湖南省怀化市中小学生近视现况调查及影响因素分析

Prevalence and associated factors of myopia in primary and secondary school students in Huaihua City, Hunan Province

目的调查湖南省怀化市中小学生近视患病现状并分析其相关因素。设计横断面研究。研究对象湖南省怀化市鹤城区3～12年级学生2103名。方法采用分层整群抽样方法，2014年9～12月对怀化市鹤城区6所学校中小学生进行视力检查、非睫状肌麻痹下自动验光和问卷调查。近视定义为等效球镜度（SE）≤-0．50D。应用非条件Logistic回归模型对可能与近视发生相关的33项因素进行多因素分析。主要指标近视患病率。结果在入选的2103名学生中，2064名（98．1％）（平均年龄12．5＋2．8岁，范围7～18岁）参与了调查。近视患病率为46．3％（95％CI：44．1％～48．5％），小学生为22．1％（95％CI：19．3％。24．9％），仞中生为53．8％（95％CI：50．0％～57．6％），高中生为74．4％（95％CI：70．8％～78．1％）。近视患病率随着年级增高呈增长趋势（x^2=425．626，P=0．000）。女生近视患病率50．4％（95％可信区间：47．2％-53．6％）高于男生42．8％（95％可信区间：39．9％～45．7％）（x^2=12．043，P=0．001）。乡村小学和城区小学的近视患病率无显著性差异（x^2=0．140，P=0．708）。近视学生中69．2％（660／954）配戴眼镜。Logistic回归分析显示，近视的危险因素为父母近视、更长的近距离用眼时间、更短的近距离用眼距离、更少的睡眠时间、照明过暗。课桌高度合适、户外活动、几乎不看电视或玩电脑、无不良用眼行为和习惯是近视的保护l大1素。结论怀化市中小学生近视患病率较高，乡村学校的近视防治工作亦刻不容缓，视力保护的关键年龄在9岁以前。（眼科，2016，25：241—246）

Objective To investigate the prevalence of myopia and to analyze associated factors in primary and secondary school students in Huaihua City, Hunan Province. Design Cross-sectional survey. Participants 2103 students from Grade 3 to 12 in Hecheng district of Huaihua City. Methods Stratified cluster random sampling approach was conducted to selected 2103 students from September to December in 2014. The students underwent vision examination, non-cylcoplegic auto-refiactometry and questionnaires. The difinition of myopia is SE ≤-0.50 D in the worse eye. Logistic regression analysis was used for 33 possible risk factors associated with myopia. Main Outcome Measures Prevalence of myopia. Results Out of 2103 eligible students, 2064 （98.1%） students （mean age： 12.5±2.8 years; range： 7-18 years） participated. The overall prevalence of myopia was 46.3% （95% Confidence Interval （CI）： 44.1%-48.5%）. The prevalence of myopia in primary schools, junior high schools and senior high schools were 22.1% （95% Ch 19.3%-24.9%）, 53.8% （95% CI： 50.0%-57.6%）, 74.4% （95% CI： 70.8%-78.1%）, respectively. There was a statistical significant difference of prevalence of myopia among different grade （x^2=425.626, P=0.000）. The prevalence of myopia showed an increasing trend with raising grade, and it increased at age 9 significantly. The prevalence of myopia in girls （50.4%, 95% Ch 47.2%-53.6%） was higher than boys （42.8%, 95% Ch 39.9% -45.7%） （x^2=12.043,P=0.001）. There was no statistical significant difference of prevalence of myopia between rural primary schools and urban primary school （x^2=0.140,P=0.708）. 69.2% （660/954） students with myopia wore glasses daily. In muhivariate logistic regression analysis, a higher prevalence of myopia was associated with parental myopia, longer time spent for near work, shorter near work distance, less sleep time, dim lighting. While comfortable height of desk, outdoor activities, scarcely watching TV or playing computer, without unhealthy habits of using eyes were associated with less myopia. Conclusions There is a higher prevalence of myopia in prima- ry and middle schools of Huaihua city. Prevention of myopia in rural primary schools is urgent. The crucial period of eye protection is before 9 years old. （Ophthcdmol CHN, 2016, 25： 241-246）