Article(id=1325532274078535707, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325531848021140417, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025340, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1751385600000, receivedDateStr=2025-07-02, revisedDate=1755100800000, revisedDateStr=2025-08-14, acceptedDate=null, acceptedDateStr=null, onlineDate=1793961121338, onlineDateStr=2026-11-06, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793961121338, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793961121338, creator=13701087609, updateTime=1793961121338, updator=13701087609, issue=Issue{id=1325531848021140417, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='11', pageStart='1521', pageEnd='1672', issueExtLink='null', onlineDate='null', pubDate='1764000000000', pubDateStr='2025-11-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793961019759, creator='13701087609', updateTime=1793961019759, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1544, endPage=1548, ext={EN=ArticleExt(id=1325532279677931549, articleId=1325532274078535707, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association of participation in non-sports extracurricular tutoring classes with screening myopia and axial length among primary school students, columnId=1325532060311638890, journalTitle=Chinese Journal of School Health, columnName=Column on Learning Environment and Student Health, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the association of participation in non-sports extracurricular tutoring classes with the prevalence of screening myopia, axial length (AL) and axial length to corneal radius ratio (AL/CR) among primary school students, so as to provide evidences for formulating myopia prevention and control policies.

Methods

In December 2024, combination of convenience and cluster sampling method was used to select 2 273 students from two primary schools in Hefei City, Anhui Province. Ophthalmic examinations and questionnaire surveys were conducted to obtain information on myopia, AL, AL/CR and participation in various types of extracurricular tutoring. A binary Logistic regression model was used to analyze the association between non-sports tutoring and screening myopia, and multiple linear regression models were used to examine the associations between non-sports tutoring and AL and AL/CR.

Results

Among the surveyed students, the participation rate in non-sports extracurricular tutoring classes was 64.9%, and the overall prevalence of screening myopia was 39.1%. The average AL and AL/CR were (23.60±1.01) mm and (3.00±0.12), respectively. Univariate analysis showed that students who attended non-sports, music, or academic tutoring classes for ≥2 h per week had higher risks of screening myopia and greater AL/CR values than non-participants (screening myopia: OR=1.38, 1.82, 1.55; AL/CR: β=0.01, 0.03, 0.03; all P < 0.05). After adjusting for sex, grade, and participation in sports tutoring, multivariate analysis indicated that participation in non-sports and musical instrument tutoring classes for ≥2 h per week remained significantly associated with higher risks of screening myopia (OR=1.26, 1.49, both P < 0.05). Multiple linear regression showed that participation in musical instrument tutoring for ≥2 h per week was positively correlated with AL (β=0.14, P < 0.05).

Conclusion

s Participation in non-sports extracurricular tutoring is common among primary school students. Attending non-sports tutoring classes for ≥2 h per week increases the risk of screening myopia.

, authors=Yuan YAO1, Shaojun XU2, Yu SU3, Liping WANG4, Yaxin ZHANG2, Jing WU5, Yuting WANG5, Haifeng PAN*, 1, Guoping CHEN*, 1, 5, authorsList=Yuan YAO, Shaojun XU, Yu SU, Liping WANG, Yaxin ZHANG, Jing WU, Yuting WANG, Haifeng PAN, Guoping CHEN, authorCompany=null, correspAuthors=Haifeng PAN, Guoping CHEN, 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=1325532287286399006, articleId=1325532274078535707, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=非体育类校外辅导与小学生筛查性近视及眼轴长度的关联, columnId=1325532062874358636, journalTitle=中国学校卫生, columnName=学习生活环境与学生健康专栏, runingTitle=null, highlight=null, articleAbstract=
目的

