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Article(id=1325521264110088816, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325521023759691810, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025204, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1739980800000, receivedDateStr=2025-02-20, revisedDate=1748275200000, revisedDateStr=2025-05-27, acceptedDate=null, acceptedDateStr=null, onlineDate=1793958496357, onlineDateStr=2026-11-06, pubDate=1753372800000, pubDateStr=2025-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793958496357, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793958496357, creator=13701087609, updateTime=1793958496357, updator=13701087609, issue=Issue{id=1325521023759691810, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='7', pageStart='913', pageEnd='1064', issueExtLink='null', onlineDate='null', pubDate='1753372800000', pubDateStr='2025-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793958439054, creator='13701087609', updateTime=1793958439054, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1046, endPage=1050, ext={EN=ArticleExt(id=1325521264504353393, articleId=1325521264110088816, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Epidemiological characteristics of spinal curvature abnormalities in children and adolescents in Karst landform in Guizhou Province, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To understand the epidemiological characteristics of abnormalities spinal curvature among children and adolescents in Karst landform in Guizhou Province, so as to provide a scientific basis for targeted comprehensive intervention.

Methods

From September to December 2023, 194 875 children and adolescents aged 6-18 were selected from all countieldistricts of 9 cities (prefectures) in Guizhou Province by stratified random cluster sampling method according to the proportion of Karst landform area in Guizhou Province for carrying out spinal curvature abnormality screening, and a questionnaire survey was conducted on 139 449 students in the fourth grade and above of primary school. Binary Logistic regression was used for multivariate analysis.

Results

The detection rate of abnormal spinal curvature among children and adolescents aged 6-18 in Guizhou Province was 1.13%. The detection rates of abnormal spinal curvature in areas with a high proportion of Karst landform, areas with a low proportion of Karst landform, intercalation areas, and non-Karst landform areas were 1.10%, 2.00%, 0.90%, and 0.60%, respectively. Among them, the detection rates of abnormal spinal curvature in female students (2.40%, 1.60%, 0.90%) in areas with a low proportion of Karst landform, intercalation areas and non-Karst landform were higher than those in male students (1.60%, 0.10%, 0.30) (χ2=12.66, 112.69, 30.22, all P < 0.05). The detection rates of abnormal spinal curvature among senior high school students (2.00%, 4.30%, 1.40%, 1.30%) in different Karst landform distributions were successively higher than those among junior high school students (1.40%, 3.20%, 1.00%, 0.60%) and primary school students (0.70%, 0.80%, 0.60%, 0.30%) (χ2=306.11, 175.80, 14.24, 39.57, all P < 0.05). The results of multivariate Logistic regression analysis showed that the detection rates of abnormal spinal curvature in both high-proportion and low-proportion Karst landform areas were higher than those in non-Karst landform areas [OR(95%CI)=1.84(1.05-2.25), 1.60(1.23-2.09), both P < 0.05].

Conclusion

The detection rate of abnormal spinal curvature in children and adolescents aged 6-18 in Guizhou Province is related to the distribution of Karst landform, so it is necessary to strengthen screening and appropriate comprehensive interventions.

, authors=Xiujuan LU, Xin LI, Xiying PENG, Zhuan WANG, Xiaoli HUANG, Xiaoqin ZHANG*, authorsList=Xiujuan LU, Xin LI, Xiying PENG, Zhuan WANG, Xiaoli HUANG, Xiaoqin ZHANG, authorCompany=null, correspAuthors=Xiaoqin ZHANG, 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=1325521266635059826, articleId=1325521264110088816, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=贵州喀斯特地貌地区儿童青少年脊柱弯曲异常流行特征, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

