上海市小学生身体发育情况与近视眼关系的临床研究

The relationship between myopia and physical development in primary school children in Shanghai

目的探讨小学生身体发育与近视眼的关系。方法收集2021年10月至2021年12月于上海市徐汇区1183人(1183只眼)小学生右眼的临床资料。其中,男生603人(603只眼),女生580人(580只眼);年龄6~12周岁,平均年龄(8.9±1.4)岁。测量裸眼视力、非睫状肌麻痹状态的球镜屈光度、柱镜屈光度、等效球镜(SE)屈光度、角膜曲率半径(CR)、眼轴长度(AL)、身高及体质量,计算轴率比(AL/CR)及身体质量指数(BMI)。根据各年龄段的身高分为身高偏低组、中等组及偏高组;根据各年龄段BMI分为BMI过轻组、正常组及超重组。裸眼视力、球镜屈光度、柱镜屈光度、SE屈光度、CR、AL、AL/CR、身高及BMI的检测结果经KolmogorovSmirmov检验均符合正态分布,以x±s表示。小学生不同身高和BMI屈光状态的比较均采用单因素方差分析。身高和BMI与屈光度的相关性采用Pearson相关分析,排除干扰因素的相关性分析采用偏相关分析。结果身高偏低、身高正常及身高偏高小学生裸眼视力分别为(0.17±0.26)最小分辨视角的对数(logMAR)、(0.15±0.25)logMAR及(0.21±0.28)logMAR;球镜屈光度分别为(-0.52±1.40)D、(-0.51±1.40)D及(-0.88±1.56)D;柱镜屈光度分别为(-0.70±0.80)D、(-0.61±0.56)D及(-0.71±0.69)D;SE屈光度分别为(-0.88±1.48)D、(-0.85±1.45)D、(-1.27±1.65)D;AL分别为(23.20±1.03)mn、(23.34±0.98)mm及(23.77±1.04)mm;角膜CR分别为(7.76±0.28)mm、(7.80±0.26)mm及(7.88±0.25)mm;AL/CR分别为(2.99±0.12)、(2.99±0.11)及(3.02±0.12)。身高偏高小学生比身高正常者裸眼视力更差AL/CR更大,差异有统计学意义(F=5.186,5.619;P<0.05);身高偏高小学生比其他身高者球镜屈光度更高,SE屈光度、AL及角膜CR更长,差异有统计学意义(F=8.768,10.064,29.614,19.615;P<0.05)。小学生身高与屈光状态相关性具有统计学意义(r=0.274,0.483,0.177,0.401,-0.326,-0.142,-0.353;P<0.05)。经年龄作为控制变量的偏相关分析,身高与AL、角膜CR、AL/CR、球镜屈光度及SE屈光度相关性有统计学意义(r=0.229,0.178,0.089,-0.085,-0.094;P<0.05)。BMI过轻、BMI正常及BMI超重小学生的裸眼视力分别为(0.17±0.23)logMAR、(0.18±0.28)logMAR及(0.17±0.25)logMAR;球镜屈光度分别为(-0.68±1.21)D、(-0.67±1.41)D及(-0.62±1.64)D;柱镜屈光度分别为(-0.52±0.50)D、(-0.62±0.62)D及(-0.78±0.70)D;SE屈光度分别为(-1.00±1.25)D、(-1.01±1.50)D及(-1.05±1.68)D;AL分别为(23.42±1.05)mm、(23.40±1.00)mm及(23.72±1.07)mm;角膜CR分别为(7.81±0.26)mm、(7.81±0.25)mm及(7.88±0.27)mm;AL/CR分别为(3.00±0.11)、(3.00±0.11)及(3.01±0.13)。BMI超重小学生比BMI正常者的AL和角膜CR更长,差异有统计学意义(F=12.068,8.071;P<0.05)。小学生BMI与除球镜屈光度外的屈光状态的相关性均具有统计学意义(r=0.062,0.234,0.134,0.154,-0.179,-0.095;P<0.05)。经年龄作为控制变量的偏相关分析,BMI与AL、柱镜屈光度及角膜CR的相关性均具有统计学意义(r=0.086,-0.135,0.109;P<0.05)。结论上海小学生的眼球发育情况与身高及BMI有关。身高和BMI越高,屈光状态越差,近视眼发生与发展的风险越高。