分析参加非体育类校外辅导与小学生筛查性近视发生及眼轴长度(AL)、轴率比(AL/CR)的关联,为制定学生近视防控政策提供依据。

方法

于2024年12月采用方便与整群抽样相结合的方法抽取安徽省合肥市2所普通小学的全体2 273名学生进行眼科检查和问卷调查,获取学生近视、AL、AL/CR及各类型校外辅导情况。采用二元Logistic回归和多元线性回归模型分别分析参加非体育类校外辅导与小学生筛查性近视、AL、AL/CR的关联。

结果

小学生非体育类校外辅导班参与率为64.9%,总体筛查性近视率为39.1%。学生AL平均为(23.60±1.01)mm,AL/CR为(3.00±0.12)。单因素分析结果显示,每周参加非体育类、乐器类、文化课类校外辅导≥2 h的学生筛查性近视发生风险(OR值分别为1.38,1.82,1.55)及AL/CR(β值分别为0.01,0.03,0.03)均高于未参加者(P值均 < 0.05)。将性别、年级、参加体育类校外辅导等作为协变量,多因素Logistic回归分析结果显示,每周参加非体育类和乐器类校外辅导≥2 h的小学生筛查性近视发生风险较高(OR值分别为1.26,1.49);多元线性回归模型显示,每周参加乐器类校外辅导≥2 h与小学生AL呈正相关(β=0.14)(P值均 < 0.05)。

结论

小学生参加非体育类校外辅导现象普遍,每周参加非体育类校外辅导≥2 h增加小学生筛查性近视发生风险。

, authors=姚远1, 许韶君2, 苏娱3, 王莉萍4, 张亚新2, 吴静5, 王宇婷5, 潘海峰*, 1, 陈国平*, 1, 5, authorsList=姚远, 许韶君, 苏娱, 王莉萍, 张亚新, 吴静, 王宇婷, 潘海峰, 陈国平, authorCompany=null, correspAuthors=潘海峰, 陈国平, authorNote=

姚远(2001-),男,安徽阜阳人,在读硕士,主要研究方向为儿童青少年卫生

, correspAuthorsNote=
潘海峰,E-mail:
陈国平,E-mail:
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Association of piano playing with myopia among primary and secondary school students in Shanghai in 2021: a cross-sectional survey[J]. Chin J Public Health, 2024, 40(7): 835-839. 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Comparison of AL and AL/CR among primary school students of different genders and grades(x±s)

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性别与年级选项人数统计值眼轴/mm轴率比
性别男1 19623.83±0.993.01±0.12
女1 07723.35±0.983.00±0.12
t值11.512.36
P值< 0.010.02
年级一31822.81±0.742.91±0.08
二40723.13±0.802.95±0.08
三40223.44±0.842.98±0.10
四40123.77±0.943.03±0.11
五39624.05±0.973.06±0.11
六34924.34±0.953.09±0.12
F值149.69156.78
P值< 0.01< 0.01
), ArticleFig(id=1325532353531236454, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532274078535707, language=CN, label=表1, caption=

不同性别年级小学生眼轴及轴率比比较(x±s)

, figureFileSmall=null, figureFileBig=null, tableContent=
性别与年级选项人数统计值眼轴/mm轴率比
性别男1 19623.83±0.993.01±0.12
女1 07723.35±0.983.00±0.12
t值11.512.36
P值< 0.010.02
年级一31822.81±0.742.91±0.08
二40723.13±0.802.95±0.08
三40223.44±0.842.98±0.10
四40123.77±0.943.03±0.11
五39624.05±0.973.06±0.11
六34924.34±0.953.09±0.12
F值149.69156.78
P值< 0.01< 0.01
), ArticleFig(id=1325532356052013160, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532274078535707, language=EN, label=Tab.2, caption=

Multivariate Logistic regression analysis of primary school students' participation in non-sports extracurricular tutoring and screening-detected myopia (n=2 273)