了解贵州省不同喀斯特地貌地区6~18岁儿童青少年脊柱弯曲异常流行特征，为针对性开展综合干预提供科学依据。

方法

于2023年9—12月，采用分层随机整群抽样的方法，根据贵州省喀斯特地貌面积比例，在贵州省9个市(州)所有县(区)抽取6~18岁儿童青少年194 875名开展脊柱弯曲异常筛查，并抽取小学四年级及以上共139 449名学生开展问卷调查，采用二元Logistic回归进行相关因素的多因素分析。

结果

贵州省儿童青少年脊柱弯曲异常检出率为1.13%，喀斯特地貌高比例地区、低比例地区、间插区、非喀斯特地貌区儿童青少年脊柱弯曲异常检出率分别为1.10%，2.00%，0.90%，0.60%；其中喀斯特地貌低比例地区、间插区及非喀斯特地貌区女生脊柱弯曲异常检出率(2.40%，1.60%，0.90%)均高于男生(1.60%，0.10%，0.30%)(χ2值分别为12.66，112.69，30.22)，喀斯特地貌高比例地区、低比例地区、间插区和非喀斯特地貌区高中生脊柱弯曲异常检出率(2.00%，4.30%，1.40%，1.30%)均高于初中生(1.40%，3.20%，1.00%，0.60%)及小学生(0.70%，0.80%，0.60%，0.30%)(χ2值分别为306.11，175.80，14.24，39.57)(P值均 < 0.05)。多因素Logistic回归分析结果显示，喀斯特地貌高比例地区及低比例地区儿童青少年脊柱弯曲异常风险均高于非喀斯特地貌区[OR值(95%CI)分别为1.84(1.05~2.25)，1.60(1.23~2.09)，P值均 < 0.05]。

结论

贵州省儿童青少年脊柱弯曲异常检出率与喀斯特地貌分布有关，要加强筛查及积极采取适宜的综合干预措施。

, authors=卢秀娟, 李忻, 彭西英, 王转, 黄小丽, 张晓琴*, authorsList=卢秀娟, 李忻, 彭西英, 王转, 黄小丽, 张晓琴, authorCompany=null, correspAuthors=张晓琴, authorNote=

卢秀娟(1986-)，女，广西柳州人，硕士，副主任医师，主要从事学校卫生与健康影响因素监测工作

, correspAuthorsNote=
张晓琴，E-mail:
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卢秀娟(1986-)，女，广西柳州人，硕士，副主任医师，主要从事学校卫生与健康影响因素监测工作

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卢秀娟(1986-)，女，广西柳州人，硕士，副主任医师，主要从事学校卫生与健康影响因素监测工作

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Study on temporal and spatial variation chareteristics of spring climete change in different geomorphological types in Guizhou Province[D]. Guiyang: Guizhou Normal University, 2021. (in Chinese), articleTitle=null, refAbstract=null), Reference(id=1325521295525425866, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521264110088816, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=21, rfOrder=37, authorNames=null, journalName=null, refType=null, unstructuredReference=ZHUO T L, CHAO F G, JIONG L, et al. The role of endocrine hormones in the pathogenesis of adolescent idiopathic scoliosis[J]. FASEB J, 2021, 35(9): e21839., articleTitle=null, refAbstract=null), Reference(id=1325521295634477771, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521264110088816, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=38, authorNames=null, journalName=null, refType=null, unstructuredReference=韩雁, 胡玉环, 温晓飒, 等. 上海市闵行区中小学生脊柱弯曲异常现状分析[J]. 上海预防医学, 2024, 36(6): 574-578., articleTitle=null, refAbstract=null), Reference(id=1325521297341559500, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521264110088816, doi=null, pmid=null, pmcid=null, year=null, volume=null, issue=null, pageStart=null, pageEnd=null, url=null, language=null, rfNumber=22, rfOrder=39, authorNames=null, journalName=null, refType=null, unstructuredReference=HAN Y, HU Y H, WEN X S, et al. Analysis of the current situation of spinal curvature abnormalities among primary, middle, and high school students in Minhang District, Shanghai[J]. Shanghai J Prev Med, 2024, 36(6): 574-578. 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Comparison of the detection rates of abnormal spinal curvature in children and adolescents with different demographic characteristics in karst landform

