Article(id=1325502414308122827, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325502070660407522, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025148, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1741276800000, receivedDateStr=2025-03-07, revisedDate=1743091200000, revisedDateStr=2025-03-28, acceptedDate=null, acceptedDateStr=null, onlineDate=1793954002215, onlineDateStr=2026-11-06, pubDate=1748102400000, pubDateStr=2025-05-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793954002215, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793954002215, creator=13701087609, updateTime=1793954002215, updator=13701087609, issue=Issue{id=1325502070660407522, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='5', pageStart='609', pageEnd='760', issueExtLink='null', onlineDate='null', pubDate='1748102400000', pubDateStr='2025-05-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953920283, creator='13701087609', updateTime=1793953920283, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=728, endPage=731, ext={EN=ArticleExt(id=1325502415235064012, articleId=1325502414308122827, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Longitudinal trajectory analysis of orthokeratology lens wearing adherence in myopic children and adolescents, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the potential categories and influencing factors of the compliance trajectory of orthokeratology lenses (OK lens) in myopic children and adolescents, so as to provide a basis for dynamic and accurate intervention of OK lens compliance in myopic children and adolescents.

Methods

From January to June 2024, 310 myopic children and adolescents wearing OK lens were selected as research subjects from the Ophthalmology Medical Center of Cangzhou Central Hospital using a convenient sampling method. Data were collected at four time points: when the glasses were first fitted (T0), 2 weeks after fitting (T1), 1 month later (T2), 3 months later (T3), and 6 months later (T4). The data collection methods included general information questionnaires, compliance surveys for OK lens wearers, the Behavior Rating Inventory of Executive Function-Self-report Version (BRIEF-SR), family support scales, and a self-made questionnaire on myopia control attitudes. A growth mixed model was used to identify the trajectory categories of compliance with OK lens wearing among myopic children and adolescents, and multiple Logistic regression analysis was employed to examine the influencing factors.

Results

The compliance with OK lens among myopic children and adolescents were roughly divided into four developmental trajectories: C1 exemplary adherent (58 cases, 18.71%), C2 gradual progressor (130 cases, 41.94%), C3 fluctuating (85 cases, 27.42%), and C4 stubborn low follower (37 cases, 11.94%). Multivariate Logistic regression analysis showed that, with C1 group as the reference, age (C3, OR=0.74), parental education level (C4, OR=0.67), executive function (C2, OR=0.69; C4, OR=0.44), family support (C3, OR=0.75) and myopia control attitude (C2, OR=0.39) were all influencing factors for the compliance trajectory of OK lens; with C2 group as the reference, age (C3, OR=0.55), parental education level (C3, OR=0.34; C4, OR=0.64), executive function (C3, OR=0.77), and family support (C4, OR=0.58) were all influencing factors for the compliance trajectory of OK lens; with C3 group as the reference, age (C4, OR=0.68), and myopia control attitude (C4, OR=0.44) were both influencing factors for the compliance trajectory of OK lens (P < 0.05).

Conclusions

The compliance of wearing OK lens in children and adolescents with myopia can be roughly divided into four trajectories, and there is group heterogeneity. Dynamic and precise compliance intervention strategies should be given based on different trajectories and influencing factors.

, authors=Guoxin BAI1, Mingcong CAO1, Haiyue LI1, Jian WANG2, Yuhe WANG2, Xiaoteng XU1, Zhongfei CHEN2, authorsList=Guoxin BAI, Mingcong CAO, Haiyue LI, Jian WANG, Yuhe WANG, Xiaoteng XU, Zhongfei CHEN, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2025 Chinese Journal of School Health. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1325502420616356050, articleId=1325502414308122827, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=近视儿童青少年角膜塑形镜配戴依从性纵向轨迹分析, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析近视儿童青少年角膜塑形镜(OK镜)配戴依从性轨迹的潜在类别及影响因素,为近视儿童青少年OK镜配戴依从性的动态精准干预提供依据。

方法

2024年1—6月,采用方便抽样方法选取沧州市中心医院眼科医学中心配戴OK镜的310名近视儿童青少年为研究对象。采用一般资料调查表、OK镜配戴者依从性调查问卷、执行功能行为评定量表自评版(BRIEF-SR)、家庭支持量表以及自制近视控制态度问卷于患者配镜时(T0),戴镜后2周(T1)、1个月(T2)、3个月(T3)及6个月(T4)进行资料收集。采用增长混合模型识别近视儿童青少年OK镜配戴依从性轨迹类别,采用多元Logistic回归分析其影响因素。

