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Article(id=1325532429309731282, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325531848021140417, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025341, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1751472000000, receivedDateStr=2025-07-03, revisedDate=1758988800000, revisedDateStr=2025-09-28, acceptedDate=null, acceptedDateStr=null, onlineDate=1793961158348, onlineDateStr=2026-11-06, pubDate=1764000000000, pubDateStr=2025-11-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793961158348, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793961158348, creator=13701087609, updateTime=1793961158348, 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=1549, endPage=1553, ext={EN=ArticleExt(id=1325532432333824468, articleId=1325532429309731282, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Relationship between changes in classroom lighting environment and refractive progression among primary and secondary 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 changes in classroom lighting environment of schools in Suzhou and their impact on refractive progression among primary and secondary school students, so as to provide the basis for accurate provention and control of myopia.

Methods

A baseline investigation was conducted in October 2022 by using a stratified cluster random sampling method to recruit primary and secondary school students from Suzhou.A follow-up visit was performed in October 2023.A total of 12 302 students and 360 classrooms that participated in both surveys were included analysis.The visual acuity progression over one year and classroom lighting conditions were assessed.Group comparisons were performed by using the Wilcoxon or Kruskal-Wallis rank-sum, and Chi-square tests.Multivariate Logistic regression was employed to identify the major factors influencing refractive changes.

Results

The compliance rate of average illuminance on classroom blackboard surface increased from 72.22% to 75.28%, while the compliance rate of average illuminance on desks decreased from 89.44% to 87.22%, the overall myopia rate among students rose from 59.63% to 66.99% from 2022 to 2023.The average annual progression of equivalent spherical power (SE) in the right eye of students was-0.25(-0.75, 0.06) D.Significant statistical differences were observed in the annual mean changes across different school levels, regions, baseline refractive statuses, and classroom lighting environment change groups (Z/H=316.59, -8.27, 38.80, 51.01, all P < 0.05).Multivariate Logistic regression analysis showed that pre-myopia, low myopia, junior high school, senior high school, vocational high school, and improved classroom lighting environment were protective factors of reducing the risk of rapid progression in refractive error (OR=0.58, 0.69, 0.81, 0.50, 0.28, 0.82, all P < 0.05).Conversely, female students and rural students had higher risks of rapid myopia progression (OR=1.09, 1.42, both P < 0.05).

Conclusions

Over one-year follow-up, the complance rate of classroom lighting indicators in Suzhou remaines stable, while students'refractive status shows a trend toward myopia.Improving classroom lighting environment can reduce the risk of rapid myopia progression.

, authors=Di HAN1, Ruizhe LING1, Liye ZHANG1, Yuehong WANG1, Xinyu BAO1, Hui SHEN*, 1, 2, 3, Jia HU*, 1, 2, 3, authorsList=Di HAN, Ruizhe LING, Liye ZHANG, Yuehong WANG, Xinyu BAO, Hui SHEN, Jia HU, authorCompany=null, correspAuthors=Hui SHEN, Jia HU, 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=1325532451598262743, articleId=1325532429309731282, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=教室照明环境变化与中小学生屈光进展的关系, 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

分析苏州市学校教室照明环境的变化及对中小学生屈光进展的影响, 为近视精准防控提供依据。

方法

于2022年10月进行基线调查, 采用分层整群随机抽样方法, 选取苏州市中小学生为研究对象, 于2023年10月进行随访, 将2022和2023年均参加监测的12 302名学生和360间教室纳入研究, 分析学生1年的视力进展情况, 并对其所在教室(360间)开展教学环境监测。数据组间比较采用Wilcoxon或Kruskal-Wallis秩和检验、χ2检验, 采用多因素Logistic回归分析中小学生屈光变化的影响因素。

结果

2022-2023年教室黑板面平均照度合格率由72.22%上升至75.28%, 课桌面平均照度合格率由89.44%下降至87.22%;学生总体屈光近视率由59.63%增长至66.99%。学生右眼等效球镜度数(SE)年均进展为-0.25(-0.75, 0.06) D, 不同学段、地区、基线屈光状态和教室照明环境变化组的年均变化均有统计学意义(Z/H值分别为316.59, -8.27, 38.80, 51.01, P值均 < 0.05)。多因素Logistic回归分析结果显示, 近视前期、低度近视、初中、普通高中、职业高中、教室照明环境有改善能够降低屈光中快速进展的风险(OR值分别为0.58, 0.69, 0.81, 0.50, 0.28, 0.82), 女生、乡村中小学生屈光中快速进展风险较大(OR值分别为1.09, 1.42)(P值均 < 0.05)。

