目的：以睫状肌麻痹下检影验光结果作为屈光参差诊断的金标准，比较双眼裸眼远视力(UCDVA)、自然瞳孔下电脑验光等效球镜度(PR-SE)、眼轴长度(AL)差值及其不同组合在儿童青少年屈光参差筛查中的诊断效能，评估不同指标组合在简化筛查流程中的实用价值。

方法：回顾性研究。纳入6-18岁屈光状态连续病例500例。以睫状肌麻痹下检影验光结果作为屈光参差诊断金标准，将双眼UCDVA、PR-SE、AL差值纳入ROC曲线，分析各指标的诊断效能。构建预测模型并进行可靠性分析。

结果：纳入病例平均年龄10.75±2.24岁； 其中男239例，女261例。病例双眼PR-SE差值曲线下面积AUC(0.972，95%CI：0.960-0.984)显著高于其他指标。当双眼UCDVA差值为0.25、PR-SE差值为0.743、AL差值为0.31时，Youden指数最大。双眼PR-SE差值以0.743、1.00 D作为筛查界值时，前者AUC更高(AUC=0.924，95%CI：0.895-0.953)。通过构建不同预测模型比较发现：双眼PR-SE差值≥0.743 D时阴性预测值达98.89%，适合初筛。UCDVA+PR-SE+AL组合特异度和阳性预测值最高，PR-SE+AL组合一致率最高。

结论：双眼PR-SE差值是单指标筛查的最佳选择，联合UCDVA+AL可提升特异度至98.00%，阳性预测值至88.24%。PR-SE+AL组合可获得最高的一致率。

METHODS: This was a retrospective study. A total of 500 consecutive cases of children and adolescents aged 6-18 years with known refractive status were included. Taking cycloplegic retinoscopy results as the gold standard for anisometropia diagnosis, the binocular UCDVA, PR-SE, and AL difference were incorporated into ROC curve analysis to assess the diagnostic efficacy of each indicator. Furthermore, predictive models were constructed and reliability analysis was performed.

RESULTS: The average age of the included cases was 10.75±2.24 years, including 239 males and 261 females. The AUC of the interocular PR-SE difference(0.972, 95%CI: 0.960-0.984)was significantly higher than that of other indicators. The Youden index was the largest when the bincular UCDVA difference was 0.25, the PR-SE difference was 0.743, and the AL difference was 0.31. When the interocular PR-SE difference used 0.743 and 1.00 D as screening cutoffs, the former had a higher AUC(AUC=0.924, 95%CI: 0.895-0.953). Comparison of different constructed predictive models showed that when the binocular PR-SE difference was ≥0.743 D, the negative predictive value reached 98.89%, making it suitable for initial screening. The combination of UCDVA+PR-SE+AL had the highest specificity and positive predictive value, while the PR-SE+AL combination had the highest consistency rate.

CONCLUSION: The binocular PR-SE difference is the best choice for single-indicator screening. Combining UCDVA and AL can increase the specificity to 98.00% and the positive predictive value to 88.24%. The PR-SE+AL combination can achieve the highest consistency rate.