, figureFileSmall=null, figureFileBig=null, tableContent=
校外辅导类型每周辅导时间/h模型1模型2
OR值(95%CI)P值OR值(95%CI)P值
非体育类未参加1.001.00
>0~ < 21.07(0.81~1.41)0.641.25(0.92~1.71)0.15
≥ 21.38(1.15~1.66)< 0.011.26(1.02~1.55)0.03
乐器类未参加1.001.00
>0~ < 20.78(0.56~1.09)0.140.80(0.56~1.14)0.22
≥ 21.82(1.36~2.43)< 0.011.49(1.08~2.06)0.01
文化课类未参加1.001.00
>0~ < 21.13(0.82~1.56)0.441.11(0.78~1.56)0.57
≥ 21.55(1.28~1.89)< 0.011.11(0.89~1.38)0.35
), ArticleFig(id=1325532357637460073, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532274078535707, language=CN, label=表2, caption=

小学生参加非体育类校外辅导班与筛查性近视的多因素Logistic回归分析(n=2 273)

, figureFileSmall=null, figureFileBig=null, tableContent=
校外辅导类型每周辅导时间/h模型1模型2
OR值(95%CI)P值OR值(95%CI)P值
非体育类未参加1.001.00
>0~ < 21.07(0.81~1.41)0.641.25(0.92~1.71)0.15
≥ 21.38(1.15~1.66)< 0.011.26(1.02~1.55)0.03
乐器类未参加1.001.00
>0~ < 20.78(0.56~1.09)0.140.80(0.56~1.14)0.22
≥ 21.82(1.36~2.43)< 0.011.49(1.08~2.06)0.01
文化课类未参加1.001.00
>0~ < 21.13(0.82~1.56)0.441.11(0.78~1.56)0.57
≥ 21.55(1.28~1.89)< 0.011.11(0.89~1.38)0.35
), ArticleFig(id=1325532359248072810, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532274078535707, language=EN, label=Tab.3, caption=

Multiple linear regression analysis of primary school students' participation in non-sports extracurricular tutoring on AL and AL/CR[β(95%CI), n=2 273]

, figureFileSmall=null, figureFileBig=null, tableContent=
校外辅导类型每周辅导时间/h眼轴轴率比
模型1模型2模型1模型2
非体育类>0~ < 2-0.07(-0.21~0.06)0.04(-0.08~0.15)0.00(-0.02~0.02)0.01(-0.00~0.02)
≥ 20.04(-0.05~0.13)0.03(-0.05~0.11)0.01(0.00~0.03)*0.01(-0.00~0.02)
乐器类>0~ < 2-0.16(-0.32~-0.01)*-0.06(-0.19~0.07)-0.00(-0.02~0.01)0.00(-0.01~0.02)
≥ 20.19(0.04~0.33)*0.14(0.02~0.26)*0.03(0.01~0.04)**0.01(-0.00~0.03)
文化课类>0~ < 20.03(-0.13~0.18)-0.02(-0.15~0.11)0.00(-0.02~0.02)-0.00(-0.02~0.01)
≥ 20.25(0.16~0.35)**0.05(-0.03~0.14)0.03(0.02~0.04)**0.01(-0.00~0.02)
), ArticleFig(id=1325532360921600107, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532274078535707, language=CN, label=表3, caption=

小学生参加非体育类校外辅导班与眼轴及轴率比的多元线性回归分析[β值(95%CI),n=2 273]