结论

随访1年发现苏州市学校教室照明指标合格率平稳波动, 学生屈光度向近视化发展; 改善教室照明环境能够降低学生近视中快速进展的风险。

, authors=韩迪1, 凌睿哲1, 张俪叶1, 王越红1, 包新宇1, 沈蕙*, 1, 2, 3, 胡佳*, 1, 2, 3, authorsList=韩迪, 凌睿哲, 张俪叶, 王越红, 包新宇, 沈蕙, 胡佳, authorCompany=null, correspAuthors=沈蕙, 胡佳, authorNote=

韩迪(1989-)，女，甘肃兰州人，硕士，主管医师，主要研究方向为儿童青少年生长发育

, correspAuthorsNote=
沈蕙，E-mail:
胡佳，E-mail:
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2南京医科大学公共卫生学院
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Classroom illumination parameter pass rate from 2022 to 2023 among different groups of primary and secondary schools in Suzhou

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组别选项教室数黑板面平均照度黑板面照度均匀度课桌面平均照度课桌面照度均匀度
2022年2023年2022年2023年2022年2023年2022年2023年
基线学段小学120104(86.67)101(84.17)102(85.00)106(88.33)114(95.00)103(85.83)96(80.00)100(83.33)
初中10277(75.49)78(76.47)94(92.16)84(82.35)94(92.16)95(93.14)83(81.37)79(77.45)
普通高中9065(72.22)66(73.33)75(83.33)71(78.89)78(86.67)77(85.56)81(90.00)73(81.11)
职业高中4814(29.17)26(54.17)33(68.75)41(85.42)36(75.00)39(81.25)41(85.42)35(72.92)
地区城市198148(74.75)165(83.33)166(83.84)175(88.38)173(87.37)176(88.89)175(88.38)169(85.35)
乡村162112(69.14)106(65.43)138(85.19)127(78.40)149(91.98)138(85.19)126(77.78)118(72.84)
合计360260(72.22)271(75.28)304(84.44)302(83.89)322(89.44)314(87.22)301(83.61)287(79.72)
), ArticleFig(id=1325532508166840855, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532429309731282, language=CN, label=表1, caption=

苏州市2022—2023年不同组别中小学校教室照明参数合格率

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项教室数黑板面平均照度黑板面照度均匀度课桌面平均照度课桌面照度均匀度
2022年2023年2022年2023年2022年2023年2022年2023年
基线学段小学120104(86.67)101(84.17)102(85.00)106(88.33)114(95.00)103(85.83)96(80.00)100(83.33)
初中10277(75.49)78(76.47)94(92.16)84(82.35)94(92.16)95(93.14)83(81.37)79(77.45)
普通高中9065(72.22)66(73.33)75(83.33)71(78.89)78(86.67)77(85.56)81(90.00)73(81.11)
职业高中4814(29.17)26(54.17)33(68.75)41(85.42)36(75.00)39(81.25)41(85.42)35(72.92)
地区城市198148(74.75)165(83.33)166(83.84)175(88.38)173(87.37)176(88.89)175(88.38)169(85.35)
乡村162112(69.14)106(65.43)138(85.19)127(78.40)149(91.98)138(85.19)126(77.78)118(72.84)
合计360260(72.22)271(75.28)304(84.44)302(83.89)322(89.44)314(87.22)301(83.61)287(79.72)
), ArticleFig(id=1325532508619825688, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532429309731282, language=EN, label=Tab.2, caption=

Comparison of right eye spherical equivalent among different groups of primary and secondary school students in Suzhou from 2022 and 2023[M(P25, P75), D]