Objective The aim of this study is to explore the relationship between physical development and myopia in primary school students.Methods The clinical data on the right eye of 1183 primary school students(1183 eyes)in Xuhui District,Shanghai from October 2021 to December 2021 was collected.Among them,603 males(603 eyes)and 580 females(580 eyes)with an average age of(8.9±1.4)years(ranging from 6 to 12 years old).The naked eye visual acuity,spherical degree,cylindrical degree in non ciliary muscle paralysis state,equivalent spherical degree(SE),corneal curvature radius(CR),axial length(AL),height,and body mass were measured.The axial ratio(AL/CR)and body mass index(BMI)were calculated.According to the height of each age group,they were divided into three groups:low height group,medium height group,and high height group,as well as low BMI group,normal group,and overweight group.Visual acuity,spherical diopter,cylindrical diopter,SE,CR,AL,AL/CR,height,and BMI were tested by Kolmogorov Smirnov and found to follow a normal distribution,described by x±s.The different heights and BMI refractive status was both compared by one-way analysis of variance.The correlation between height,BMI,and refractive index was analyzed using Pearson correlation analysis,while partial correlation analysis was used to exclude confounding factors.Results The naked eye visual acuity of elementary school students with low height,normal height,and high height are(0.17±0.26)logarithm of the minimum angle of resolution(logMAR),(0.15±0.25)logMAR,and(0.21±0.28)logMAR,respectively.The diopters of the spherical mirror were(-0.52±1.40)D,(-0.51±1.40)D,and(-0.88±1.56)D,respectively.The column mirror diopters were(-0.70±0.80)D,(-0.61±0.56)D,and(-0.71±0.69)D,respectively.The SE values were(-0.88±1.48)D,(-0.85±1.45)D,and(-1.27±1.65)D,respectively.The AL values were(23.20±1.03)mm,(23.34±0.98)mm,and(23.77±1.04)mm,respectively.The corneal CR values were(7.76±0.28)mm,(7.80±0.26)mm,and(7.88±0.25)mm,respectively.The AL/CR ratios were(2.99±0.12),(2.99±0.11),and(3.02±0.12),respectively.Primary school students with higher height had poorer naked eye vision and greater AL/CR compared to those with normal height,and the difference was statistically significant(F=5.186,5.619;P<0.05).Elementary school students with higher height had higher spherical degree,longer SE,AL,and CR than those with normal height and those with lower height,and the differences were statistically significant(F=8.768,10.064,29.614,19.615;P<0.05).The height and refractive status of elementary school students were correlated,and there was statistically significant(r=0.274,0.483,0.177,0.401,-0.326,-0.142,-0.353;P<0.05).Partial correlation analysis using age as a control variable showed that height was significantly correlated with AL,CR,AL/CR,spherical degree,and SE(r=0.229,0.178,0.089,-0.085,-0.094;P<0.05).The naked eye visual acuity of primary school students with low BMI,normal BMI,and overweight were(0.17±0.23)logMAR,(0.18±0.28)logMAR,and(0.17±0.25)logMAR,respectively.The spherical degree were(-0.68±1.21)D,(-0.67±1.41)D,and(-0.62±1.64)D,respectively.The cylindrical degree were(-0.52±0.50)D,(-0.62±0.62)D,and(-0.78±0.70)D,respectively.The SE values were(-1.00±1.25)D,(-1.01±1.50)D,and(-1.05±1.68)D,respectively.The AL/CR values were(3.00±0.11),(3.00±0.11),and(3.01±0.13),respectively.The AL were(23.42±1.05)mm,(23.40±1.00)mm,and(23.72±1.07)mm,respectively.The CR were(7.81±0.26)mm,(7.81±0.25)mm,and(7.88±0.27)mm,respectively.The AL and CR of overweight students with BMI were longer than those of normal primary school students with BMI,and the difference was statistically significant(F=12.068,8.071;P<0.05).The BMI of students was correlated with refractive status except for spherical degree,and there was statistical significance(r=0.062,0.234,0.134,0.154,-0.179,-0.095;P<0.05).After partial correlation analysis using age as a control variable,BMI was found to be correlated with AL,cylindrical degree,and CR,and there was a statistical significance(r=0.086,-0.135,0.109;P<0.05).Conclusions The eye development of primary school students in Shanghai is related to height and BMI.The higher the height and BMI of student,the worse the refractive state,and the higher the risk involved in the occurrence and development of myopia.