"安阳儿童眼病研究"模式对儿童青少年近视眼防控效果的临床研究

Effects of"Anyang Childhood Eye Study"on prevention and control of myopia in children

目的探讨"安阳儿童眼病研究"模式开展后对安阳当地儿童青少年近视眼防控的效果。方法收集2011年10月至12月在河南安阳地区的小学一年级和初中一年级在校学生4981例(4981只眼)的研究资料。其中,小学一年级学生男性1654例(1654只眼),女性1203例(1203只眼);年龄5.7~9.3岁,平均年龄(7.1±0.4)岁。初中一年级学生男性1065例(1065只眼),女性1059例(1059只眼);年龄10.0~15.6岁,平均年龄(12.7±0.5)岁。采用数字表法随机抽取2018年11月至12月在河南安阳地区的小学一年级和初中一年级在校学生387例(387只眼)进行研究。其中,小学一年级学生男性103例(103只眼),女性79例(79只眼);年龄6.3~7.4岁,平均年龄(6.8±0.3)岁。初中一年级学生男性112例(112只眼),女性93例(93只眼);年龄10.8~14.7岁,平均年龄(12.7±0.4)岁。采用非散瞳电脑验光的方式获得学生患眼屈光度,测量3次取平均屈光度值,计算求得等效球镜屈光度(SE)。SE屈光度采用均数±标准差进行描述,并计算其屈光不正的患病率。"安阳儿童眼病研究"开展期间,采取政府-医院-学校三方模式来防控儿童青少年近视眼,采用独立样本t检验比较"安阳儿童眼病研究"模式开展前后学龄儿童的屈光度,采用χ^(2)检验比较"安阳儿童眼病研究"模式开展前后学龄儿童近视眼的患病率。结果2011年随机抽取2857例小学一年级和2124例初中一年级学生的平均屈光度为(-0.50±1.10)D和(-2.28±1.78)D。2018年随机抽取的182例小学一年级和205例初中一年级人群的平均屈光度为(0.12±0.64)D和(-2.02±2.01)D。经t检验,"安阳儿童眼病研究"模式开展前后,2018年与2011年相比小学一年级学生屈光度的差异具有统计学意义(t=-12.024,P<0.05)。初中一年级学生屈光度差异不明显,但2018年比2011年患者近视眼屈光度有所降低。根据屈光度分成近视组、正视组及远视组3组,2011年小学一年级近视眼患者1256例,占43.96%;正视眼者1300例,占45.50%;远视眼患者301例,占10.54%。初中一年级近视眼患者1860例,占87.57%;正视眼者225例,占10.59%;远视眼患者39例,占1.84%;两个年级合并的近视眼患病率为62.56%。2018年小学一年级近视眼患者31例,占17.00%;正视眼97例,占53.30%;远视眼患者54例,占29.67%。初中一年级近视眼患者167例,占81.46%;正视眼者30例,占14.64%;远视患者8例,占3.90%;两个年级合并的近视眼患病率为51.16%。考虑到人群构成比,经过7年时间,中小学生近视眼患病率下降了17.90%。经χ^(2)检验,小学一年级、初中一年级及合并后学生的近视眼患病率前后差异具有统计学意义(χ^(2)=49.725,5.649,19.259;P<0.05)。结论安阳地区儿童青少年的近视眼患病率下降明显,说明"安阳儿童眼病研究"模式这种构建政府-医院-学校三方近视眼综合防治平台模式对降低儿童青少年的近视眼患病率有较好的效果。防控近视眼重点要放在小学和幼儿园阶段。

Objective To explore the effective myopia prevention and control strategy after"Anyang Childhood Eye Study".Methods The research data of 4981 cases(4981 eyes)of grade 1 and grade 7 students of Anyang city from October to December 2011 were collected.There were 1654 males(1654 eyes)and 1203 females(1203 eyes)in grade 1 students with the average age of(7.1±0.4)years-old(ranged from 5.7 to 9.3 years-old).Among them,there were 1065 males(1065 eyes)and 1059 females(1059 eyes)in grade 7 students with the average age of(12.7±0.5)years-old(ranged from 10.0 to 15.6 years-old).387 students(387 eyes)in grade 1 and grade 7 students in Anyang city from November to December 2018 were randomly selected.Among them,there were 103 males(103 eyes)and 79 females(79 eyes)in grade 1 students with the average age of(6.8±0.3)years-old(ranged from 6.3 to 7.4 years-old).There were 112 males(112 eyes)and 93 females(93 eyes)in grade 7 students with the average age of(12.7±0.4)years-old(ranged from 10.8 to 14.7 years-old).Refraction were measured by noncycloplegic autorefraction for three times,and spherical equivalent(SE)were calculated.SE was described by±s,and then the prevalence of refractive error were analyzed.During the period of"Anyang Childhood Eye Study",the government-hospital-school tripartite model was used to prevent and control children′s myopia.The children′diopters before and after the"Anyang Childhood Eye Study"model were compared by independent sample t test,and the prevalence of myopia before and after was compared by Chi square test.Results In 2011,the average diopters of 2857 in grade 1 students and 2124 in grade 7 students were(-0.50±1.10)D and(-2.28±1.78)D,respectively.In 2018,the average diopters of 182 in grade 1 students and 205 in grade 7 students were(0.12±0.64)D and(-2.02±2.01)D.There was statistically significant difference in eye diopter before and after the"Anyang Childhood Eye Study"model(t=-12.024,P<0.05).There was no significant difference in diopter in grade 7 students,but the diopter of children′myopia in 2018 was lower than that in 2011.According to the value of their diopter,they were divided into three groups:myopic group,emmetropic group and hyperopic group.In 2011,there were 1256 cases(43.96%)with myopia in grade 1 students;1300 cases(45.50%)with emmetropia;301 patients(10.54%)with hyperopia.There were 1860 cases(87.57%)with myopia in grade 7 students;225 cases(10.59%)with emmetropia;39 patients(1.84%)with hyperopia.The prevalence of children′myopia in two grades was 62.56%.In 2018,there were 31 cases(17.00%)with myopia in grade 1 students;97 cases(53.30%)with emmetropia;54 patients(29.67%)with hyperopia.There were 167 cases(81.46%)with myopia in grade 7 students;30 cases(14.64%)with emmetropia;8 cases(3.90%)with hyperopia.The prevalence of myopia in two grades was 51.16%.The prevalence of children′myopia between grade 1 and grade 7 students decreased by 17.90%over the past 7 years when the population composition ratio was considered.Chi square test showed that there was significant difference in the prevalence of children′myopia in grade 1 students,grade 7 students and the combination(χ^(2)=49.725,5.649,19.259;P<0.05).Conclusions The prevalence of children′myopia has declined obviously in Anyang city,which suggesting that the"Anyang Childhood Eye Study"model that the myopia prevention and control platform of government-hospital-school,play a key role in the battle fightening against myopia.The myopia control should pay more attention to kindergarten and primary school students.