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组别选项人数基线值随访值年均进展Z/H值P值
基线学段小学6 777-0.38(-1.38, 0.13)-0.75(-1.88, 0.00)-0.38(-0.75, 0.00)316.59< 0.01
初中2 521-2.38(-4.00, -1.13)-2.75(-4.38, -1.38)-0.38(-0.63, 0.00)
高中1 805-3.75(-5.38, -2.25)-4.13(-5.63, -2.5)-0.25(-0.63, 0.13)
职高1 199-3.63(-5.00, -1.75)-3.63(-5.25, -1.75)-0.13(-0.38, 0.25)
性别男6 201-1.13(-3.13, -0.13)-1.5(-3.56, -0.38)-0.25(-0.63, 0.13)-1.830.07
女6 101-1.38(-3.38, -0.18)-1.75(-3.75, -0.5)-0.32(-0.75, 0.00)
地区城市6 585-1.25(-3.25, -0.13)-1.63(-3.5, -0.25)-0.25(-0.63, 0.13)-8.27< 0.01
乡村5 717-1.37(-3.38, -0.13)-1.75(-3.75, -0.5)-0.38(-0.75, 0.00)
基线屈光状态远视2491.38(1.00, 2.25)0.88(0.38, 1.88)-0.50(-1.00, 0.00)38.80< 0.01
近视前期3 1710.13(-0.13, 0.38)-0.13(-0.63, 0.25)-0.38(-0.75, 0.00)
低度近视5 047-1.13(-1.88, -0.63)-1.63(-2.38, -0.75)-0.25(-0.75, 0.13)
中度近视3 031-3.88(-4.63, -3.25)-4.25(-5.00, -3.50)-0.25(-0.63, 0.00)
高度近视804-6.63(-7.63, -6.13)-7.00(-8.00, -6.38)-0.25(-0.63, 0.00)
教室照明环境均不达标1 522-2.25(-4.25, -0.50)-2.63(-4.63, -0.75)-0.25(-0.63, 0.00)51.01< 0.01
  变化改善1 123-2.06(-4.25, -0.56)-2.25(-4.25, -0.75)-0.25(-0.63, 0.13)
变差1 442-0.63(-2.63, 0.13)-1.13(-2.88, -0.13)-0.38(-0.75, 0.00)
均达标8 215-1.13(-3.00, -0.13)-1.63(-3.38, -0.38)-0.38(-0.75, 0.00)
合计12 302-1.25(-3.25, -0.13)-1.63(-3.63, -0.38)-0.25(-0.75, 0.06)
), ArticleFig(id=1325532509412549145, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532429309731282, language=CN, label=表2, caption=

苏州市2022—2023年不同组别中小学生右眼SE比较[M(P25，P75), D]

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数基线值随访值年均进展Z/H值P值
基线学段小学6 777-0.38(-1.38, 0.13)-0.75(-1.88, 0.00)-0.38(-0.75, 0.00)316.59< 0.01
初中2 521-2.38(-4.00, -1.13)-2.75(-4.38, -1.38)-0.38(-0.63, 0.00)
高中1 805-3.75(-5.38, -2.25)-4.13(-5.63, -2.5)-0.25(-0.63, 0.13)
职高1 199-3.63(-5.00, -1.75)-3.63(-5.25, -1.75)-0.13(-0.38, 0.25)
性别男6 201-1.13(-3.13, -0.13)-1.5(-3.56, -0.38)-0.25(-0.63, 0.13)-1.830.07
女6 101-1.38(-3.38, -0.18)-1.75(-3.75, -0.5)-0.32(-0.75, 0.00)
地区城市6 585-1.25(-3.25, -0.13)-1.63(-3.5, -0.25)-0.25(-0.63, 0.13)-8.27< 0.01
乡村5 717-1.37(-3.38, -0.13)-1.75(-3.75, -0.5)-0.38(-0.75, 0.00)
基线屈光状态远视2491.38(1.00, 2.25)0.88(0.38, 1.88)-0.50(-1.00, 0.00)38.80< 0.01
近视前期3 1710.13(-0.13, 0.38)-0.13(-0.63, 0.25)-0.38(-0.75, 0.00)
低度近视5 047-1.13(-1.88, -0.63)-1.63(-2.38, -0.75)-0.25(-0.75, 0.13)
中度近视3 031-3.88(-4.63, -3.25)-4.25(-5.00, -3.50)-0.25(-0.63, 0.00)
高度近视804-6.63(-7.63, -6.13)-7.00(-8.00, -6.38)-0.25(-0.63, 0.00)
教室照明环境均不达标1 522-2.25(-4.25, -0.50)-2.63(-4.63, -0.75)-0.25(-0.63, 0.00)51.01< 0.01
  变化改善1 123-2.06(-4.25, -0.56)-2.25(-4.25, -0.75)-0.25(-0.63, 0.13)
变差1 442-0.63(-2.63, 0.13)-1.13(-2.88, -0.13)-0.38(-0.75, 0.00)
均达标8 215-1.13(-3.00, -0.13)-1.63(-3.38, -0.38)-0.38(-0.75, 0.00)
合计12 302-1.25(-3.25, -0.13)-1.63(-3.63, -0.38)-0.25(-0.75, 0.06)
), ArticleFig(id=1325532509500629530, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532429309731282, language=EN, label=Tab.3, caption=