结果

近视儿童青少年OK镜配戴依从性大致可以分为4种类别发展轨迹:C1典范坚守型(58例,18.71%)、C2循序渐进型(130例,41.94%)、C3起伏不定型(85例,27.42%)以及C4顽固低从型(37例11.94%)。多元Logistic回归分析结果显示,以C1组为参照,年龄(C3, OR=0.74)、父母受教育程度(C4, OR=0.67)、执行功能(C2, OR=0.69;C4, OR=0.44)、家庭支持(C3, OR=0.75)与近视控制态度(C2, OR=0.39)均是OK镜配戴依从性轨迹类别的影响因素;以C2组为参照,年龄(C3, OR=0.55)、父母受教育程度(C3, OR=0.34;C4, OR=0.64)、执行功能(C3, OR=0.77)、家庭支持(C4, OR=0.58)均是OK镜配戴依从性轨迹类别的影响因素;以C3组为参照,年龄(C4, OR=0.68)、近视控制态度(C4, OR=0.44)均是OK镜配戴依从性轨迹类别的影响因素(P值均 < 0.05)。

结论

近视儿童青少年OK镜配戴依从性可大致分为4种变化轨迹,存在群体异质性。应基于不同轨迹及影响因素,给予动态、精准的配戴依从性干预策略。

, authors=白国欣1, 曹明聪1, 李海月1, 王健2, 王玉荷2, 徐晓腾1, 陈忠飞2, authorsList=白国欣, 曹明聪, 李海月, 王健, 王玉荷, 徐晓腾, 陈忠飞, authorCompany=null, correspAuthors=null, authorNote=

白国欣(1979-),女,河北沧州人,硕士,副主任护师,主要研究方向为眼科护理与近视防控管理

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白国欣(1979-),女,河北沧州人,硕士,副主任护师,主要研究方向为眼科护理与近视防控管理

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白国欣(1979-),女,河北沧州人,硕士,副主任护师,主要研究方向为眼科护理与近视防控管理

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Growth mixed model fitting analysis of OK lens wearing adherence scores for myopic children and adolescents

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模型AIC值BIC值aBIC值Entropy值PLMR-LRT值PBLRT值类别概率
14 872.384 924.184 880.84---1
24 429.124 486.304 434.280.73< 0.01< 0.010.78/0.22
34 189.674 218.374 196.330.87< 0.01< 0.010.26/0.58/0.16
44 073.174 136.774 109.750.93< 0.01< 0.010.19/0.42/0.27/0.12
54 002.114 064.174 018.350.880.070.030.13/0.37/0.24/0.16/0.10
), ArticleFig(id=1325502446180638988, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502414308122827, language=CN, label=表1, caption=

近视儿童青少年OK镜配戴依从性得分的增长混合模型拟合分析

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AIC值BIC值aBIC值Entropy值PLMR-LRT值PBLRT值类别概率
14 872.384 924.184 880.84---1
24 429.124 486.304 434.280.73< 0.01< 0.010.78/0.22
34 189.674 218.374 196.330.87< 0.01< 0.010.26/0.58/0.16
44 073.174 136.774 109.750.93< 0.01< 0.010.19/0.42/0.27/0.12
54 002.114 064.174 018.350.880.070.030.13/0.37/0.24/0.16/0.10
), ArticleFig(id=1325502446323245325, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502414308122827, language=EN, label=Tab.2, caption=

Univariate analysis of trajectory categories for OK lens wearing adherence in myopic children and adolescents

, figureFileSmall=null, figureFileBig=null, tableContent=
类别人数性别年龄/岁居住地家庭月收入/万元父母受教育程度
男女7~10>10~12>12~18农村城镇< 11~2>2高中及以下大专/本科研究生及以上
C15826(44.83)32(55.17)15(25.86)19(32.76)24(41.38)22(37.93)36(62.07)15(25.86)30(51.72)13(22.41)11(18.97)28(48.28)19(32.76)
C213062(47.69)68(52.31)41(31.54)68(52.31)21(16.15)66(50.77)64(49.23)25(19.23)79(60.77)26(20.00)25(19.23)88(67.69)17(13.08)
C38543(50.59)42(49.41)44(51.76)17(20.00)24(28.24)27(31.76)58(68.24)22(25.88)42(49.41)21(24.71)39(45.88)32(37.64)14(16.47)
C43722(59.46)15(40.54)10(27.03)9(24.32)18(48.65)16(43.24)21(56.76)9(24.32)20(54.05)8(21.62)22(59.46)10(27.03)5(13.51)
χ2值1.386.281.201.128.13
P值0.100.020.190.390.01
), ArticleFig(id=1325502446616846606, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325502414308122827, language=CN, label=表2, caption=