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项统计值高比例地区低比例地区间插区非喀斯特地貌区
筛查人数检出人数筛查人数检出人数筛查人数检出人数筛查人数检出人数
性别男72 791827(1.10)8 823142(1.60)8 68411(0.10)11 05933(0.30)
女67 778780(1.20)7 733184(2.40)8 127133(1.60)9 88086(0.90)
χ2值0.0712.66112.6930.22
P值0.80< 0.01< 0.01< 0.01
学段小学78 831582(0.70)9 52872(0.80)9 84764(0.60)12 15842(0.30)
初中37 678538(1.40)4 305137(3.20)4 65648(1.00)5 87138(0.60)
高中24 060487(2.00)2 723117(4.30)2 30832(1.40)2 91039(1.30)
χ2值306.11175.8014.2439.57
P值< 0.01< 0.01< 0.01< 0.01
), ArticleFig(id=1325521277271814817, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521264110088816, language=CN, label=表1, caption=

不同人口学特征各喀斯特地貌地区儿童青少年脊柱弯曲异常检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项统计值高比例地区低比例地区间插区非喀斯特地貌区
筛查人数检出人数筛查人数检出人数筛查人数检出人数筛查人数检出人数
性别男72 791827(1.10)8 823142(1.60)8 68411(0.10)11 05933(0.30)
女67 778780(1.20)7 733184(2.40)8 127133(1.60)9 88086(0.90)
χ2值0.0712.66112.6930.22
P值0.80< 0.01< 0.01< 0.01
学段小学78 831582(0.70)9 52872(0.80)9 84764(0.60)12 15842(0.30)
初中37 678538(1.40)4 305137(3.20)4 65648(1.00)5 87138(0.60)
高中24 060487(2.00)2 723117(4.30)2 30832(1.40)2 91039(1.30)
χ2值306.11175.8014.2439.57
P值< 0.01< 0.01< 0.01< 0.01
), ArticleFig(id=1325521277594776226, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521264110088816, language=EN, label=Tab.2, caption=

Univariate analysis of abnormal spinal curvature in children and adolescents aged 6-18 years in Guizhou Province

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数脊柱弯曲异常χ2值P值
平时背书包习惯*
  双肩包背胸前11 204116(1.03)1.790.77
  双肩包背背后116 2731 198(1.03)
  双肩包背一侧4 60943(0.93)
  单肩背包3 73245(1.20)
  使用带轮书包1 00912(1.19)
书包重量*
  轻11 054111(1.00)1.740.88
  较轻26 524283(1.07)
  中等69 977710(1.01)
  较重19 948218(1.09)
  很重5 90056(0.95)
  没感觉3 42436(1.05)
班级座位左右轮换情况*
  是102 0341 073(1.05)1.300.27
  否34 793341(0.98)
床垫(床)柔软度*
  偏软13 493122(0.90)13.13< 0.01
  适中106 9741 160(1.08)
  偏硬16 360132(0.81)
平时对坐姿、站姿的自我要求*
  无所谓37 919368(0.97)5.480.14
  有时会监督自己53 403557(1.04)
  时常会提醒自己23 981277(1.16)
  时刻保持良好的姿势21 524212(0.98)
每天户外运动时长/h*
   < 295 133998(1.05)0.010.91
  ≥244 316462(1.04)
每周进行≥1 h高强度运动/d
  020 172196(0.97)1.200.27
  ≥1119 7561 265(1.06)
每天室内静坐时长/h*
   < 10119 0801 257(1.06)4.410.04
  ≥1017 747157(0.88)
BMI/(kg·m-2)
   < 18.5108 3651 103(1.02)52.30< 0.01
  18.5~23.968 054925(1.36)
  ≥24.018 456168(0.91)
地貌分布
  喀斯特高比例地区140 5691 607(1.14)39.68< 0.01
  喀斯特低比例地区16 556326(1.97)
  间插区16 811144(0.86)
  非喀斯特地貌区20 939119(0.57)
), ArticleFig(id=1325521279608042147, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325521264110088816, language=CN, label=表2, caption=