Comparison of detection rates of rapid progress in refraction among different groups of primary and secondary school students in Suzhou

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数检出人数χ2值P值
基线学段小学6 7774 010(59.17)383.28< 0.01
初中2 5211 398(55.45)
高中1 805824(45.65)
职高1 199370(30.86)
性别男6 2013 262(52.60)5.670.02
女6 1013 340(54.75)
地区城市6 5853 313(50.31)64.13< 0.01
乡村5 7173 289(57.53)
基线屈光状态远视249168(67.47)39.96< 0.01
近视前期3 1711 741(54.90)
低度近视5 0472 761(54.71)
中度近视3 0311 524(50.28)
高度近视804408(50.75)
教室照明环境变化均不达标1 522778(51.12)62.90< 0.01
改善1 123486(43.28)
变差1 442803(55.69)
均达标8 2154 535(55.20)
), ArticleFig(id=1325532510322713115, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532429309731282, language=CN, label=表3, caption=

苏州市不同组别中小学生屈光中快速进展检出率比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别选项人数检出人数χ2值P值
基线学段小学6 7774 010(59.17)383.28< 0.01
初中2 5211 398(55.45)
高中1 805824(45.65)
职高1 199370(30.86)
性别男6 2013 262(52.60)5.670.02
女6 1013 340(54.75)
地区城市6 5853 313(50.31)64.13< 0.01
乡村5 7173 289(57.53)
基线屈光状态远视249168(67.47)39.96< 0.01
近视前期3 1711 741(54.90)
低度近视5 0472 761(54.71)
中度近视3 0311 524(50.28)
高度近视804408(50.75)
教室照明环境变化均不达标1 522778(51.12)62.90< 0.01
改善1 123486(43.28)
变差1 442803(55.69)
均达标8 2154 535(55.20)
), ArticleFig(id=1325532511962685980, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532429309731282, language=EN, label=Tab.4, caption=

Logistic regression analysis of influencing factors of rapid progress in refraction among primary and secondary school students in Suzhou(n=12 302)

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自变量与常量β值标准误Wald χ2值P值OR值(95%CI)
性别
  女0.080.045.130.021.09(1.01~1.17)
基线学段
  初中-0.280.0528.01< 0.010.81(0.73~0.90)
  普通高中-0.780.06147.45< 0.010.50(0.44~0.56)
  职业高中-1.380.08306.01< 0.010.28(0.24~0.32)
地区
  乡村0.350.0489.94< 0.011.42(1.32~1.53)
基线屈光状态
  近视前期-0.550.1414.85< 0.010.58(0.44~0.77)
  低度近视-0.370.146.950.010.69(0.53~0.91)
  中度近视-0.240.152.620.110.79(0.60~1.05)
  高度近视0.020.160.010.931.02(0.74~1.39)
教室照明环境变化
  改善-0.200.085.530.020.82(0.70~0.97)
  变差-0.050.080.340.560.96(0.82~1.11)
  均达标-0.090.062.380.120.91(0.81~1.03)
常量0.680.1520.78< 0.011.97
), ArticleFig(id=1325532512424059421, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325532429309731282, language=CN, label=表4, caption=

苏州市中小学生屈光中快速进展影响因素Logistic回归分析(n=12 302)

