Article(id=1325500910780167034, tenantId=1146029695717560320, journalId=1256213402557890569, issueId=1325500677975318675, articleNumber=null, orderNo=null, doi=10.16835/j.cnki.1000-9817.2025059, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1733932800000, receivedDateStr=2024-12-12, revisedDate=1735747200000, revisedDateStr=2025-01-02, acceptedDate=null, acceptedDateStr=null, onlineDate=1793953643746, onlineDateStr=2026-11-06, pubDate=1740412800000, pubDateStr=2025-02-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793953643746, onlineIssueDateStr=2026-11-06, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793953643746, creator=13701087609, updateTime=1793953643746, updator=13701087609, issue=Issue{id=1325500677975318675, tenantId=1146029695717560320, journalId=1256213402557890569, year='2025', volume='46', issue='2', pageStart='153', pageEnd='304', issueExtLink='null', onlineDate='null', pubDate='1740412800000', pubDateStr='2025-02-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793953588241, creator='13701087609', updateTime=1793953588241, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=255, endPage=259, ext={EN=ArticleExt(id=1325500911006659451, articleId=1325500910780167034, tenantId=1146029695717560320, journalId=1256213402557890569, language=EN, title=Association of blood pressure and body mass index trajectory with visual outcomes among primary and secondary school students in Shunyi District of Beijing, columnId=1325500884406379444, journalTitle=Chinese Journal of School Health, columnName=Disease Control, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the trajectories of blood pressure and body mass index (BMI) among primary and secondary school students aged 7-17 in Shunyi District of Beijing, and to explore the association between different growth trajectories and visual outcomes, so as to provide a scientific basis for the prevention and control of common diseases in children and adolescents.

Methods

Health examination data (including vision, blood pressure and BMI) of primary and secondary school students in Shunyi District of Beijing from 2019 to 2023 were collected and analyzed. Group-based trajectory modeling was used to classify the trajectories of BMI and blood pressure (systolic and diastolic) into distinct groups among students aged 7-17 years. The relationship between these trajectories and visual outcomes was examined using binary Logistic regression analysis.

Results

The prevalence of screening myopia among students in Shunyi District was 57.2%, while the rate of moderate to severe visual impairment was 55.8%. Based on the latent growth model, the trajectories of systolic blood pressure, diastolic blood pressure, and BMI were divided into three groups: low-growth trajectory, moderate-growth trajectory and high-maintenance trajectory. Logistic regression analysis revealed that, compared to the low-growth trajectory group, the moderate-growth and high-maintenance trajectory groups for systolic blood pressure, diastolic blood pressure, and BMI were associated with an increased risk of screening myopia (OR=1.14, 1.11; 1.07, 1.19; 1.06, 1.08, P < 0.05). Similarly, the moderate-growth and high-maintenance trajectory groups for systolic blood pressure, diastolic blood pressure, and BMI were similarly associated with an increased risk of moderate to severe visual impairment (OR=1.12, 1.12; 1.09, 1.17; 1.08, 1.11, P < 0.05).

Conclusions

Moderate-growth and high-maintenance trajectories of blood pressure and BMI are associated with an increased risk of screening myopia and moderate to severe visual impairment among students. It is recommended to closely monitor changes in blood pressure and overweight/obesity trajectories in primary and secondary school students, conduct regular assessments, and actively prevent the development and progression of multimorbidity and comorbidity.

, authors=Bin LIU1, Jie SHI1, Dejing PAN1, Ruilan ZHAO*, 2, authorsList=Bin LIU, Jie SHI, Dejing PAN, Ruilan ZHAO, authorCompany=null, correspAuthors=Ruilan ZHAO, 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=1325500912004903808, articleId=1325500910780167034, tenantId=1146029695717560320, journalId=1256213402557890569, language=CN, title=北京顺义区中小学生血压和体质量指数轨迹与视力结局关联, columnId=1325500884628677558, journalTitle=中国学校卫生, columnName=疾病控制, runingTitle=null, highlight=null, articleAbstract=
目的

分析北京市顺义区7~17岁中小学生血压和体质量指数(BMI)轨迹,探讨不同类型生长轨迹与视力结局的关联,为儿童青少年常见病防控工作提供科学依据。

方法

对2019—2023年北京市顺义区中小学生健康体检数据(视力、血压、BMI)进行整理,运用群组轨迹模型拟合7~17岁学生BMI和血压轨迹分组,采用二分类Logistic回归分析模型分析生长轨迹与视力结局的关联。