贵州省6~18岁儿童青少年脊柱弯曲异常的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量人数脊柱弯曲异常χ2值P值
平时背书包习惯*
  双肩包背胸前11 204116(1.03)1.790.77
  双肩包背背后116 2731 198(1.03)
  双肩包背一侧4 60943(0.93)
  单肩背包3 73245(1.20)
  使用带轮书包1 00912(1.19)
书包重量*
  轻11 054111(1.00)1.740.88
  较轻26 524283(1.07)
  中等69 977710(1.01)
  较重19 948218(1.09)
  很重5 90056(0.95)
  没感觉3 42436(1.05)
班级座位左右轮换情况*
  是102 0341 073(1.05)1.300.27
  否34 793341(0.98)
床垫(床)柔软度*
  偏软13 493122(0.90)13.13< 0.01
  适中106 9741 160(1.08)
  偏硬16 360132(0.81)
平时对坐姿、站姿的自我要求*
  无所谓37 919368(0.97)5.480.14
  有时会监督自己53 403557(1.04)
  时常会提醒自己23 981277(1.16)
  时刻保持良好的姿势21 524212(0.98)
每天户外运动时长/h*
   < 295 133998(1.05)0.010.91
  ≥244 316462(1.04)
每周进行≥1 h高强度运动/d
  020 172196(0.97)1.200.27
  ≥1119 7561 265(1.06)
每天室内静坐时长/h*
   < 10119 0801 257(1.06)4.410.04
  ≥1017 747157(0.88)
BMI/(kg·m-2)
   < 18.5108 3651 103(1.02)52.30< 0.01
  18.5~23.968 054925(1.36)
  ≥24.018 456168(0.91)
地貌分布
  喀斯特高比例地区140 5691 607(1.14)39.68< 0.01
  喀斯特低比例地区16 556326(1.97)
  间插区16 811144(0.86)
  非喀斯特地貌区20 939119(0.57)
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贵州喀斯特地貌地区儿童青少年脊柱弯曲异常流行特征
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卢秀娟 , 李忻 , 彭西英 , 王转 , 黄小丽 , 张晓琴 *
中国学校卫生 | 疾病控制 2025,46(7): 1046-1050
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中国学校卫生 |疾病控制 2025 , 46 (7) : 1046 -1050
贵州喀斯特地貌地区儿童青少年脊柱弯曲异常流行特征
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卢秀娟, 李忻, 彭西英, 王转, 黄小丽, 张晓琴*
作者信息
  • 贵州省疾病预防控制中心学校卫生科，贵阳 550004
通讯作者:
张晓琴，E-mail:
作者简介:

卢秀娟(1986-)，女，广西柳州人，硕士，副主任医师，主要从事学校卫生与健康影响因素监测工作

Epidemiological characteristics of spinal curvature abnormalities in children and adolescents in Karst landform in Guizhou Province
Xiujuan LU, Xin LI, Xiying PENG, Zhuan WANG, Xiaoli HUANG, Xiaoqin ZHANG*
Affiliations
  • Department of School Health, Guizhou Center for Disease Control and Prevention, Guiyang 550004, Guizhou Province, China
出版时间: 2025-07-25 doi: 10.16835/j.cnki.1000-9817.2025204
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摘要
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目的

了解贵州省不同喀斯特地貌地区6~18岁儿童青少年脊柱弯曲异常流行特征，为针对性开展综合干预提供科学依据。

方法

于2023年9—12月，采用分层随机整群抽样的方法，根据贵州省喀斯特地貌面积比例，在贵州省9个市(州)所有县(区)抽取6~18岁儿童青少年194 875名开展脊柱弯曲异常筛查，并抽取小学四年级及以上共139 449名学生开展问卷调查，采用二元Logistic回归进行相关因素的多因素分析。