, figureFileSmall=null, figureFileBig=null, tableContent=
自变量与常量β值标准误Wald χ2值P值OR值(95%CI)
性别
  女0.080.045.130.021.09(1.01~1.17)
基线学段
  初中-0.280.0528.01< 0.010.81(0.73~0.90)
  普通高中-0.780.06147.45< 0.010.50(0.44~0.56)
  职业高中-1.380.08306.01< 0.010.28(0.24~0.32)
地区
  乡村0.350.0489.94< 0.011.42(1.32~1.53)
基线屈光状态
  近视前期-0.550.1414.85< 0.010.58(0.44~0.77)
  低度近视-0.370.146.950.010.69(0.53~0.91)
  中度近视-0.240.152.620.110.79(0.60~1.05)
  高度近视0.020.160.010.931.02(0.74~1.39)
教室照明环境变化
  改善-0.200.085.530.020.82(0.70~0.97)
  变差-0.050.080.340.560.96(0.82~1.11)
  均达标-0.090.062.380.120.91(0.81~1.03)
常量0.680.1520.78< 0.011.97
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教室照明环境变化与中小学生屈光进展的关系
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韩迪 1 , 凌睿哲 1 , 张俪叶 1 , 王越红 1 , 包新宇 1 , 沈蕙 *, 1, 2, 3 , 胡佳 *, 1, 2, 3
中国学校卫生 | 学习生活环境与学生健康专栏 2025,46(11): 1549-1553
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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) : 1549 -1553
教室照明环境变化与中小学生屈光进展的关系
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韩迪1, 凌睿哲1, 张俪叶1, 王越红1, 包新宇1, 沈蕙*, 1, 2, 3 , 胡佳*, 1, 2, 3
作者信息
  • 1苏州市疾病预防控制中心学校卫生科, 江苏 215131
  • 2南京医科大学公共卫生学院
  • 3南京医科大学姑苏学院苏州市公共卫生高等研究院
通讯作者:
沈蕙，E-mail:
胡佳，E-mail:
作者简介:

韩迪(1989-)，女，甘肃兰州人，硕士，主管医师，主要研究方向为儿童青少年生长发育

Relationship between changes in classroom lighting environment and refractive progression among primary and secondary school students
Di HAN1, Ruizhe LING1, Liye ZHANG1, Yuehong WANG1, Xinyu BAO1, Hui SHEN*, 1, 2, 3 , Jia HU*, 1, 2, 3
Affiliations
  • 1Department of School Health, Suzhou Center for Disease Prevention and Control, Suzhou 215131, Jiangsu Province, China
出版时间: 2025-11-25 doi: 10.16835/j.cnki.1000-9817.2025341
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摘要
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目的

分析苏州市学校教室照明环境的变化及对中小学生屈光进展的影响, 为近视精准防控提供依据。

方法

于2022年10月进行基线调查, 采用分层整群随机抽样方法, 选取苏州市中小学生为研究对象, 于2023年10月进行随访, 将2022和2023年均参加监测的12 302名学生和360间教室纳入研究, 分析学生1年的视力进展情况, 并对其所在教室(360间)开展教学环境监测。数据组间比较采用Wilcoxon或Kruskal-Wallis秩和检验、χ2检验, 采用多因素Logistic回归分析中小学生屈光变化的影响因素。

结果

2022-2023年教室黑板面平均照度合格率由72.22%上升至75.28%, 课桌面平均照度合格率由89.44%下降至87.22%;学生总体屈光近视率由59.63%增长至66.99%。学生右眼等效球镜度数(SE)年均进展为-0.25(-0.75, 0.06) D, 不同学段、地区、基线屈光状态和教室照明环境变化组的年均变化均有统计学意义(Z/H值分别为316.59, -8.27, 38.80, 51.01, P值均 < 0.05)。多因素Logistic回归分析结果显示, 近视前期、低度近视、初中、普通高中、职业高中、教室照明环境有改善能够降低屈光中快速进展的风险(OR值分别为0.58, 0.69, 0.81, 0.50, 0.28, 0.82), 女生、乡村中小学生屈光中快速进展风险较大(OR值分别为1.09, 1.42)(P值均 < 0.05)。

结论

随访1年发现苏州市学校教室照明指标合格率平稳波动, 学生屈光度向近视化发展; 改善教室照明环境能够降低学生近视中快速进展的风险。

光  /  环境  /  近视  /  回归分析  /  学生
Objective

To analyze the changes in classroom lighting environment of schools in Suzhou and their impact on refractive progression among primary and secondary school students, so as to provide the basis for accurate provention and control of myopia.