结果

顺义区中小学生筛查性近视率为57.2%,中重度视力不良率为55.8%。根据潜变量增长模型,可将中小学生收缩压轨迹、舒张压轨迹和BMI轨迹均分为低增长轨迹组、中增长轨迹组和高维持轨迹组3组。Logistic回归分析显示,与低增长轨迹组相比,收缩压、舒张压、BMI中增长轨迹组和高维持轨迹组的筛查性近视发生风险均增加(OR值分别为1.14,1.11;1.07,1.19;1.06,1.08,P值均 < 0.05);收缩压、舒张压、BMI中增长轨迹组和高维持轨迹组的中重度视力不良发生风险均增加(OR值分别为1.12,1.12;1.09,1.17;1.08,1.11,P值均 < 0.05)。

结论

血压和BMI中增长轨迹、高维持轨迹增加中小学生筛查性近视和中重度视力不良风险。应密切关注中小学生血压和超重肥胖轨迹变化,开展定期监测,积极预防学生多病共患的发生发展。

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刘斌(1986-),男,北京市人,大学本科,主治医师,主要研究方向为学生常见病防控

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赵瑞兰,E-mail:
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(2024-10-21)[2025-01-02]. http://www.gov.cn/zhengce/zhengceku/202411/content_6986582.htm., articleTitle=null, refAbstract=null)], funds=[Fund(id=1325500918229250988, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, awardId=null, language=CN, fundingSource=首都卫生发展科研专项项目(2024-2G-7107), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1325500913888146305, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, xref=1, ext=[AuthorCompanyExt(id=1325500913896534914, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, companyId=1325500913888146305, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1Division of School Health, Primary and Secondary School Healthcare Center of Shunyi District, Beijing (101300), China), AuthorCompanyExt(id=1325500913900729219, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, companyId=1325500913888146305, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1北京市顺义区中小学卫生保健所卫生科,北京 101300)]), AuthorCompany(id=1325500913972032388, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, xref=2, ext=[AuthorCompanyExt(id=1325500913980420997, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, companyId=1325500913972032388, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2北京市顺义区疾病预防控制中心学校卫生科)])], figs=[ArticleFig(id=1325500915846886308, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=EN, label=Fig.1, caption=Blood pressure and BMI trajectories among primary and secondary school students based on the GBTM model analysis, figureFileSmall=kmsiN+NFrgfPOAeQHbzXbQ==, figureFileBig=AKzWNe4Ma3iXf36BB2T9sA==, tableContent=null), ArticleFig(id=1325500915930772389, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=CN, label=图1, caption=基于GBTM模型分析的中小学生血压和BMI轨迹分组, figureFileSmall=kmsiN+NFrgfPOAeQHbzXbQ==, figureFileBig=AKzWNe4Ma3iXf36BB2T9sA==, tableContent=null), ArticleFig(id=1325500916123710374, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=EN, label=Fig.2, caption=Non-linear dose-response association of curves between long-term blood pressure and BMI levels with vision outcomes risk, figureFileSmall=LEkEb7XkaWAaGFUP+4l9Vg==, figureFileBig=wiLOzAl16WLfptekfL5zzA==, tableContent=null), ArticleFig(id=1325500916215985063, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=CN, label=图2, caption=中小学生长期平均血压和BMI水平与视力结局风险的非线性剂量反应关系, figureFileSmall=LEkEb7XkaWAaGFUP+4l9Vg==, figureFileBig=wiLOzAl16WLfptekfL5zzA==, tableContent=null), ArticleFig(id=1325500916299871144, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=EN, label=Tab.1, caption=

Comparison of vision screening results and comorbidity of myopia, high blood pressure and obesity results and trajectory group classifications of blood pressure and BMI among students of different genders