结果

贵州省儿童青少年脊柱弯曲异常检出率为1.13%，喀斯特地貌高比例地区、低比例地区、间插区、非喀斯特地貌区儿童青少年脊柱弯曲异常检出率分别为1.10%，2.00%，0.90%，0.60%；其中喀斯特地貌低比例地区、间插区及非喀斯特地貌区女生脊柱弯曲异常检出率(2.40%，1.60%，0.90%)均高于男生(1.60%，0.10%，0.30%)(χ2值分别为12.66，112.69，30.22)，喀斯特地貌高比例地区、低比例地区、间插区和非喀斯特地貌区高中生脊柱弯曲异常检出率(2.00%，4.30%，1.40%，1.30%)均高于初中生(1.40%，3.20%，1.00%，0.60%)及小学生(0.70%，0.80%，0.60%，0.30%)(χ2值分别为306.11，175.80，14.24，39.57)(P值均 < 0.05)。多因素Logistic回归分析结果显示，喀斯特地貌高比例地区及低比例地区儿童青少年脊柱弯曲异常风险均高于非喀斯特地貌区[OR值(95%CI)分别为1.84(1.05~2.25)，1.60(1.23~2.09)，P值均 < 0.05]。

结论

贵州省儿童青少年脊柱弯曲异常检出率与喀斯特地貌分布有关，要加强筛查及积极采取适宜的综合干预措施。

脊柱弯曲  /  流行病学研究  /  回归分析  /  儿童  /  青少年
Objective

To understand the epidemiological characteristics of abnormalities spinal curvature among children and adolescents in Karst landform in Guizhou Province, so as to provide a scientific basis for targeted comprehensive intervention.

Methods

From September to December 2023, 194 875 children and adolescents aged 6-18 were selected from all countieldistricts of 9 cities (prefectures) in Guizhou Province by stratified random cluster sampling method according to the proportion of Karst landform area in Guizhou Province for carrying out spinal curvature abnormality screening, and a questionnaire survey was conducted on 139 449 students in the fourth grade and above of primary school. Binary Logistic regression was used for multivariate analysis.

Results

The detection rate of abnormal spinal curvature among children and adolescents aged 6-18 in Guizhou Province was 1.13%. The detection rates of abnormal spinal curvature in areas with a high proportion of Karst landform, areas with a low proportion of Karst landform, intercalation areas, and non-Karst landform areas were 1.10%, 2.00%, 0.90%, and 0.60%, respectively. Among them, the detection rates of abnormal spinal curvature in female students (2.40%, 1.60%, 0.90%) in areas with a low proportion of Karst landform, intercalation areas and non-Karst landform were higher than those in male students (1.60%, 0.10%, 0.30) (χ2=12.66, 112.69, 30.22, all P < 0.05). The detection rates of abnormal spinal curvature among senior high school students (2.00%, 4.30%, 1.40%, 1.30%) in different Karst landform distributions were successively higher than those among junior high school students (1.40%, 3.20%, 1.00%, 0.60%) and primary school students (0.70%, 0.80%, 0.60%, 0.30%) (χ2=306.11, 175.80, 14.24, 39.57, all P < 0.05). The results of multivariate Logistic regression analysis showed that the detection rates of abnormal spinal curvature in both high-proportion and low-proportion Karst landform areas were higher than those in non-Karst landform areas [OR(95%CI)=1.84(1.05-2.25), 1.60(1.23-2.09), both P < 0.05].

Conclusion

The detection rate of abnormal spinal curvature in children and adolescents aged 6-18 in Guizhou Province is related to the distribution of Karst landform, so it is necessary to strengthen screening and appropriate comprehensive interventions.