Methods

A baseline investigation was conducted in October 2022 by using a stratified cluster random sampling method to recruit primary and secondary school students from Suzhou.A follow-up visit was performed in October 2023.A total of 12 302 students and 360 classrooms that participated in both surveys were included analysis.The visual acuity progression over one year and classroom lighting conditions were assessed.Group comparisons were performed by using the Wilcoxon or Kruskal-Wallis rank-sum, and Chi-square tests.Multivariate Logistic regression was employed to identify the major factors influencing refractive changes.

Results

The compliance rate of average illuminance on classroom blackboard surface increased from 72.22% to 75.28%, while the compliance rate of average illuminance on desks decreased from 89.44% to 87.22%, the overall myopia rate among students rose from 59.63% to 66.99% from 2022 to 2023.The average annual progression of equivalent spherical power (SE) in the right eye of students was-0.25(-0.75, 0.06) D.Significant statistical differences were observed in the annual mean changes across different school levels, regions, baseline refractive statuses, and classroom lighting environment change groups (Z/H=316.59, -8.27, 38.80, 51.01, all P < 0.05).Multivariate Logistic regression analysis showed that pre-myopia, low myopia, junior high school, senior high school, vocational high school, and improved classroom lighting environment were protective factors of reducing the risk of rapid progression in refractive error (OR=0.58, 0.69, 0.81, 0.50, 0.28, 0.82, all P < 0.05).Conversely, female students and rural students had higher risks of rapid myopia progression (OR=1.09, 1.42, both P < 0.05).

Conclusions

Over one-year follow-up, the complance rate of classroom lighting indicators in Suzhou remaines stable, while students'refractive status shows a trend toward myopia.Improving classroom lighting environment can reduce the risk of rapid myopia progression.