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性别人数近视、血压偏高、肥胖共患筛查性近视中重度视力不良长期收缩压轨迹分组
低增长轨迹组中增长轨迹组高维持轨迹组
男35 5501 834(5.2)19 185(54.0)18 555(52.2)18 014(50.7)13 380(37.6)4 156(11.7)
女33 543757(2.3)20 353(60.7)19 994(59.6)20 186(60.2)11 497(34.3)1 860(5.5)
合计69 0932 591(3.8)39 538(57.2)38 549(55.8)38 200(55.3)24 877(36.0)6 016(8.7)
χ2值402.72317.55384.521 084.90
P值< 0.01< 0.01< 0.01< 0.01
性别人数长期舒张压轨迹分组长期BMI轨迹分组
低增长轨迹组中增长轨迹组高维持轨迹组低增长轨迹组中增长轨迹组高维持轨迹组
男35 55026 743(75.2)7 925(22.3)882(2.5)18 366(51.7)12 286(34.6)4 898(13.8)
女33 54325 612(76.4)7 163(21.4)768(2.3)21 309(63.5)9 865(29.4)2 369(7.1)
合计69 09352 355(75.8)15 088(21.8)1 650(2.4)39 675(57.4)22 151(32.1)7 267(10.5)
χ2值12.501 305.83
P值< 0.01< 0.01
), ArticleFig(id=1325500916375368617, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=CN, label=表1, caption=

不同性别学生视力检出和近视、血压偏高、肥胖共患检出情况及血压与BMI轨迹分组情况比较

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性别人数近视、血压偏高、肥胖共患筛查性近视中重度视力不良长期收缩压轨迹分组
低增长轨迹组中增长轨迹组高维持轨迹组
男35 5501 834(5.2)19 185(54.0)18 555(52.2)18 014(50.7)13 380(37.6)4 156(11.7)
女33 543757(2.3)20 353(60.7)19 994(59.6)20 186(60.2)11 497(34.3)1 860(5.5)
合计69 0932 591(3.8)39 538(57.2)38 549(55.8)38 200(55.3)24 877(36.0)6 016(8.7)
χ2值402.72317.55384.521 084.90
P值< 0.01< 0.01< 0.01< 0.01
性别人数长期舒张压轨迹分组长期BMI轨迹分组
低增长轨迹组中增长轨迹组高维持轨迹组低增长轨迹组中增长轨迹组高维持轨迹组
男35 55026 743(75.2)7 925(22.3)882(2.5)18 366(51.7)12 286(34.6)4 898(13.8)
女33 54325 612(76.4)7 163(21.4)768(2.3)21 309(63.5)9 865(29.4)2 369(7.1)
合计69 09352 355(75.8)15 088(21.8)1 650(2.4)39 675(57.4)22 151(32.1)7 267(10.5)
χ2值12.501 305.83
P值< 0.01< 0.01
), ArticleFig(id=1325500916450866090, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=EN, label=Tab.2, caption=

Binary Logistic regression analysis of correlation of blood pressure and BMI trajectories with visual outcomes among primary and secondary school students derived from the GBTM model(n=69 093)

, figureFileSmall=null, figureFileBig=null, tableContent=
轨迹分组筛查性近视中重度视力不良
OR值(95%CI)P值OR值(95%CI)P值
收缩压
  低增长轨迹组1.001.00
  中增长轨迹组1.14(1.10~1.19)< 0.011.12(1.08~1.17)< 0.01
  高维持轨迹组1.11(1.03~1.19)0.011.12(1.04~1.21)< 0.01
舒张压
  低增长轨迹组1.001.00
  中增长轨迹组1.07(1.02~1.11)< 0.011.09(1.05~1.14)< 0.01
  高维持轨迹组1.19(1.05~1.36)0.011.17(1.03~1.32)0.01
BMI
  低增长轨迹组1.001.00
  中增长轨迹组1.06(1.02~1.10)< 0.011.08(1.04~1.12)< 0.01
  高维持轨迹组1.08(1.01~1.15)0.021.11(1.04~1.18)< 0.01
), ArticleFig(id=1325500916576695211, tenantId=1146029695717560320, journalId=1256213402557890569, articleId=1325500910780167034, language=CN, label=表2, caption=

基于GBTM模型的中小学生血压和BMI轨迹与视力结局关联性二分类Logistic回归分析(n=69 093)

