children in urban setting of Southern China. Methods In this population-based cross-sectional study, children aged 5 to 15 years old were randomly selected by clustering sampling and door-to-door survey, and were examined in 71 schools and 19 community stations from October 2002 to January 2003. The examination included visual acuity measurement, ocular motility evaluation, retinoscopy, autorefraction under cycloplegia and examination of the external eye, anterior segment, media, and fundus. Results Of 5053 children living in 4814 households enumerated, 4364 （86. 4% ） were examined. The prevalence of myopia （spherical equivalent, SE 〈 -0. 50 D） was 35.1% （95% CI： 33.2%-36. 9% ） with retinoscopy, this rate increased from 3.3% in 5-year-old to 73. 1% in 15-year-old. Females had a significantly higher risk of myopia （adjusted odds ratio： 1.29, 95% CI： 1.11-1.51）. The prevalence of hyperopia （SE≥ ＋2.00 D） was 5.8% （95% CI： 5.3%-6. 3% ） and decreased from 16.7% in 5-year-old to less than 1% in 15-year-old. Astigmatism （ cylinder ≥ 0. 75 D） was presented in 33. 6% of children examined with retinoscopy and in 42. 7% with autorefraction. Conclusions The prevalence of myopia is high in Chinese school-age children living in urban Guangzhou, representing an important public health problem. The coverage and quality of refractive correction in the children need to be improved.