Light  /  Environment  /  Myopia  /  Regression analysis  /  Students
韩迪, 凌睿哲, 张俪叶, 王越红, 包新宇, 沈蕙, 胡佳. 教室照明环境变化与中小学生屈光进展的关系. 中国学校卫生, 2025 , 46 (11) : 1549 -1553 . DOI: 10.16835/j.cnki.1000-9817.2025341
Di HAN, Ruizhe LING, Liye ZHANG, Yuehong WANG, Xinyu BAO, Hui SHEN, Jia HU. Relationship between changes in classroom lighting environment and refractive progression among primary and secondary school students[J]. Chinese Journal of School Health, 2025 , 46 (11) : 1549 -1553 . DOI: 10.16835/j.cnki.1000-9817.2025341
正文
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中国是全球近视流行水平最高的国家之一，儿童青少年群体尤为突出，其近视率呈持续上升趋势[1]。2022年我国儿童青少年近视率为51.9%[2]，且低龄化问题突出，高度近视患病率呈增长态势[3-4]。有学者预测，若无有效的干预措施，2030年我国儿童青少年近视率可上升至61.8%[5]。有研究表明，良好的照明环境有助于延缓视力水平的下降[6-7]。2019年苏州市教育局等七部门印发的《关于做好儿童青少年近视综合防控工作的意见》[8]中对学校教室照明环境达标率提出明确要求。本研究旨在探讨教室照明环境变化与学生屈光进展的关系，为近视干预策略的制定提供科学依据。
1　对象与方法
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1.1　对象
基于苏州市学生常见病监测项目和学校视觉环境提升工程，于2022年10月进行基线调查，采取分层整群随机抽样的方法选取研究对象，以市、区为最初抽样单元(全市10个地区)，按城区和乡村分层；采用随机数字表法在每个市、区各抽取2所小学、2所初中、2所普通高中、1所职业高中；以年级分层，每个年级抽取2个以上班级(至少80人)的全部学生开展调查。基线期共监测23 172名学生，并对420间教室开展教学环境监测。2023年10月对同批学校进行监测随访。纳入标准：同时参加2022和2023年监测的学生，排除存在基础性眼病或研究期间使用角膜塑形镜等近视控制者。最终纳入12 302名学生和360间教室数据进行分析。其中男生6 201名，女生6 101名；城市学生6 585名，乡村学生5 717名；平均年龄(11.49±3.44)岁。本研究获得学生本人及家长的知情同意，且通过苏州市疾病预防控制中心伦理委员会审查(批号：SZJK2022-XW001)。
1.2　方法
1.2.1　问卷调查
通过问卷形式获取研究对象的性别、年龄、年级、地区等。
1.2.2　视力检查
基线期与随访期均执行统一的视力检查方法。(1)使用5 m标准对数视力表检查裸眼远视力；(2)非散瞳状态下采用台式电脑验光仪进行屈光检测，单眼连续测量3次取均值，若任意2次球镜度数相差≥0.50 D需加测，再取平均值。屈光度数以等效球镜度数(spherical equivalent, SE)表示，SE=球镜度数+1/2×柱镜度数。考虑双眼屈光度和裸眼视力存在高度相关性，参考既往研究[9-11]，本研究仅对右眼数据进行分析。
1.2.3　教室照明检测
根据《照明测量方法》(GB 5700—2008)[12]测量并计算课桌面和黑板面平均照度及照度均匀度，根据《中小学校教室采光和照明卫生标准》(GB 7793—2010)[13]，合格标准为课桌面平均照度≥300 lx，课桌面照度均匀度≥0.7，黑板面平均照度≥500 lx，黑板面照度均匀度≥0.8。
1.2.4　指标定义
(1) 近视判定标准：裸眼远视力＜5.0且非睫状肌麻痹下电脑验光SE＜-0.50 D，单眼判定为近视者则计入近视人数[14]。近视率=(近视人数/受检人数)×100%。(2)屈光年均进展为2023年SE减去2022年SE[15]。(3)根据SE划分基线屈光状态：远视(SE＞+0.75 D)，近视前期(-0.50 D＜SE≤+0.75 D)，低度近视(-3.00 D＜SE≤-0.50 D)，中度近视(-6.00 D＜SE≤-3.00 D)，高度近视(SE≤-6.00 D)[16]。(4)根据SE的年变化量，对屈光进展进行分类：中快速进展(SE年变化量≤-0.50 D)，慢速进展或稳定模式(-0.50 D＜SE年变化量≤+0.50 D)[17]。(5)根据课桌面和黑板面平均照度的合格情况判定教室照明环境是否达标，两者均合格则达标，否则不达标，并对2年的变化情况进行区分：2年均不达标、改善(2022年不达标，2023年达标)、变差(2022年达标，2023年不达标)、2年均达标。
1.3　质量控制
严格规范研究数据的采集、管理和应用，确保监测质量。科学选择监测学校，确定监测对象，使用符合要求的仪器、设备。项目开展前对所有监测人员进行培训，考核合格后上岗。监测数据采用“学生常见病和健康影响因素监测平台”进行录入和管理。每日随机抽取5%的受检者进行现场复核，裸眼远视力误差允许范围为±1行、SE为±0.50 D；误差率在5%~10%时分析原因并改进，＞10%时当天数据需全部重测。
1.4　统计学分析
使用SPSS 26.0软件进行统计分析。计数资料用频数和构成比描述，采用Kolmogomv-Smirnov检验对数据进行正态性检验。不符合正态分布的计量资料用M(P25，P75)描述。不同组别中小学生的屈光和裸眼视力变化情况比较用Wilcoxon或Kruskal-Wallis秩和检验，不同组别中小学生屈光中快速进展情况比较采用χ2检验。以屈光是否中快速进展为因变量，以单因素分析中有统计学意义的变量为自变量，进行二分类多因素Logistic回归分析。以P < 0.05表示有统计学意义。
2　结果