近视儿童青少年OK镜配戴依从性轨迹类别的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
类别人数性别年龄/岁居住地家庭月收入/万元父母受教育程度
男女7~10>10~12>12~18农村城镇< 11~2>2高中及以下大专/本科研究生及以上
C15826(44.83)32(55.17)15(25.86)19(32.76)24(41.38)22(37.93)36(62.07)15(25.86)30(51.72)13(22.41)11(18.97)28(48.28)19(32.76)
C213062(47.69)68(52.31)41(31.54)68(52.31)21(16.15)66(50.77)64(49.23)25(19.23)79(60.77)26(20.00)25(19.23)88(67.69)17(13.08)
C38543(50.59)42(49.41)44(51.76)17(20.00)24(28.24)27(31.76)58(68.24)22(25.88)42(49.41)21(24.71)39(45.88)32(37.64)14(16.47)
C43722(59.46)15(40.54)10(27.03)9(24.32)18(48.65)16(43.24)21(56.76)9(24.32)20(54.05)8(21.62)22(59.46)10(27.03)5(13.51)
χ2值1.386.281.201.128.13
P值0.100.020.190.390.01
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近视儿童青少年角膜塑形镜配戴依从性纵向轨迹分析
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白国欣 1 , 曹明聪 1 , 李海月 1 , 王健 2 , 王玉荷 2 , 徐晓腾 1 , 陈忠飞 2
中国学校卫生 | 疾病控制 2025,46(5): 728-731
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中国学校卫生 |疾病控制 2025 , 46 (5) : 728 -731
近视儿童青少年角膜塑形镜配戴依从性纵向轨迹分析
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白国欣(1979-),女,河北沧州人,硕士,副主任护师,主要研究方向为眼科护理与近视防控管理

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白国欣1, 曹明聪1, 李海月1, 王健2, 王玉荷2, 徐晓腾1, 陈忠飞2
作者信息
  • 1河北省沧州市中心医院眼科医学中心,061000
  • 2沧州市眼科医院小儿斜弱视二科
作者简介:

白国欣(1979-),女,河北沧州人,硕士,副主任护师,主要研究方向为眼科护理与近视防控管理

Longitudinal trajectory analysis of orthokeratology lens wearing adherence in myopic children and adolescents
Guoxin BAI1, Mingcong CAO1, Haiyue LI1, Jian WANG2, Yuhe WANG2, Xiaoteng XU1, Zhongfei CHEN2
Affiliations
  • 1Eye Medicine Center of Cangzhou Central Hospital, Cangzhou (061000), Hebei Province, China
出版时间: 2025-05-25 doi: 10.16835/j.cnki.1000-9817.2025148
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目的

分析近视儿童青少年角膜塑形镜(OK镜)配戴依从性轨迹的潜在类别及影响因素,为近视儿童青少年OK镜配戴依从性的动态精准干预提供依据。

方法

2024年1—6月,采用方便抽样方法选取沧州市中心医院眼科医学中心配戴OK镜的310名近视儿童青少年为研究对象。采用一般资料调查表、OK镜配戴者依从性调查问卷、执行功能行为评定量表自评版(BRIEF-SR)、家庭支持量表以及自制近视控制态度问卷于患者配镜时(T0),戴镜后2周(T1)、1个月(T2)、3个月(T3)及6个月(T4)进行资料收集。采用增长混合模型识别近视儿童青少年OK镜配戴依从性轨迹类别,采用多元Logistic回归分析其影响因素。