, figureFileSmall=null, figureFileBig=null, tableContent=
轨迹分组筛查性近视中重度视力不良
OR值(95%CI)P值OR值(95%CI)P值
收缩压
  低增长轨迹组1.001.00
  中增长轨迹组1.14(1.10~1.19)< 0.011.12(1.08~1.17)< 0.01
  高维持轨迹组1.11(1.03~1.19)0.011.12(1.04~1.21)< 0.01
舒张压
  低增长轨迹组1.001.00
  中增长轨迹组1.07(1.02~1.11)< 0.011.09(1.05~1.14)< 0.01
  高维持轨迹组1.19(1.05~1.36)0.011.17(1.03~1.32)0.01
BMI
  低增长轨迹组1.001.00
  中增长轨迹组1.06(1.02~1.10)< 0.011.08(1.04~1.12)< 0.01
  高维持轨迹组1.08(1.01~1.15)0.021.11(1.04~1.18)< 0.01
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北京顺义区中小学生血压和体质量指数轨迹与视力结局关联
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刘斌 1 , 史杰 1 , 潘德静 1 , 赵瑞兰 *, 2
中国学校卫生 | 疾病控制 2025,46(2): 255-259
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中国学校卫生 |疾病控制 2025 , 46 (2) : 255 -259
北京顺义区中小学生血压和体质量指数轨迹与视力结局关联
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刘斌1, 史杰1, 潘德静1, 赵瑞兰*, 2
作者信息
  • 1北京市顺义区中小学卫生保健所卫生科,北京 101300
  • 2北京市顺义区疾病预防控制中心学校卫生科
通讯作者:
赵瑞兰,E-mail:
作者简介:

刘斌(1986-),男,北京市人,大学本科,主治医师,主要研究方向为学生常见病防控

Association of blood pressure and body mass index trajectory with visual outcomes among primary and secondary school students in Shunyi District of Beijing
Bin LIU1, Jie SHI1, Dejing PAN1, Ruilan ZHAO*, 2
Affiliations
  • 1Division of School Health, Primary and Secondary School Healthcare Center of Shunyi District, Beijing (101300), China
出版时间: 2025-02-25 doi: 10.16835/j.cnki.1000-9817.2025059
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目的

分析北京市顺义区7~17岁中小学生血压和体质量指数(BMI)轨迹,探讨不同类型生长轨迹与视力结局的关联,为儿童青少年常见病防控工作提供科学依据。

方法

对2019—2023年北京市顺义区中小学生健康体检数据(视力、血压、BMI)进行整理,运用群组轨迹模型拟合7~17岁学生BMI和血压轨迹分组,采用二分类Logistic回归分析模型分析生长轨迹与视力结局的关联。

结果

顺义区中小学生筛查性近视率为57.2%,中重度视力不良率为55.8%。根据潜变量增长模型,可将中小学生收缩压轨迹、舒张压轨迹和BMI轨迹均分为低增长轨迹组、中增长轨迹组和高维持轨迹组3组。Logistic回归分析显示,与低增长轨迹组相比,收缩压、舒张压、BMI中增长轨迹组和高维持轨迹组的筛查性近视发生风险均增加(OR值分别为1.14,1.11;1.07,1.19;1.06,1.08,P值均 < 0.05);收缩压、舒张压、BMI中增长轨迹组和高维持轨迹组的中重度视力不良发生风险均增加(OR值分别为1.12,1.12;1.09,1.17;1.08,1.11,P值均 < 0.05)。

结论

血压和BMI中增长轨迹、高维持轨迹增加中小学生筛查性近视和中重度视力不良风险。应密切关注中小学生血压和超重肥胖轨迹变化,开展定期监测,积极预防学生多病共患的发生发展。

血压  /  人体质量指数  /  近视  /  回归分析  /  学生
Objective

To analyze the trajectories of blood pressure and body mass index (BMI) among primary and secondary school students aged 7-17 in Shunyi District of Beijing, and to explore the association between different growth trajectories and visual outcomes, so as to provide a scientific basis for the prevention and control of common diseases in children and adolescents.

Methods

Health examination data (including vision, blood pressure and BMI) of primary and secondary school students in Shunyi District of Beijing from 2019 to 2023 were collected and analyzed. Group-based trajectory modeling was used to classify the trajectories of BMI and blood pressure (systolic and diastolic) into distinct groups among students aged 7-17 years. The relationship between these trajectories and visual outcomes was examined using binary Logistic regression analysis.