Spinal curvatures  /  Epidemiologic studies  /  Regression analysis  /  Child  /  Adolescent
卢秀娟, 李忻, 彭西英, 王转, 黄小丽, 张晓琴. 贵州喀斯特地貌地区儿童青少年脊柱弯曲异常流行特征. 中国学校卫生, 2025 , 46 (7) : 1046 -1050 . DOI: 10.16835/j.cnki.1000-9817.2025204
Xiujuan LU, Xin LI, Xiying PENG, Zhuan WANG, Xiaoli HUANG, Xiaoqin ZHANG. Epidemiological characteristics of spinal curvature abnormalities in children and adolescents in Karst landform in Guizhou Province[J]. Chinese Journal of School Health, 2025 , 46 (7) : 1046 -1050 . DOI: 10.16835/j.cnki.1000-9817.2025204
正文
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健康与环境息息相关，喀斯特地貌作为中国四大生态环境敏感区之一，其复杂的地质结构、多变的地貌类型以及特殊的气候条件[1]，对人体健康有着不可忽视的影响。近年来，儿童青少年脊柱弯曲异常患病率呈现出逐渐上升趋势，已与近视、肥胖并列为三大学生常见病[2]。目前有众多学者针对不同地区[3-6]、不同人群[7]开展了大量的研究，表明脊柱弯曲异常的发生与多种因素有关，包括遗传因素、生长发育因素、生活方式等。本次研究对贵州省喀斯特地貌地区6~18岁儿童青少年脊柱弯曲异常流行特征开展分析，拟从医学地理学研究角度，为制定适合该地区的针对性预防和干预措施提供科学依据，从而有效保障儿童青少年的脊柱健康。
1　对象与方法
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1.1　对象
根据贵州省喀斯特地貌面积比例分布[8]，将全省各县(区)分别划分为喀斯特高比例地区(>60%)、低比例地区(< 50%~60%)、喀斯特与非喀斯特地貌间插区(以下简称“间插区”)(25%~50%)、非喀斯特地貌区(< 25%)。采用分层随机整群抽样方法，于2023年9—12月在贵州省9个市(州)所有县(区)开展调查，其中每个市(州)城区随机抽取6所学校(2所小学、2所初中、2所普通高中)，每个郊县随机抽取5所学校(2所小学、2所初中、1所普通高中)。每所学校各年级随机抽取2个及以上班级，确保每个年级至少80人，被抽取班级全体学生作为调查对象，共调查194 875名学生，其中男生101 357名，女生93 518名；并从中抽取小学四年级以上学生开展问卷调查，共发放问卷140 662份，收回有效问卷139 449份，有效回收率为99.1%。本次调查已取得贵州省疾病预防控制中心医学研究伦理委员会批准(Q2024—04)，所有调查对象均签署知情同意书。
1.2　方法
1.2.1　体格检查
由经过统一培训并考核合格的专业骨科或社区全科医生，按照《儿童青少年脊柱弯曲异常防控技术指南》[2]开展脊柱弯曲异常筛查，包括脊柱侧弯和脊柱前后弯曲异常检查，其中脊柱侧弯异常检查包括一般检查前屈试验(Adam's试验)、躯干旋转测量仪(健升ATR-2)检查及脊柱运动试验；脊柱前后弯曲异常检查包括一般检查、俯卧试验。脊柱侧弯异常结果评定：一般检查异常或前屈试验阳性或脊柱运动试验后进行躯干旋转测量仪检查躯干旋转角度(angle of trunk rotation, ATR)≥5°；脊柱前后弯曲异常结果评定：脊柱侧面检查有脊柱前凸或后凸体征，且俯卧试验为阳性者，视为脊柱前凸或后凸异常。按照《学生健康检查技术规范》(GB/T 26343—2010)[9]方法测量儿童青少年身高、体重，并计算体质量指数(body mass index，BMI)=体重(kg)/[身高(m)]2。按照《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)[10]将BMI < 18.5 kg/m2判定为消瘦，18.5~23.9 kg/m2判定为正常，≥24.0 kg/m2判定为超重。