结果

近视儿童青少年OK镜配戴依从性大致可以分为4种类别发展轨迹:C1典范坚守型(58例,18.71%)、C2循序渐进型(130例,41.94%)、C3起伏不定型(85例,27.42%)以及C4顽固低从型(37例11.94%)。多元Logistic回归分析结果显示,以C1组为参照,年龄(C3, OR=0.74)、父母受教育程度(C4, OR=0.67)、执行功能(C2, OR=0.69;C4, OR=0.44)、家庭支持(C3, OR=0.75)与近视控制态度(C2, OR=0.39)均是OK镜配戴依从性轨迹类别的影响因素;以C2组为参照,年龄(C3, OR=0.55)、父母受教育程度(C3, OR=0.34;C4, OR=0.64)、执行功能(C3, OR=0.77)、家庭支持(C4, OR=0.58)均是OK镜配戴依从性轨迹类别的影响因素;以C3组为参照,年龄(C4, OR=0.68)、近视控制态度(C4, OR=0.44)均是OK镜配戴依从性轨迹类别的影响因素(P值均 < 0.05)。

结论

近视儿童青少年OK镜配戴依从性可大致分为4种变化轨迹,存在群体异质性。应基于不同轨迹及影响因素,给予动态、精准的配戴依从性干预策略。

近视  /  角膜塑性术  /  病人依从  /  回归分析  /  儿童  /  青少年
Objective

To analyze the potential categories and influencing factors of the compliance trajectory of orthokeratology lenses (OK lens) in myopic children and adolescents, so as to provide a basis for dynamic and accurate intervention of OK lens compliance in myopic children and adolescents.

Methods

From January to June 2024, 310 myopic children and adolescents wearing OK lens were selected as research subjects from the Ophthalmology Medical Center of Cangzhou Central Hospital using a convenient sampling method. Data were collected at four time points: when the glasses were first fitted (T0), 2 weeks after fitting (T1), 1 month later (T2), 3 months later (T3), and 6 months later (T4). The data collection methods included general information questionnaires, compliance surveys for OK lens wearers, the Behavior Rating Inventory of Executive Function-Self-report Version (BRIEF-SR), family support scales, and a self-made questionnaire on myopia control attitudes. A growth mixed model was used to identify the trajectory categories of compliance with OK lens wearing among myopic children and adolescents, and multiple Logistic regression analysis was employed to examine the influencing factors.

Results

The compliance with OK lens among myopic children and adolescents were roughly divided into four developmental trajectories: C1 exemplary adherent (58 cases, 18.71%), C2 gradual progressor (130 cases, 41.94%), C3 fluctuating (85 cases, 27.42%), and C4 stubborn low follower (37 cases, 11.94%). Multivariate Logistic regression analysis showed that, with C1 group as the reference, age (C3, OR=0.74), parental education level (C4, OR=0.67), executive function (C2, OR=0.69; C4, OR=0.44), family support (C3, OR=0.75) and myopia control attitude (C2, OR=0.39) were all influencing factors for the compliance trajectory of OK lens; with C2 group as the reference, age (C3, OR=0.55), parental education level (C3, OR=0.34; C4, OR=0.64), executive function (C3, OR=0.77), and family support (C4, OR=0.58) were all influencing factors for the compliance trajectory of OK lens; with C3 group as the reference, age (C4, OR=0.68), and myopia control attitude (C4, OR=0.44) were both influencing factors for the compliance trajectory of OK lens (P < 0.05).

Conclusions

The compliance of wearing OK lens in children and adolescents with myopia can be roughly divided into four trajectories, and there is group heterogeneity. Dynamic and precise compliance intervention strategies should be given based on different trajectories and influencing factors.

