【作者】 李敏；

【导师】 陈继华； 谢文娟；

【作者基本信息】 中南大学 ， 公共卫生（专业学位）， 2025， 硕士

【摘要】 目的:(1)了解株洲市芦淞区小学生的近视现状,分析小学生近视的影响因素;(2)通过1年随访了解小学生的近视动态变化情况,探索小学生近视进展和发病的影响因素;(3)为该地区相关部门制定预防及延缓近视发生发展的针对性措施提供理论依据。方法:(1)采用现况研究了解株洲市芦淞区小学生近视现状,分析小学生近视的影响因素。本研究于2023年10～12月,以株洲市芦淞区的2所小学为研究现场,再在这2所学校中按分层整群随机抽样的方式抽取小学生为研究对象。通过视力筛查和问卷调查的方式收集小学生的视力信息、社会人口学信息、遗传信息、饮食行为、用眼行为、活动及睡眠等方面的信息。通过描述性统计方法了解小学生的近视现况;采用χ~2检验对不同特征分组间小学生近视患病率进行差异性比较,利用二元logistic回归模型探索小学生近视的主要影响因素。(2)采用前瞻性队列研究进一步了解小学生1年内的近视进展、发病情况及影响因素。2024年10～12月对参与基线调查的小学生开展同样的现场调查。采用描述性统计方法、χ~2检验、秩和检验了解小学生的视力动态变化情况;采用χ~2检验对不同特征分组间小学生近视进展率和发病率进行差异性比较,应用二元logistic回归模型探索小学生近视进展和发病的主要影响因素。结果:(1)现况研究共纳入1253名小学生,平均年龄为(8.70±1.77)岁。近视508人,近视检出率40.5%;二元logistic回归分析结果显示,与小学一年级相比,小学三年级(OR=1.828,95%CI:1.189～2.810)、小学四年级(OR=3.546,95%CI:2.317～5.428)、小学五年级(OR=4.813,95%CI:3.161～7.329)、小学六年级(OR=5.203,95%CI:3.415～7.928)的小学生近视风险更高,仅父亲近视(OR=2.017,95%CI:1.354～3.006)、仅母亲近视(OR=1.698,95%CI:1.239～2.327)、父母均近视(OR=2.631,95%CI:1.585～4.368)、女生(OR=1.323,95%CI:1.037～1.688)、每天看电视电脑(OR=1.357,95%CI:1.034～1.781)为小学生近视的危险因素;天黑后读写时仅使用台灯(OR=0.515,95%CI:0.317～0.836)为小学生近视的保护因素。(2)队列研究共纳入989名小学生,随访1年后,小学生的近视检出率增加了7.4%,其中轻度、中度、重度近视患病率均有不同程度的升高。小学生的近视年均进展量为[-0.13(-0.51,0.25)D],近视进展304人,近视进展率为30.7%。二元logistic回归分析结果显示,与小学一年级相比,小学三年级(OR=2.046,95%CI:1.325～3.160)、小学四年级(OR=2.211,95%CI:1.413～3.460)的小学生近视进展风险更高,基线中重度近视(OR=3.982,95%CI:1.561～10.157)、每天看电脑时间≥2h(OR=2.041,95%CI:1.075～3.875)为小学生近视进展的危险因素;基线轻度近视(OR=0.703,95%CI:0.516～0.958)的小学生近视进展风险更低。(3)随访1年后,2024年共纳入基线626名非近视小学生,近视发病159人,近视发病率为25.4%;二元logistic回归分析结果显示,与小学一年级相比,小学四年级(OR=2.714,95%CI:1.492～4.937)、小学五年级(OR=1.954,95%CI:1.055～3.620)的小学生近视发病风险更高,每天参加补习班时长≥4h(OR=3.013,95%CI:1.143～7.944)、家长不限制看电子产品(OR=1.886,95%CI:1.088～3.270)为小学生近视发病的危险因素。结论:(1)株洲市芦淞区小学生的近视检出率为40.5%,高于全国平均水平。小学三至六年级、父母近视、女生、每天看电视电脑和天黑后读写时仅使用台灯为小学生近视的主要相关因素。(2)株洲市芦淞区小学生近视进展率和发病率较高,分别为30.7%和25.4%。小学三至四年级、每天看电脑时间≥2h、基线轻度近视和中重度近视为小学生近视进展的主要相关因素;小学四至五年级、每天参加补习班时长≥4h、家长不限制看电子产品为小学生近视发病的主要相关因素。图8幅,表36个,参考文献157篇更多还原