, figureFileSmall=null, figureFileBig=null, tableContent=
校外辅导类型每周辅导时间/h眼轴轴率比
模型1模型2模型1模型2
非体育类>0~ < 2-0.07(-0.21~0.06)0.04(-0.08~0.15)0.00(-0.02~0.02)0.01(-0.00~0.02)
≥ 20.04(-0.05~0.13)0.03(-0.05~0.11)0.01(0.00~0.03)*0.01(-0.00~0.02)
乐器类>0~ < 2-0.16(-0.32~-0.01)*-0.06(-0.19~0.07)-0.00(-0.02~0.01)0.00(-0.01~0.02)
≥ 20.19(0.04~0.33)*0.14(0.02~0.26)*0.03(0.01~0.04)**0.01(-0.00~0.03)
文化课类>0~ < 20.03(-0.13~0.18)-0.02(-0.15~0.11)0.00(-0.02~0.02)-0.00(-0.02~0.01)
≥ 20.25(0.16~0.35)**0.05(-0.03~0.14)0.03(0.02~0.04)**0.01(-0.00~0.02)
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非体育类校外辅导与小学生筛查性近视及眼轴长度的关联
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姚远 1 , 许韶君 2 , 苏娱 3 , 王莉萍 4 , 张亚新 2 , 吴静 5 , 王宇婷 5 , 潘海峰 *, 1 , 陈国平 *, 1, 5
中国学校卫生 | 学习生活环境与学生健康专栏 2025,46(11): 1544-1548
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中国学校卫生 |学习生活环境与学生健康专栏 2025 , 46 (11) : 1544 -1548
非体育类校外辅导与小学生筛查性近视及眼轴长度的关联
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姚远1, 许韶君2, 苏娱3, 王莉萍4, 张亚新2, 吴静5, 王宇婷5, 潘海峰*, 1 , 陈国平*, 1, 5
作者信息
  • 1安徽医科大学公共卫生学院流行病与卫生统计学系,合肥 230032
  • 2安徽医科大学公共卫生学院儿少卫生与妇幼保健学系
  • 3安徽省妇女儿童医学中心眼科
  • 4合肥市蜀山区疾病预防控制中心学校卫生与食品卫生科
  • 5安徽省疾病预防控制中心儿童青少年健康所
通讯作者:
潘海峰,E-mail:
陈国平,E-mail:
作者简介:

姚远(2001-),男,安徽阜阳人,在读硕士,主要研究方向为儿童青少年卫生

Association of participation in non-sports extracurricular tutoring classes with screening myopia and axial length among primary school students
Yuan YAO1, Shaojun XU2, Yu SU3, Liping WANG4, Yaxin ZHANG2, Jing WU5, Yuting WANG5, Haifeng PAN*, 1 , Guoping CHEN*, 1, 5
Affiliations
  • 1Department of Epidemiology and Health Statistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui Province, China
出版时间: 2025-11-25 doi: 10.16835/j.cnki.1000-9817.2025340
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目的

分析参加非体育类校外辅导与小学生筛查性近视发生及眼轴长度(AL)、轴率比(AL/CR)的关联,为制定学生近视防控政策提供依据。

方法

于2024年12月采用方便与整群抽样相结合的方法抽取安徽省合肥市2所普通小学的全体2 273名学生进行眼科检查和问卷调查,获取学生近视、AL、AL/CR及各类型校外辅导情况。采用二元Logistic回归和多元线性回归模型分别分析参加非体育类校外辅导与小学生筛查性近视、AL、AL/CR的关联。

结果

小学生非体育类校外辅导班参与率为64.9%,总体筛查性近视率为39.1%。学生AL平均为(23.60±1.01)mm,AL/CR为(3.00±0.12)。单因素分析结果显示,每周参加非体育类、乐器类、文化课类校外辅导≥2 h的学生筛查性近视发生风险(OR值分别为1.38,1.82,1.55)及AL/CR(β值分别为0.01,0.03,0.03)均高于未参加者(P值均 < 0.05)。将性别、年级、参加体育类校外辅导等作为协变量,多因素Logistic回归分析结果显示,每周参加非体育类和乐器类校外辅导≥2 h的小学生筛查性近视发生风险较高(OR值分别为1.26,1.49);多元线性回归模型显示,每周参加乐器类校外辅导≥2 h与小学生AL呈正相关(β=0.14)(P值均 < 0.05)。

结论

小学生参加非体育类校外辅导现象普遍,每周参加非体育类校外辅导≥2 h增加小学生筛查性近视发生风险。

课外辅导  /  近视  /  眼轴长度  /  回归分析  /  学生
Objective

To analyze the association of participation in non-sports extracurricular tutoring classes with the prevalence of screening myopia, axial length (AL) and axial length to corneal radius ratio (AL/CR) among primary school students, so as to provide evidences for formulating myopia prevention and control policies.