Myopia  /  Orthokeratologic procedures  /  Patient compliance  /  Regression analysis  /  Child  /  Adolescent
白国欣, 曹明聪, 李海月, 王健, 王玉荷, 徐晓腾, 陈忠飞. 近视儿童青少年角膜塑形镜配戴依从性纵向轨迹分析. 中国学校卫生, 2025 , 46 (5) : 728 -731 . DOI: 10.16835/j.cnki.1000-9817.2025148
Guoxin BAI, Mingcong CAO, Haiyue LI, Jian WANG, Yuhe WANG, Xiaoteng XU, Zhongfei CHEN. Longitudinal trajectory analysis of orthokeratology lens wearing adherence in myopic children and adolescents[J]. Chinese Journal of School Health, 2025 , 46 (5) : 728 -731 . DOI: 10.16835/j.cnki.1000-9817.2025148
近视在儿童青少年人群中已成为日益严重的公共卫生问题。研究显示,我国儿童青少年近视患病率高达64.90%,呈逐年增长趋势[1]。角膜塑形镜又称OK镜,是一种硬性角膜接触镜,通过生物力学作用、视网膜周边离焦以及脉络膜效应等原理降低眼睛屈光度达到临床矫正近视的作用[2]。OK镜作为一种无创的近视治疗有效手段,颇受近视人群青睐[3]。然而,由于儿童青少年人群自制力有限,且OK镜的配戴具备一定的侵入性,护理与复查过程漫长且繁琐,配戴依从性问题成为影响近视治疗效果的关键因素。有横断面调查结果显示,OK镜配戴者的完全依从性仅为14.1%[4]。然而,横断面调查忽视了患者不同时间节点的依从性变化趋势,并且未明确个体差异,不利于精准干预方案的制定。基于此,本研究运用增长混合模型(growth mixture modle, GMM)[5]识别近视儿童青少年OK镜配戴依从性纵向变化轨迹,并分析影响因素,以期为近视儿童青少年OK镜配戴依从性的动态精准干预提供依据。
根据多因素分析样本量估算原则[6],样本总量为自变量个数的5~10倍,本研究共31个自变量,考虑10%的失访可能性,共需纳入调查对象171~341名。采用方便抽样方法,选取2024年1—6月在沧州市中心医院眼科医学中心就诊的325名近视儿童青少年角膜塑形镜配戴者为研究对象。纳入标准:年龄7~18岁;单眼屈光度为-1.00~4.00 D,散光 < 1.50 D,双眼屈光参差 < 2.00 D;眼压为>10 mmHg~ < 21 mmHg;OK镜配戴时间预期半年以上。排除标准:既往有眼部疾病史、外伤史及手术史;有结膜炎、角膜炎及严重干眼症等OK镜配戴禁忌症;既往配戴过OK镜。本研究所有资料收集采用面对面问卷调查填写的方式,现场发放及回收,共310名完成4次复查与调查,15例失访,失访率为4.62%;其中男生153(49.35%)例,女生157(50.65%)例;来自农村131(42.26%)例,城镇179(57.74%)例;患者平均年龄(11.06±4.33)岁。所有患者均签署知情同意书,本研究已通过沧州市中心医院伦理委员会审批[批号:2024-1192-01(z)]。
根据既往文献[7]复查频率并结合实际工作情况,本研究分别于配镜时(T0)收集患者的一般资料、执行功能行为评定量表自评版(Behavior Rating Inventory of Executive Function-Self-report Version, BRI-EF-SR)、家庭支持量表及近视控制态度问卷得分情况,于戴镜后2周(T1)、1个月(T2)、3个月(T3)及6个月(T4)进行OK镜配戴者依从性资料收集。
能力、机会、动机-行为模型(capacity, opportunity, motivation-behavior, COM-B)[8]用于全面分析个体行为改变的障碍,只有能力、机会、动机3个行为组件同时具备,行为才会发生改变。结合COM-B模型,选取BRIEF-SR[9](能力-执行能力)、家庭支持量表[10](机会-家庭关系与支持程度)、近视控制态度问卷(动机-视力健康态度)及OK镜配戴者依从性调查问卷[11](OK镜配戴依从行为)作为本研究的研究工具,其中OK镜配戴者依从性调查问卷作为主量表。
由团队自制,包括性别、年龄、家庭月收入、居住地、父母受教育程度、每天用眼时长等人口学资料,以及平均屈光度数与双眼屈光参差等疾病相关资料。
采用郑森国[11]汉化调整后的OK镜配戴者依从性调查问卷,涉及镜片护理、附件护理、相关液体护理等17题。本研究对该问卷进行量化赋分,选项正确计1分,错误计0分,主观题或开放性问题不计分,量表总分为0~32分,分数越高表示依从性越好。本研究中该量表Cronbach α系数为0.88。