【Abstract】 Objective:(1)To understand the current situation of myopia in primary school students in Lusong District of Zhuzhou City,and to analyze the influencing factors of myopia in primary school students.(2)To understand the dynamic changes of myopia in primary school students through 1-year follow-up,and to explore the influencing factors of myopia progression and pathogenesis in primary school students;(3)To provide a theoretical basis for the relevant departments in the region to formulate targeted measures to prevent and delay the occurrence and development of myopia.Methods:(1)A cross-sectional study was conducted to understand the current situation of myopia in primary school students in Lusong District of Zhuzhou City,and to analyze the influencing factors of myopia in primary school students.This study was conducted from October to December 2023,with two primary schools in Lushu District,Zhuzhou City as the research sites.Students were then randomly selected from these two schools using stratified cluster sampling as the research subjects.By means of visual acuity screening and questionnaire survey,the visual information,socio-demographic information,genetic information,eating behavior,eye use behavior,activity and sleep information of primary school students were collected.Through descriptive statistical methods to understand the current situation of myopia in primary school students;theχ~2test was used to compare the prevalence of myopia among primary school students with different characteristics,and the binary logistic regression model was used to explore the main influencing factors of myopia among primary school students.(2)A prospective cohort study was conducted to further understand the progression,incidence and influencing factors of myopia in primary school students within 1 year.The same field survey was conducted among primary school students participating in the baseline survey from October to December 2024.Descriptive statistical methods,χ~2test and rank sum test were used to understand the dynamic changes of primary school students’visual acuity.Theχ~2test was used to compare the difference of myopia progression rate and incidence rate among different characteristic groups,and the binary logistic regression model was used to explore the main influencing factors of myopia progression and incidence in primary school students.Result:(1)A total of 1253 primary school students were included in the current study,with an average age of(8.70±1.77)years.508 people have myopia,with a myopia detection rate of 40.5%;The results of binary logistic regression analysis showed that compared with the first grade of primary school,primary school students in the third grade(OR=1.828,95%CI:1.189～2.810),fourth grade(OR=3.546,95%CI:2.317～5.428),fifth grade(OR=4.813,95%CI:3.161～7.329),and sixth grade(OR=5.203,95%CI:3.415～7.928)had a higher risk of myopia.Only the father had myopia(OR=2.017,95%CI:1.354～3.006),only the mother had myopia(OR=1.698,95%CI:1.239～2.327),and both parents had myopia(OR=2.631,95%CI:1.585～4.368),female students(OR=1.323,95%CI:1.037～1.688),and daily TV and computer watching(OR=1.357,95%CI:1.034～1.781)are risk factors for myopia in primary school students;Using only a desk lamp(OR=0.515,95%CI:0.317～0.836)when reading or writing after dark is a protective factor for myopia in primary school students.(2)A total of 989 primary school students were included in the cohort study.After one year of follow-up,the prevalence of myopia among primary school students increased by 7.4%,with varying degrees of increase in the prevalence of mild,moderate and severe myopia.The average annual progression of myopia among primary school students was[-0.13(-0.51,0.25)D],and 304 students had myopia progression,with a myopia progression rate of 30.7%.The results of binary logistic regression analysis showed that compared with first grade primary school students,third grade(OR=2.046,95%CI:1.325-3.160)and fourth grade(OR=2.211,95%CI:1.413-3.460)primary school students had a higher risk of myopia progression.Baseline moderate to severe myopia(OR=3.982,95%CI:1.561-10.157)and daily computer use time≥2 hours(OR=2.041,95%CI:1.075-3.875)were risk factors for myopia progression in primary school students.Primary school students with baseline mild myopia(OR=0.703,95%CI:0.516-0.958)had a lower risk of myopia progression.(3)After one year of follow-up,a total of 626 non-myopic primary school students were included in the baseline in 2024,among whom 159developed myopia,with an incidence rate of 25.4%.The results of binary logistic regression analysis showed that compared with first-grade primary school students,fourth-grade(OR=2.714,95%CI:1.492-4.937)and fifth-grade(OR=1.954,95%CI:1.055-3.620)primary school students had a higher risk of developing myopia.Attending after-school tutoring for≥4 hours per day(OR=3.013,95%CI:1.143-7.944)and parents not restricting the use of electronic products(OR=1.886,95%CI:1.088-3.270)were risk factors for myopia in primary school students.Conclusion:(1)The myopia detection rate among primary school students in Lushu District,Zhuzhou City is 40.5%,which is higher than the national average.The main related factors for myopia among primary school students are grades three to six,parents with myopia,female students,watching TV and using computers every day,and reading and writing only by using a desk lamp after dark.(2)The progression rate and incidence of myopia among primary school students in Lushu District,Zhuzhou City are relatively high,at30.7%and 25.4%respectively.The main related factors for the progression of myopia among primary school students are being in grades three to four,spending≥2 hours a day on the computer,having mild myopia and moderate to severe myopia at baseline.The main related factors for the onset of myopia among primary school students are being in grades four to five,spending≥4 hours a day in after-school classes,and parents not restricting the use of electronic products.更多还原