Methods

In December 2024, combination of convenience and cluster sampling method was used to select 2 273 students from two primary schools in Hefei City, Anhui Province. Ophthalmic examinations and questionnaire surveys were conducted to obtain information on myopia, AL, AL/CR and participation in various types of extracurricular tutoring. A binary Logistic regression model was used to analyze the association between non-sports tutoring and screening myopia, and multiple linear regression models were used to examine the associations between non-sports tutoring and AL and AL/CR.

Results

Among the surveyed students, the participation rate in non-sports extracurricular tutoring classes was 64.9%, and the overall prevalence of screening myopia was 39.1%. The average AL and AL/CR were (23.60±1.01) mm and (3.00±0.12), respectively. Univariate analysis showed that students who attended non-sports, music, or academic tutoring classes for ≥2 h per week had higher risks of screening myopia and greater AL/CR values than non-participants (screening myopia: OR=1.38, 1.82, 1.55; AL/CR: β=0.01, 0.03, 0.03; all P < 0.05). After adjusting for sex, grade, and participation in sports tutoring, multivariate analysis indicated that participation in non-sports and musical instrument tutoring classes for ≥2 h per week remained significantly associated with higher risks of screening myopia (OR=1.26, 1.49, both P < 0.05). Multiple linear regression showed that participation in musical instrument tutoring for ≥2 h per week was positively correlated with AL (β=0.14, P < 0.05).

Conclusion

s Participation in non-sports extracurricular tutoring is common among primary school students. Attending non-sports tutoring classes for ≥2 h per week increases the risk of screening myopia.