该量表由Walker等[9]编制,用于评定青少年的执行功能。量表共80个条目,包括行为管理和元认知2个维度。评分采用李克特3级,1(从不)~3分(经常),总分80~240分,评分越高表明执行功能受损越严重、执行功能越差。本研究中该量表Cronbach α系数为0.98。
该量表由Procidano等[10]编制用于评估儿童青少年家庭支持程度。量表共计15个条目,回答“是”得1分,回答“否”得0分,得分范围在0~15分,得分越高说明家庭支持程度越好。本研究中该量表Cronbach α系数为0.79。
该问卷为研究团队自行设计,通过文献检索制定问卷初稿,经过两轮函询15位相关领域专家(专家权威系数为0.83)进行问卷内容完善,最终确定问卷终稿。共包含对近视重视程度、对近视成因认知、近视预防行为意向、对近视控制措施态度、对近视控制的经济投入意愿、对社会及家庭近视防控责任认知、对近视控制的坚持性态度7个方面,共计20个条目,采用Likert 5级计分,从“非常不同意”到“非常同意”分别计1~5分,得分范围20~100分,分数越高表明对近视控制的态度越积极、越重视。该量表Cronbach α系数为0.83。
研究设计阶段,保证研究工具选取合理,自制问卷通过信效度检验;研究实施阶段,所有调查参与者均由主研人进行调查方法及注意事项的培训并通过考核,保证方法的一致性;数据收集与录入阶段,双人录入,异常值核查,保证数据的真实性。
采用SPSS 26.0和Mplus 8.3统计软件进行数据分析。本研究中计量数据均符合正态分布,以(x±s)表示;计数资料以频数和百分比的形式描述。建模过程中,运用GMM,类别设置从“1”开始逐步递增,通过综合评估选定最佳模型。模型拟合评估指标包括赤池信息量准则(akaike information criterion, AIC)、贝叶斯信息准则(Bayesian information criterion, BIC)、校正BIC(sample size-adjusted BIC, aBIC)、熵(Entropy)、Lo-Mendell-Rubin校正似然比检验(LMR-LRT)、Bootstrap似然比检验(BLRT)等。AIC值、BIC值和aBIC值越低,表明模型拟合效果越好;Entropy的范围为0~1,当Entropy值>0.7,分类结果被认为可接受;LMR-LRT与BLRT显著性结果显示K类别模型优于K-1类别模型。通过单因素和多元Logistic回归分析儿童青少年OK镜配戴依从性轨迹的影响因素。检验水准α=0.05。
T1~T4时期,OK镜配戴者依从性得分分别为(16.91±4.76)(20.68±5.12)(20.26±5.64)(24.08±5.87)分。配镜时BRIEF-SR得分为(114.17±11.48)分、家庭支持量表得分为(10.96±2.55)分、近视控制态度问卷得分为(76.05±8.21)分。
按照自由估计时间参数模型进行设置,依次提取1~5个类别的模型拟合结果,呈现出不同的增长变化趋势。结果显示,当类别数从1增加至5时,AIC、BIC、aBIC的值逐渐减小,类别为4时,LMR-LRT、BLRT均有统计学意义(P值均 < 0.05),Entropy值最大为0.93,模型分类准确。因此,最终确定4个轨迹潜在类别组。见表1。
在4组潜在类别中,1组(C1)58例,占比18.71%;2组(C2)130例,占比41.94%;3组(C3)85例,占比27.42%;4组(C4)37例,占比11.94%。4个潜在类别轨迹发展如图1所示。
根据各潜在类别组变化趋势与特点,C1患者始终保持较高水平依从性,命名为“典范坚守组”;C2患者在第1次调查时依从性处于最低点,之后逐渐提高,命名为“循序渐进组”;C3患者OK镜配戴依从性不稳定,其中第1和3次相对较差,第2和4次相对较好,命名为“起伏不定组”;C4患者依从性始终处于较低水平,命名为“顽固低从组”。
单因素分析结果显示,不同轨迹类别组儿童青少年在年龄、父母受教育程度分布上差异均有统计学意义(P值均 < 0.05)。见表2。不同轨迹类别组(C1、C2、C3、C4)儿童青少年BRIEF-SR得分[(93.45±8.66,108.33±10.32,126.54±10.72,138.75±12.33)分]、家庭支持量表得分[(13.44±3.37,11.65±2.89,9.76±2.25,7.38±1.64)分]及近视控制态度问卷得分[(86.76±9.86,80.68±9.21,68.85±7.69,59.57±6.26)分]差异均有统计学意义(F值分别为10.65,15.66,9.88,P值均 < 0.05)。