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2.1　教室照明环境2022—2023年变化情况
2022年教室课桌面平均照度及照度均匀度、黑板面平均照度及照度均匀度合格率分别为89.44%，83.61%，72.22%，84.44%。2023年随访发现，黑板面平均照度合格率增长了3.06百分点；课桌面平均照度及照度均匀度、黑板面照度均匀度合格率分别降低2.22，3.89和0.56百分点。见表1。
2.2　中小学生近视2022—2023年进展情况
2022年学生近视率为59.63%(7 336/12 302)，2023年为66.99%(8 241/12 302)，增长了7.36百分点。小学生近视率变化(11.67百分点)高于初中生(3.73百分点)、普通高中生(1.11百分点)和职业高中生(0)，女生(7.90百分点)快于男生(6.82百分点)。学生右眼SE年均进展为-0.25(-0.75, 0.06)D，乡村学生屈光进展速度快于城市，差异均有统计学意义(Z=-8.27，P < 0.05)；不同学段、基线屈光状态和教室照明环境变化均呈现不同变化速度(H值分别为316.59，38.80，51.01，P值均 < 0.01)。见表2。
2.3　中小学生视力进展影响因素
不同基线学段、性别、地区、基线屈光状态以及教室照明环境变化组中小学生屈光中快速进展检出率差异均有统计学意义(P值均 < 0.05)。见表3。
以屈光是否中快速进展为因变量(否=0，是=1)，单因素分析中有统计学意义的变量为自变量，进行二分类多因素Logistic回归分析。结果显示，初中、普通高中、职业高中、近视前期、低度近视、教室照明环境改善有利于降低屈光中快速进展的风险；女生和乡村学生屈光中快速进展风险较大(P值均 < 0.05)。见表4。
3　讨论
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本研究发现，苏州市教室照明指标合格率平稳波动，中小学生年近视率增长了7.36百分点，右眼SE平均进展为-0.25(-0.75，0.06)D。上海一项针对儿童青少年1年屈光进展的研究显示，SE年变化介于(-0.07±0.49)~(-0.50±0.46)D[17]，与本研究结果相近。青岛市一项学生近视进展队列研究中屈光进展速度快于本研究[18]。可能与地区差异、不同的研究节点以及采取的近视防控干预措施等有关，日照时数、饮食习惯等对近视的影响往往具有区域性[19]。
本研究发现小学生近视增长较快；北京市一项针对15 031名中小学生近视筛查的研究发现，小学一年级学生近视增长率达到最高，小学四年级学生高度近视增长率最高[20]；刘瑛等[21]提出9岁儿童近视化进展最快。提示当前儿童青少年近视低龄化问题严重，需重点关注小学阶段人群。本研究还发现女生屈光进展速度相比男生更快，与其他研究结果一致[22]，Czepita等[23]分析了4 875名6~16岁波兰儿童青少年的屈光进展情况，发现9岁前不同性别儿童的SE相似，9~16岁女生SE低于男生且近视患病率高于男生。可能与女生相较于男生户外活动更少，近视相关风险因素发生率更高有关，也有学者认为可能与男女生生长突增差异有关[24-25]。乡村地区学生屈光进展速度快于城市，可能与城市学校、家长和学生更易获取健康知识，拥有更多的医疗资源以及更高的经济水平有关。徐李莎等[26]分析河南省2 222名中小学生近视进展情况，发现地区经济水平低与学生近视进展有关，与本研究结果类似。对于不同的基线屈光状态，远视组进展速度最快，应针对该人群实施前瞻性干预措施。通过分析发现教室照明环境有改善会降低近视中快速进展的风险，纵向验证了近视进展与教室照明环境的关系，与其他学者研究结果相一致[27-28]。提示教室照明环境因素对近视进展的影响作用，改善学校教室照明环境是减缓近视一项重要干预手段。
本研究存在一定局限性：首先，屈光检测采用的是非散瞳电脑验光，可能存在一定误差；其次，教室照明环境评估指标仅涵盖照度和均匀度，未纳入相关色温、显色指数、统一眩光值和光源频闪等参数；最后，研究人群的遗传和生活行为数据未纳入分析，班级的更换、学生的失访等一定程度上限制了屈光进展的全面评估。因此，本研究结果外推时需谨慎，建议未来研究充分纳入以上变量并进一步阐明屈光进展的变化规律和影响因素。
基金
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  • 苏州市科技发展计划(医疗卫生科技创新)项目(SKY2022067)；苏州市“科教强卫”青年项目(QNXM2024059)；苏州市科教兴卫青年科技项目(KJXW2021058)
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2025年第46卷第11期
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doi: 10.16835/j.cnki.1000-9817.2025341
  • 接收时间：2025-07-03
  • 首发时间：2026-11-06
  • 出版时间：2025-11-25
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  • 收稿日期：2025-07-03
  • 修回日期：2025-09-28
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苏州市科技发展计划(医疗卫生科技创新)项目(SKY2022067)；苏州市“科教强卫”青年项目(QNXM2024059)；苏州市科教兴卫青年科技项目(KJXW2021058)
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    1苏州市疾病预防控制中心学校卫生科, 江苏 215131
    2南京医科大学公共卫生学院
    3南京医科大学姑苏学院苏州市公共卫生高等研究院

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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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