Extracurricular tutoring  /  Myopia  /  Axial length  /  Regression analysis  /  Students
姚远, 许韶君, 苏娱, 王莉萍, 张亚新, 吴静, 王宇婷, 潘海峰, 陈国平. 非体育类校外辅导与小学生筛查性近视及眼轴长度的关联. 中国学校卫生, 2025 , 46 (11) : 1544 -1548 . DOI: 10.16835/j.cnki.1000-9817.2025340
Yuan YAO, Shaojun XU, Yu SU, Liping WANG, Yaxin ZHANG, Jing WU, Yuting WANG, Haifeng PAN, Guoping CHEN. Association of participation in non-sports extracurricular tutoring classes with screening myopia and axial length among primary school students[J]. Chinese Journal of School Health, 2025 , 46 (11) : 1544 -1548 . DOI: 10.16835/j.cnki.1000-9817.2025340
近年来,全球近视患病率显著增加,预计2050年近视人口将近50亿[1]。我国儿童青少年近视呈现低龄化趋势,2022年总体近视率为51.9%,小学生为36.7%[2],已成为重要公共卫生问题。环境因素在近视发生中起主导作用,长时间近距离用眼和户外活动不足是近视的独立危险因素[3-4]。非体育类校外辅导增加学生室内近距离用眼、减少户外活动时间[5],可能与近视有关。因此,本研究调查安徽省小学生校外辅导班参与及视力状况,探究非体育类校外辅导班与小学生筛查性近视率及眼轴长度(axial length, AL)、轴率比(axial length corneal radius, AL/CR)的关联,为“双减”政策下近视精准防控提供依据。
于2024年12月根据地理位置及调查可行性,采用方便抽样方法选取安徽省合肥市2所普通小学,以学校全体在校生为调查对象。所选学校办学条件与当地多数小学一致,学生主要来自无特殊教育资源倾斜、无显著外来务工子女集中或高收入家庭聚集的社区。对所有在读学生进行视力检查和问卷调查,排除患常见眼病、智力障碍及无法配合者,共2 383名小学生参与调查。剔除未填写完整、存在逻辑错误等无效问卷后,纳入有效问卷2 273份,有效率为95.4%。其中男生1 196名(52.6%),女生1 077名(47.4%),平均年龄(8.76±1.67)岁。本研究经安徽省疾病预防控制中心医学伦理委员会批准(批号: AHJK2025-B007-01),调查前取得所有学生及其监护人知情同意。
依据《中小学生屈光不正筛查规范》(WS/T 663—2020)[6]进行常规眼科检查。裸眼远视力检查采用符合GB 11533—2011的标准对数视力表[7]。在非睫状肌麻痹状态下用台式验光仪TOPCON KR-800进行屈光检测,每次测量前均进行雾视,并连续测量3次后取平均值,若任意2次等效球镜度数(spherical equivalent, SE)相差≥0.50 D,则增加测量次数再取均值。任意眼睛裸眼视力 < 5.0且非睫状肌麻痹下电脑验光SE<-0.50 D或配戴角膜塑形镜者判定为筛查性近视[6]。SE=球镜度+1/2×柱镜度数。采用ZEISS IOL Master 500眼科光学生物测量仪测量AL、垂直角膜曲率(K1/K2)。角膜曲率半径(curvature radius, CR)=337.5/[(K1+K2)×2-1]。因左右眼生物学参数高度相关,本研究采用右眼数据进行分析。
参考国内外相关文献[5, 8]自行设计问卷,经多轮专家咨询和修改,最终确定研究问卷。一至三年级由家长和学生共同填写,四至六年级由学生自行填写。内容包括学生基本人口学特征及本学期校外辅导班参加情况,具体类型为:(1)乐器类(钢琴、古筝等);(2)文化课类(英语、数学等);(3)美术类(绘画、书法等);(4)文艺类(歌唱、主持等);(5)棋类(围棋、象棋等);(6)益智类(思维、乐高等);(7)计算机编程;(8)室内体育类(舞蹈、游泳等);(9)室外体育类(足球、田径)。收集各类型校外辅导每周参加次数、单次辅导时长及每周练习次数、单次练习时长,每周总时长=每周参加次数×单次辅导时长+练习次数×单次练习时长。参加前7项中任意一项定义为非体育类辅导班,参加室内或室外体育类为参加体育类辅导班。本次调查问卷Cronbach α系数为0.81。