Results

The prevalence of screening myopia among students in Shunyi District was 57.2%, while the rate of moderate to severe visual impairment was 55.8%. Based on the latent growth model, the trajectories of systolic blood pressure, diastolic blood pressure, and BMI were divided into three groups: low-growth trajectory, moderate-growth trajectory and high-maintenance trajectory. Logistic regression analysis revealed that, compared to the low-growth trajectory group, the moderate-growth and high-maintenance trajectory groups for systolic blood pressure, diastolic blood pressure, and BMI were associated with an increased risk of screening myopia (OR=1.14, 1.11; 1.07, 1.19; 1.06, 1.08, P < 0.05). Similarly, the moderate-growth and high-maintenance trajectory groups for systolic blood pressure, diastolic blood pressure, and BMI were similarly associated with an increased risk of moderate to severe visual impairment (OR=1.12, 1.12; 1.09, 1.17; 1.08, 1.11, P < 0.05).

Conclusions

Moderate-growth and high-maintenance trajectories of blood pressure and BMI are associated with an increased risk of screening myopia and moderate to severe visual impairment among students. It is recommended to closely monitor changes in blood pressure and overweight/obesity trajectories in primary and secondary school students, conduct regular assessments, and actively prevent the development and progression of multimorbidity and comorbidity.