以单因素分析中有统计学意义的因素为自变量(年龄:1=7~10岁,2=10~12岁,3=12~≤18岁;父母受教育程度:1=高中及以下,2=大专/本科,3=研究生及以上;BRIEF-SR得分、家庭支持量表得分和近视控制态度问卷得分为连续型变量),以OK镜配戴依从性4种轨迹类别作为因变量纳入多元Logistic回归分析。共线性诊断显示,所有自变量的方差膨胀因子值均 < 3,且变量间相关系数绝对值均 < 0.5,表明模型未受到多重共线性的显著影响。结果显示,以C1组为参照,年龄(C3, OR=0.74,95%CI=0.68~0.85)、父母受教育程度(C4, OR=0.67,95%CI=0.54~0.82)、执行功能(C2, OR=0.69,95%CI=0.53~0.89;C4, OR=0.44,95%CI=0.32~0.68)、家庭支持(C3, OR=0.75,95%CI=0.69~0.89)与近视控制态度(C2, OR=0.39,95%CI=0.24~0.51)均是OK镜配戴依从性轨迹类别的影响因素(P值均 < 0.05);以C2组为参照,年龄(C3, OR=0.55,95%CI=0.25~0.79)、父母受教育程度(C3, OR=0.34,95%CI=0.17~0.53;C4, OR=0.64,95%CI=0.55~0.89)、执行功能(C3, OR=0.77,95%CI=0.56~0.88)、家庭支持(C4, OR=0.58,95%CI=0.35~0.70)均是OK镜配戴依从性轨迹类别的影响因素(P值均 < 0.05);以C3组为参照,年龄(C4, OR=0.68,95%CI=0.55~0.84)、近视控制态度(C4, OR=0.44,95%CI=0.23~0.62)均是OK镜配戴依从性轨迹类别的影响因素(P值均 < 0.05)。
本研究通过GMM识别出4条近视儿童青少年OK镜配戴依从性变化轨迹,存在群体异质性。“典范坚守组”患者仅需适当指导即可维持良好的配戴依从性,避免过多干预给患者及医疗工作造成负担。“循序渐进组”占比最大,该类患者可以随着时间的延长逐步提高OK镜配戴依从性,患者在前期配戴OK镜时通常操作较为生疏、不够规范,随着配戴技巧逐渐熟练,依从性逐步提高[12]。“起伏不定组”与“顽固低从组”的轨迹提示依靠时间的延长来提高患者依从性远远不够,适当、有效且适时的干预仍是提升OK镜配戴依从性的必要措施。对于“起伏不定组”而言,应在患者配戴2周时及时给予精准配戴指导与督促干预,以避免OK镜配戴依从性下降。对于“顽固低从组”,则应该从源头明确OK镜配戴依从性低的原因,并及时纠正,改善患者后续治疗。
研究结果显示,低龄、父母受教育程度低、执行功能差、家庭支持程度低及近视控制态度不佳的OK镜配戴者,更容易进入依从性“起伏不定组”及“顽固低从组”。Chang等[13]研究发现父母受教育程度、近视知识水平影响OK镜配戴的依从性,与本研究结果一致。
从轨迹发展角度看,本研究发现多数患者依从性呈逐渐上升趋势,但在配戴3个月时,年龄较小与父母受教育程度低的患者存在明显的依从性下降趋势。其原因可能与初期适应后护理行为倦怠、家长监督减弱、配戴舒适度降低及视力改善边际效应递减共同作用有关,但也有可能与随访时间较短或某些未知的影响因素未被纳入有关。Bian等[14]研究发现,OK镜配戴依从性在配戴1年后存在下降趋势,与本研究结果有所区别,可能为随访周期设定不同而导致的差异性。
本研究结果提示,对于低龄、父母受教育程度低、执行功能差、家庭支持程度低及近视控制态度不佳的OK镜配戴者,临床工作人员应提前给予更多的关注与干预,以提高其依从性。尤其是低龄与近视控制态度较差的患儿,容易长期配戴依从性差,可提前设计较为精准的干预策略,进行配戴全周期的干预。
本研究存在一些局限性:研究随访时间为6个月,时间偏短,未能揭示OK镜配戴依从性长期的变化规律;研究采用便利抽样法,可能因样本非随机性和群体特定性导致选择偏倚,且患者来自同一地区,代表性有所欠缺。今后可考虑在多地选取患者进行长时间的随访改进研究,得出更可靠结果;同时还可以根据不同变化轨迹设计精准干预策略,以提高患者OK镜配戴依从性。
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2025年第46卷第5期
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doi: 10.16835/j.cnki.1000-9817.2025148
  • 接收时间:2025-03-07
  • 首发时间:2026-11-06
  • 出版时间:2025-05-25
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  • 收稿日期:2025-03-07
  • 修回日期:2025-03-28
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沧州市科技计划自筹经费项目(23244102098)
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    1河北省沧州市中心医院眼科医学中心,061000
    2沧州市眼科医院小儿斜弱视二科
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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