由三甲医院医务人员担任检测队长,持验光资格证的技师开展眼科检查,课题人员统一进行专业培训。仪器使用前进行校准,至少连续测量3次并取平均值。调查问卷由经统一培训的调查员发放,告知学生及家长调查目的和填写注意事项,收集时核实信息填写准确性与完整性。剔除存在明显逻辑错误或漏填率>5%的问卷后进行分析。
采用EpiData 3.1软件双录入数据,SPSS 15.0软件进行统计分析,计量资料数据经K-S检验符合正态分布,以(x±s)表示,采用t检验或方差分析对组间差异进行分析;不服从正态分布的数据以M(P25,P75)表示,采用Wilcoxon秩和检验进行组间比较;计数资料以频数和百分比(%)表示,组间比较用χ2检验。以各类型非体育类校外辅导班作为自变量,调整性别、年级等混杂变量,采用Logistic回归模型分析参加非体育类校外辅导与小学生筛查性近视的关联;运用多元线性回归模型分析参加非体育类校外辅导与小学生AL、AL/CR的关联。双侧检验水准α=0.05。
调查的小学生中,有64.9%(1 475名)参加非体育类辅导班,每周参加时长≥2 h的学生占51.9%(1 179名)。参与率较高的非体育类辅导班分别为美术类41.0%(932名)、文化课类32.4%(737名)和乐器类16.5%(374名);每周参加时长≥2 h的学生在美术类、文化课类、乐器类中的占比分别为22.8%(518名),24.7%(561名),8.9%(202名)。其他非体育类辅导班参与率均不足10%,其中棋类、文艺类、益智类和计算机编程类分别为4.7%(105名),3.7%(85名),3.2%(72名)和6.5%(148名)。每周参加非体育类校外辅导的学生筛查性近视率为42.6%(502名),其中乐器类、文化课类校外辅导的学生筛查性近视率分别为53.0%(107名),46.9%(263名),均高于未参加者[35.0%(279名),38.2%(726名)和36.3%(557名)](χ2值分别为8.89,3.76,16.14,P值均 < 0.05)。是否参加其他非体育类辅导班(美术类、棋类、文艺类、益智类、计算机编程)学生的筛查性近视率差异无统计学意义(χ2值分别为0.43,0.69,0.54,0.08,0.00,P值均>0.05)。
小学生总体筛查性近视检出率为39.1%(889名),女生(41.5%,447名)高于男生(37.0%,442名)。不同性别、年级间[一至六年级分别为9.7%(31/318)、17.2%(70/407)、32.8%(132/402)、52.1%(209/401)、55.1%(218/396)、65.6%(229/349)]筛查性近视检出率差异均有统计学意义(χ2值分别为4.92,377.53,P值均 < 0.05)。学生AL平均为(23.60±1.01)mm,AL/CR为(3.00±0.12)。不同性别、年级间AL和AL/CR差异均有统计学意义(P值均 < 0.05)。见表1。
以是否筛查性近视(是=1,否=0)为因变量,每周参加各类型校外辅导时长为自变量(未参加=0,>0~ < 2 h=1,≥2 h=2),进行多因素Logistic回归分析。模型1显示,每周参加非体育类、乐器类、文化课类校外辅导≥2 h的小学生筛查性近视发生风险均高于未参加者(P值均 < 0.05)。调整混杂因素后,模型2显示,每周参加非体育类(OR=1.26)、乐器类校外辅导(OR=1.49)≥2 h者,筛查性近视发生风险仍高于未参加者(P值均 < 0.05)。其他类型校外辅导班与筛查性近视间关联均无统计学意义(P值均>0.05)。见表2。
以AL和AL/CR为因变量,每周参加各类型校外辅导时间为自变量(未参加=0,>0~ < 2 h=1,≥2 h=2)进行多元线性回归分析。模型1结果显示,每周参加乐器类、文化课类校外辅导≥2 h与AL均呈正相关;每周参加非体育类、乐器类、文化课类校外辅导班≥2 h与AL/CR均呈正相关(P值均 < 0.05)。调整混杂因素后,模型2结果显示,每周参加乐器类校外辅导班≥2 h仍与AL呈正相关(β=0.14,P < 0.05),其他类型校外辅导班与AL及AL/CR关联均无统计学意义(P值均>0.05)。见表3。
本研究发现,小学生总体筛查性近视检出率为39.1%,高于2022年全国水平(36.7%)[2],低于深圳市研究结果[9],差异可能与地区教育压力、学生用眼行为及样本年级构成有关。随年级升高,AL由一年级的22.81 mm升至六年级的24.34 mm,提示小学生在快速发育阶段,学业负担逐渐加重,近距离用眼时间增加,可能促进AL过度增长,进而增加近视发生风险,与石梦海等[10]研究结果一致。