Blood pressure  /  Body mass index  /  Myopia  /  Regression analysis  /  Students
刘斌, 史杰, 潘德静, 赵瑞兰. 北京顺义区中小学生血压和体质量指数轨迹与视力结局关联. 中国学校卫生, 2025 , 46 (2) : 255 -259 . DOI: 10.16835/j.cnki.1000-9817.2025059
Bin LIU, Jie SHI, Dejing PAN, Ruilan ZHAO. Association of blood pressure and body mass index trajectory with visual outcomes among primary and secondary school students in Shunyi District of Beijing[J]. Chinese Journal of School Health, 2025 , 46 (2) : 255 -259 . DOI: 10.16835/j.cnki.1000-9817.2025059
视力不良是儿童青少年常见病,包含近视、远视、散光等,而近视占比最高,达85.0%[1]。我国儿童青少年近视发病率呈逐年上升的高发态势,且已成为全球近视患病率最高的国家之一[2-3]。2022年我国儿童青少年近视检出率高达51.9%[4],防控形势十分严峻。有报道显示,7~18岁学生群体中22.9%存在肥胖、营养不良、血压偏高和近视多病共患现象[5-6]。为此,本研究通过分析2019—2023年间北京市顺义区学生血压和体质量指数(body mass index, BMI)变化轨迹,探讨不同生长轨迹与视力结局的关联及共患现状,为儿童青少年常见病防控工作提供科学依据。
通过北京市中小学健康信息管理系统,导出2019—2023年间顺义区中小学生健康体检数据,同时排除体检数据不足2次、血压和BMI指标测量不足2次、血压和BMI异常值、视力评价数据缺失后,最终纳入69 093名学生为研究对象。其中男生35 550名,女生33 543名;年龄7~17岁,年龄中位数为11.0(9.0,13.0)岁。本调查已获得所有学生及其家长的知情同意,并通过北京市顺义区疾病预防控制中心伦理委员会审查(批件号:2024032802)。
学生身高、体重、血压、屈光度的测量均由统一培训的专业人员依据《学生健康检查技术规范》(GB/T 26343—2010)[7]完成,超重肥胖依据《学龄儿童青少年超重与肥胖筛查》(WS/T 586—2018)[8]进行判定;血压偏高依据《7岁~18岁儿童青少年血压偏高筛查界值》(WS/T 610—2018)[9]进行判定,筛查性近视和视力不良依据《中小学生屈光不正筛查规范》(WS/T 663—2020)[10]进行判定,其中屈光度检测在非睫状肌麻痹状态下测定。
筛查性近视:筛查标准为单眼或双眼裸眼视力 < 5.0且非睫状肌麻痹下电脑验光等效球镜度(spherical equivalent refraction, SE) < -0.50 D,判定为筛查性近视[10]。视力不良:6岁以上儿童青少年裸眼视力低于5.0,其中视力4.9为轻度视力不良,4.6~4.8为中度视力不良,≤4.5为重度视力不良[11]。同一个体同时存在近视、血压偏高、肥胖3种学生常见病,即为学生常见病共患。
依据《学生健康检查技术规范》(GB/T 26343—2010)[7]对所有参加体检工作的专业人员进行统一培训,考核合格者方可上岗;体检所用仪器设备均经检测机构认证合格;对入校专业机构进行审核, 并选取5%的学生进行现场复核;体检数据采用双录入方式进行核查。
采用SAS 9.4软件进行统计分析。连续性变量采取中位数和四分位数描述;分类变量采取频数和百分率描述,采用χ2检验进行单因素分析比较。采取群组轨迹模型(group-based trajectory modeling,GBTM)的统计方法,对血压和BMI的重复测量数据进行分析。该方法假定总体人群由不同亚组构成,而每一个亚组代表一种纵向生长发育轨迹。通过预设一定的先验参数(轨迹组数量),GBTM基于极大似然估计(maximum likelihood estimation,MLE)计算出每个个体隶属于不同轨迹分组的后验概率,并将后验概率最大的轨迹组确定为该个体的轨迹分组。本研究通过评估模型拟合指标,包括赤池信息准则(akaike information criterion,AIC)和贝叶斯信息准则(bayesian information criterion,BIC),同时参考既往文献[12],综合确定最优轨迹组数量为3组。考虑到GBTM能够处理重复测量资料中的缺失数据,本研究并未采取额外的填补方法,只纳入血压和BMI重复测量次数≥2次的研究对象。
针对GBTM模型识别得到的血压和BMI轨迹分组,进一步将其作为暴露因素,采取二分类Logistic回归模型,分析轨迹分组变量与视力结局的关联性。模型同时调整其他的协变量,包括年龄、性别、学段、疾病史、肺功能评价、贫血评价、心脏评价和脊柱评价。此外,本研究也将每个个体的长期平均血压和BMI水平作为暴露因素,直接采取二分类Logistic回归分析其与视力结局的关系,并基于限制性立方样条(restricted cubic spline,RCS)曲线建模方法,绘制剂量反应关系曲线图。双侧检验水准α=0.05。
收缩压组别中,36.0%的学生在5年内观察期轨迹增长适中,定义为中增长轨迹组;55.3%的学生轨迹增长幅度低且平缓,定义为低增长轨迹组;8.7%的学生收压缩轨迹水平较高,定义为高维持轨迹组。舒张压组别中,21.8%的学生轨迹增长适中,定义为中增长轨迹组;75.8%的学生轨迹增长幅度低且平缓,定义为低增长轨迹组;2.4%的学生舒张压整体水平较高,定义为高维持轨迹组。BMI轨迹组别中,32.1%学生的BMI轨迹增长适中,定义为中增长轨迹组;57.4%学生的BMI轨迹整体较低且上升平缓,定义为低增长轨迹组;10.5%学生的BMI轨迹整体水平较其他组别高,定义为高维持轨迹组。见表1,图1。