1.2.2　问卷调查
由学校教师组织学生利用计算机课，指导学生登录“贵州省学生近视防控与常见病检查系统”自行填写《全国学生常见病和健康影响因素监测与干预工作手册》[11]中的《学生健康状况及影响因素调查表》及《学生视力不良、脊柱弯曲异常及影响因素专项调查表》，调查内容包括人口学特征、平时背书包习惯及书包重量、班级座位左右轮换情况、床垫(床)柔软度、平时对坐姿及站姿的自我要求、每天户外运动时长、每周进行≥1 h高强度运动的天数、每天室内静坐时长等。问卷的Cronbach α系数为0.90，KMO值为0.86。
1.3　质量控制
所有检测人员均需经过严格的培训及考核，统一检测方法，按照统一的标准流程开展。调查当天，随机抽取5%的比例开展核查，重点对体检及问卷数据逻辑、异常值等数据进行核查，确保数据质量。
1.4　统计学分析
由“贵州省学生近视防控与常见病检查系统”自动生成数据库，采用SPSS 23.0软件对数据进行分析，两组间比较采用χ2检验，有序多分类资料的组间比较采用趋势χ2检验，儿童青少年脊柱弯曲异常的相关因素采用二元Logistic回归模型分析，检验水准α=0.05。
2　结果
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2.1　儿童青少年脊柱弯曲异常检出情况
调查共筛查出脊柱弯曲异常2 196人，检出率为1.13%，其中脊柱侧弯异常2 083人，检出率1.07%；脊柱前后弯曲异常113人(脊柱前凸6人，脊柱后凸107人)，检出率为5.1%。女生脊柱弯曲异常检出率(1.30%，1 183/93 518)高于男生(1.00%，1 013/101 357)；高中生(2.10%，675/32 001)高于初中生(1.40%，761/52 510)和小学生(0.70%，760/110 364)，城区学生(1.40%，456/31 907)高于郊县学生(1.10%，1 740/162 968)，差异均有统计学意义(χ2值分别为30.79，515.65，31.29，P值均 < 0.01)。
2.2　不同喀斯特地貌地区儿童青少年脊柱弯曲异常检出情况
喀斯特地貌高比例地区儿童青少年脊柱弯曲异常检出1 607人，检出率为1.10%；低比例地区检出326人，检出率为2.00%；间插区检出144人，检出率0.90%；非喀斯特地貌区检出119人，检出率为0.60%，各组间比较差异有统计学意义(χ2=39.68，P < 0.01)。且喀斯特地貌低比例地区、间插区及非喀斯特地貌女生脊柱弯曲异常检出率均高于男生，差异均有统计学意义(P值均 < 0.01)；不同喀斯特地貌及非喀斯特地貌的高中生脊柱弯曲异常率均高于初中生及小学生，差异均有统计学意义(P值均 < 0.01)。见表1。
2.3　儿童青少年脊柱弯曲异常相关因素的单因素分析
见表2。
结果显示，床垫(床)柔软度、每天室内静坐时长、BMI及地貌分布均是儿童青少年脊柱弯曲异常检出率的相关因素，组间差异均有统计学意义(P值均 < 0.05)。
2.4　喀斯特地貌分布与儿童青少年脊柱弯曲异常的关系
以学生是否检出脊柱弯曲异常为因变量(否=0，是=1)，在控制性别、学段、地区、床垫(床)柔软度、每天室内静坐时长及BMI后，Logistic回归分析结果显示，与非喀斯特地貌区比较，喀斯特高比例地区、喀斯特低比例地区儿童青少年脊柱弯曲异常检出率均较高[OR值(95%CI)分别为1.84(1.05~2.25)，1.60(1.23~2.09)，P值均 < 0.05]。
3　讨论
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本次调查结果显示，贵州省儿童青少年脊柱弯曲异常检出率为1.13%，低于2019年全国平均水平[2](2.80%)及四川[5](2022年检出率3.42%)、内蒙古[12](2021年检出率2.14%)等地，且主要表现为脊柱弯曲异常，与许馨文等[4]的研究结果一致。提示要加强贵州省6~18岁儿童青少年脊柱弯曲异常筛查，重点关注脊柱弯曲的筛查和健康管理，做到早发现、早干预、早治疗。女生脊柱弯曲异常检出率高于男生，高中生高于初中生和小学生，城区学生高于郊县学生，与曾婕等[5]的研究结果一致。