本研究结果显示,小学生非体育类校外辅导参与率为64.9%,每周时长≥2 h者占51.9%。仇晓艳等[11]对上海市小学生调查结果显示,参加课外辅导班的学生占88.26%,其中42.5%参加文化课程辅导班,59.8%参加艺术课程,高于本研究结果,可能与地区经济文化差异有关,经济与教育水平较高地区学生校外辅导参与率更高。
长时间参加非体育类校外辅导增加学生校外读写时间并挤压户外活动时间,且补习班中教学环境不符合标准,可能增加筛查性近视发生风险[12-14]。本研究发现,每周参加非体育类校外辅导≥2 h者筛查性近视发生风险高于未参加者。Ku等[15]对中国台湾省研究显示,补习班≥2 h/d的儿童发生近视的风险更高,与本研究结果一致。此外,Yue等[16]对重庆市小学生调查显示,课外补习与AL和AL/CR独立相关,本研究发现乐器类校外辅导与AL存在显著关联,而与AL/CR仅呈正向趋势但未达到显著性。该结果可能与AL/CR作为由AL与CR共同构成的综合指标,其变异度相对较小有关,因此在横断面资料中相关性不易体现。未来仍需通过纵向研究进一步验证。
本研究发现,在调整年级等因素后,每周参加文化课类校外辅导与学生筛查性近视关联无统计学意义。广东省一项针对7~18岁学生的调查发现,每天文化课补习≥2 h的学生近视肥胖共存的风险更高[17];金艳辉等[18]对包头市中小学生研究显示,每周参加文化课类补习班≥2 h者近视风险增加27.3%,与本研究结果不同,可能因本次仅调查2所小学,低年级学生占比高、学业负担轻且单次参与时长短,而初高中生学业压力大、用眼负荷重,参加校外文化课补习对其近视影响更显著。
本研究发现,每周参加乐器类校外辅导≥2 h的学生筛查性近视发生风险高于未参加者,AL更长。既往研究显示,6~10岁儿童AL年增长安全阈值约为0.20 mm[19],参加乐器类校外辅导≥2 h可能促进AL过度增长。其机制可能与长时间注视乐谱、精细手眼协调导致调节滞后及视网膜离焦风险增加有关[20],且持续近距离用眼可导致脉络膜血流量减少、巩膜缺氧,使脉络膜变薄,从而加速眼轴增长,引发近视[21-23]。然而,也有研究发现弹钢琴与中小学生近视不存在关联[24],可能与研究人群不同有关。
综合本研究发现,需关注非体育类校外辅导对学生视力健康的潜在影响,构建“家庭-学校-社会”多方协同的近视防控格局,以实现有效近视防控。家庭层面需加强对家长的宣教,根据孩子兴趣优先选择户外体育类辅导,控制每周参加非体育类辅导频率与时长,乐器类辅导应采用大字体乐谱;学校层面应减轻作业负担,合理安排课外学习任务,优化课后延时服务,增加课后户外活动兴趣课程;社会层面相关部门应结合“双减”政策,制定非体育类校外培训的用眼卫生规范,鼓励机构增设户外活动环节,限制高强度近距离用眼课程连续时长,并监管机构教学环境与设施符合标准。
本研究存在一定局限:横断面研究无法确定因果关联;问卷采用自填方式,可能存在回忆偏倚;未进行睫状肌麻痹验光,可能高估筛查性近视检出率。未来将开展前瞻性研究,探讨不同类型校外辅导与AL增长及筛查性近视发生率的关联。
  • 人口健康与优生安徽省重点实验室开放课题项目(JKYS20212);安徽省转化医学研究院科研基金项目(2023zhyx-B13)
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2025年第46卷第11期
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doi: 10.16835/j.cnki.1000-9817.2025340
  • 接收时间:2025-07-02
  • 首发时间:2026-11-06
  • 出版时间:2025-11-25
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  • 收稿日期:2025-07-02
  • 修回日期:2025-08-14
基金
人口健康与优生安徽省重点实验室开放课题项目(JKYS20212);安徽省转化医学研究院科研基金项目(2023zhyx-B13)
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    1安徽医科大学公共卫生学院流行病与卫生统计学系,合肥 230032
    2安徽医科大学公共卫生学院儿少卫生与妇幼保健学系
    3安徽省妇女儿童医学中心眼科
    4合肥市蜀山区疾病预防控制中心学校卫生与食品卫生科
    5安徽省疾病预防控制中心儿童青少年健康所

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多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
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