中小学生中重度视力不良率为55.8%,男、女生分别为52.2%和59.6%;中小学生筛查性近视率为57.2%,男、女生分别为54.0%和60.7%;中小学生近视、血压偏高和肥胖共患率为3.8%,男、女生分别为5.2%和2.3%,差异均有统计学意义(P值均 < 0.01)。不同性别中小学生在不同长期收缩压、舒张压、BMI轨迹分组的分布差异均有统计学意义(P值均 < 0.01)。见表1。
以筛查性近视和中重度视力不良(分别以无筛查性近视和无中重度视力不良为参照)为因变量,以长期收缩压、舒张压、BMI轨迹分组为自变量(以低增长轨迹组为参照)进行二分类Logistic回归分析。筛查性近视结局方面,收缩压、舒张压及BMI中增长轨迹组、高维持轨迹组的筛查性近视概率均更高(P值均 < 0.05)。在中重度视力不良结局方面,收缩压、舒张压及BMI中增长轨迹组、高维持轨迹组视力不良概率均更高(P值均 < 0.05),见表2。最后,从长期平均血压和BMI角度的分析也表明,越高的长期平均血压水平和BMI水平,均与更高的筛查性近视和中重度视力不良风险相关联,且整体上呈现非线性的关联曲线。见图2。
近视、超重肥胖、血压偏高等是我国儿童青少年面临的主要健康问题。本研究结果显示,顺义区7~17岁学生筛查性近视率为57.2%,中重度视力不良率为55.8%,近视、肥胖和血压偏高共患检出率为3.8%,低于上海市的9.19%[13],高于内蒙古的1.14%[14],可能与地区、民族构成、饮食结构差异有关。
本研究基于纵向重复测量资料,运用群组动态轨迹模型的方法,充分探索了血压和BMI随时间的潜在变化模式,并识别出潜在轨迹分组,发现血压和BMI中高轨迹的儿童青少年更易发生筛查性近视和中重度视力不良。越来越多的证据表明生命早期体格发育与学龄儿童屈光不正相关[15]。血压偏高与近视发生显著相关,可能是因为长期的血压波动或维持在较高水平而影响眼部的血流供应和代谢,进而影响视力[16]。
此外,血压的异常也可能与过量饮食、缺少运动相关[17],这些因素也间接影响视力。BMI与高度近视的发生存在显著关联,超重或肥胖的学生更易发生近视[18],并且肥胖与血管宽度参数(更宽的静脉、更窄的小动脉、更低的动静脉比率)相关,肥胖儿童黄斑视网膜厚度、脉络膜厚度和视网膜血管密度也有变化[19]。相关机制可能为BMI越高,摄取的饱和脂肪酸越多,进而增加游离的胰岛素生长因子结合蛋白,进而引起巩膜纤维的延长,增加眼轴长度引起近视的进展[20]。与Duan等[21]研究不同,本研究将识别出的纵向轨迹分组作为暴露因素,确定了学生群体中存在血压和BMI随时间逐步升高或维持的潜在发展趋势,且这种趋势与筛查性近视和视力不良概率增加存在关联性。此外,长期血压和BMI水平与视力不良风险的非线性关联表明,随着血压和BMI水平的升高,视力不良的风险并非线性增加,可能存在一定的阈值效应。提示在预防和干预视力不良时,需要综合考虑血压和BMI的水平,并采取针对性的措施。
上海、西安等多地研究结果均表明,中小学生多病共患的特征已经凸显[12, 22-23]。同时也发现学生常见病的发生往往具备共同病因[24],其中视屏时间过长[25]、户外活动时间过短[26]、持续近距离用眼时间增多[27]、不良姿势久坐[28]和不良饮食行为[29-30]为主要危险因素。因此,通过开展共同病因干预,可降低常见病的发生风险。
本研究也存在一定局限性:第一,关联研究无法验证因果关系;第二,受检查项目限制,研究的回归模型仅调整了基本的人口学信息, 未涉及其他混杂因素如家族性近视与肥胖情况、饮食情况、运动情况以及用眼习惯等, 需要在今后的研究中进一步完善。
综上,学生近视和中重度视力不良是多因素导致的结果,需要对共同风险因素干预,实施综合防控措施:一是学生群体中存在血压和BMI随时间逐步升高或维持的潜在发展趋势,且这种趋势与近视和中重度视力不良概率增加存在相关性,提示今后需在超重肥胖、血压偏高的学生群体中强化近视防控工作;二是强化政府主导、推动教育和卫生部门协同合作,大力构建家庭-学校-社会三位一体的健康管理格局,通过倡导健康生活方式、改善学校健康环境和促进学生健康行为养成开展防控工作[5];三是强化监测预警,落实健康体检和视力监测制度[31],建立多病共防重点防控档案并开展针对性干预;四是对已明确有近视、肥胖等共患情况的学生及时督促开展诊疗,积极跟进筛查和转诊档案,确保防控工作的科学性和高效性。
  • 首都卫生发展科研专项项目(2024-2G-7107)
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2025年第46卷第2期
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doi: 10.16835/j.cnki.1000-9817.2025059
  • 接收时间:2024-12-12
  • 首发时间:2026-11-06
  • 出版时间:2025-02-25
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  • 收稿日期:2024-12-12
  • 修回日期:2025-01-02
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首都卫生发展科研专项项目(2024-2G-7107)
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    1北京市顺义区中小学卫生保健所卫生科,北京 101300
    2北京市顺义区疾病预防控制中心学校卫生科

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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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