【摘要】 目的：脊柱侧弯检出人数呈逐年增加趋势，不同地域检出率不同，已经逐渐成为严重危害中小学生身心健康的公共卫生问题，其发病与多种因素有关。早期筛查并针对性地开展干预可以改变疾病进展。本研究旨在了解湖南省中小学生脊柱侧弯流行情况及其影响因素，为采取针对性干预措施提供科学依据。方法：采用分层随机整群抽样方法，在湖南省14个市(州)范围内，共抽取281 401名中小学生进行脊柱侧弯筛查、体格检查和问卷调查。通过χ~2检验进行组间比较，趋势χ~2检验比较不同特征分组各年龄段的筛查阳性率，采用多水平回归模型分析脊柱侧弯影响因素，使用ArcGIS绘制脊柱侧弯筛查阳性率空间分布图。结果：湖南省中小学生脊柱侧弯筛查阳性率为1.61%，其中，城区高于郊县(2.81%vs 0.98%,P<0.01)，男生和女生均为1.61%，身体消瘦学生高于正常体重、超重及肥胖学生(P<0.01)。按年龄分层分析，城区6～18岁各年龄段学生脊柱侧弯筛查阳性率均高于郊县(P<0.001)，男性与女性在大多数年龄段的差异均无统计学意义(均P>0.05)，仅在11岁组的女性高于男性(1.28%vs 1.02%,P=0.048)；而在11岁之后的大部分年龄段中，身体消瘦者脊柱侧弯筛查阳性率均显著高于身体正常、超重、肥胖者(均P<0.05)。无论城区或郊县，男性或女性，身体消瘦、正常、超重或肥胖，各年龄段学生脊柱侧弯筛查阳性率均呈随年龄增长而增高的趋势。地区分布显示：湖南省各市(州)中小学生脊柱侧弯筛查阳性率介于0.38%～3.36%，排名前3位的分别是郴州市(3.36%)、湘潭市(2.78%)、衡阳市(2.71%)，最低为湘西土家族苗族自治州(0.38%)。多水平回归模型显示：年龄(OR=1.160,95%CI 1.135～1.186)、城区(OR=2.497,95%CI 1.946～3.205)与脊柱侧弯筛查阳性检出率均呈正相关(均P<0.01)。女性(OR=0.931,95%CI 0.874～0.993)、身体营养状况正常(OR=0.751,95%CI 0.671～0.840)、超重(OR=0.513,95%CI 0.447～0.590)、肥胖(OR=0.418,95%CI 0.358～0.489)、每周60 min中高强度运动2～4 d(OR=0.928,95%CI 0.865～0.996)、每周60 min中高强度运动5～7 d(OR=0.912,95%CI 0.833～0.998)与脊柱侧弯筛查阳性检出率均呈负相关(均P<0.05)。结论：湖南省中小学生脊柱侧弯筛查阳性率较高，且与年龄、性别、城乡、营养状况、每周60 min中高强度运动天数等因素有关，应采取针对性措施进行干预，加强重点地区、重点人群监测，以预防和控制脊柱侧弯。更多还原

【Abstract】 Objective: The detection rate of scoliosis among school-aged children has been rising annually, varying by region, and has become a major public health concern affecting both physical and mental health. Its onset is multifactorial, and early screening combined with targeted interventions can alter disease progression. This study aims to investigate the prevalence and influencing factors of scoliosis among primary and secondary school students in Hunan Province, providing scientific evidence for targeted prevention strategies.Methods: A stratified, randomized cluster sampling method was used to select 281 401 students from 14 prefecture-level cities in Hunan Province for scoliosis screening, physical examination, and questionnaire survey. The chi-square test was used for group comparisons, and trend chi-square test analyzed differences in screening positive rate by age. A multilevel regression model was applied to identify influencing factors, and ArcGIS was used to visualize spatial distribution patterns of scoliosis.Results: The overall screening positive rate for scoliosis among Hunan students was 1.61%. Urban areas had a significantly higher rate than rural counties(2.81% vs 0.98%; P<0.01). The rate was equal between boys and girls(1.61% each). Underweight students had a higher rate than those with normal weight, overweight, or obesity(P<0.01). Stratified by age, urban students aged 6-18 years consistently showed higher positive rates than rural peers(P<0.001). No significant gender differences were observed at most ages(all P>0.05), except at age 11, where the females had a higher rate(1.28% vs 1.02%; P=0.048). After age 11, underweight students exhibited significantly higher positive rates than those with normal or higher BMI(all P<0.05). Across all groups, urban/rural, male/female, underweight/normal/overweight/obese, the scoliosis rate increased with age. By region, the screening positive rate ranged from 0.38% to 3.36%, with the top three being Chenzhou(3.36%), Xiangtan(2.78%), and Hengyang(2.71%), while the lowest was Xiangxi Tujia and Miao Autonomous Prefecture(0.38%). Multilevel regression analysis revealed that age(OR=1.160, 95% CI 1.135 to 1.186) and urban residence(OR=2.497, 95% CI 1.946 to 3.205) were positively associated with scoliosis risk(both P<0.01). Conversely, female gender(OR=0.931, 95% CI 0.874 to 0.993), normal nutritional status(OR=0.751, 95% CI 0.671 to 0.840), overweight(OR=0.513, 95% CI 0.447 to 0.590), obesity(OR=0.418, 95% CI 0.358 to 0.489), and engaging in ≥ 60 minutes of moderate-to-vigorous physical activity 2 to 4 days(OR=0.928, 95% CI 0.865 to 0.996) or 5 to 7 days per week(OR=0.912, 95% CI 0.833 to 0.998) were negatively associated with scoliosis risk(all P<0.05).Conclusion: The prevalence of scoliosis among primary and secondary school students in Hunan Province is relatively high and is significantly associated with age, gender, urbanrural status, nutritional condition, and physical activity frequency. Targeted interventions and enhanced monitoring in high-risk regions and populations are essential to prevent and control scoliosis.更多还原