调查发现，喀斯特地貌高比例地区、低比例地区儿童青少年脊柱弯曲异常检出率均高于非喀斯特地貌区，可能与喀斯特地区饮用水及食物中氟含量相关。有研究发现，喀斯特地貌区水中氟化物[13]及食物中如大米、玉米、马铃薯等氟含量[14]均高于非喀斯特地貌区。适量的氟在人体生长和发育过程中起到积极作用，氟过量则会引发氟中毒[15]。有研究表明，低浓度过量氟化物诱导骨髓间充质干细胞凋亡的作用不明显；中浓度过量氟化物可抑制骨髓间充质干细胞凋亡；而长期摄入高浓度过量氟可诱导骨髓间充质干细胞凋亡[16]，导致骨吸收增强伴骨密度下降，引起骨相损害[17]，而脊柱弯曲与骨吸收率增高和骨密度降低有关[18-19]。此外，也有可能与不同地貌形成的气候条件有关。充足的日照可使皮肤中7-脱氢醛固醇转化为维生素D，从而促进儿童青少年体内钙和磷的吸收，促使骨骼生长。人体所需的维生素D，90%来源于日照，有学者在研究贵州省不同地貌类型春季气候的时空变化特征时发现，非喀斯特地貌区日照时数的上升速率总体高于喀斯特地貌区[20]。提示要关注喀斯特地貌分布对儿童青少年脊柱弯曲异常的影响，加强喀斯特地貌高比例及低比例地区儿童青少年脊柱弯曲异常，特别是脊柱侧弯的早期筛查，因地制宜地采取综合干预措施。
本次研究还发现喀斯特低比例地区、间插区及非喀斯特地貌女生脊柱弯曲异常检出率均高于男生。可能与女性的激素分泌水平有关，有研究表明，多种激素包括雌激素、褪黑素、生长激素、瘦素、脂联素等异常水平与脊柱弯曲的发生、发展有关[21]。提示儿童青少年阶段女生是脊柱弯曲异常的重点关注人群。其次还发现，不同喀斯特地貌分布中高中生脊柱弯曲异常率均高于初中生及小学生。可能由于儿童青少年生长发育阶段身体增长速度较快，脊柱周围的肌肉韧带发育不成熟，容易造成腰背部肌肉受损[22]。提示脊柱弯曲异常的筛查及干预重点人群为高中生和初中生，且必须要从小学抓起，及早采取适宜干预措施，降低脊柱弯曲异常发生风险。
本研究也存在一定的局限性：缺乏儿童青少年饮食等相关因素调查；缺乏不同喀斯特地貌区与脊柱弯曲异常相关的内外暴露物质的检测分析，无法排除其他因素的混杂干扰，需要在今后的研究中进一步明确。
基金
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  • 贵州省卫生健康委科学技术基金项目(gzwkj2021-418)
文献
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2025年第46卷第7期
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doi: 10.16835/j.cnki.1000-9817.2025204
  • 接收时间：2025-02-20
  • 首发时间：2026-11-06
  • 出版时间：2025-07-25
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  • 收稿日期：2025-02-20
  • 修回日期：2025-05-27
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贵州省卫生健康委科学技术基金项目(gzwkj2021-418)
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    贵州省疾病预防控制中心学校卫生科，贵阳 550004

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张晓琴，E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
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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