目的：探究上海市杨浦区幼儿园中班到高三儿童青少年散光现状与相关因素，为屈光不正防控工作提供科学性参考。
方法：采用整群抽样方法，于2024年9月至11月在上海市杨浦区随机选择14所学校的在校学生为研究对象，在非睫状肌麻痹条件下测量电脑验光和眼生物测量仪，并完成问卷调查。比较不同年龄、不同学段以及性别的散光程度、检出率和轴向的差异，使用多元线性和逻辑回归来分析与散光相关的因素。
结果：纳入7 233名4-18岁学生中男3 731名，女3 502名，平均年龄10.13±4.18岁，散光-0.76±0.82 D，≤-1.00 D检出率为29.23%，散光的程度和检出率与年龄或学段有关，高中阶段达到峰值，小学阶段变化最为明显； 除年龄外，散光屈光度还受到球镜度数(β=0.105，P<0.001)、平均角膜曲率(β=-0.118，P<0.001)、性别(以男生为参照，女生β=0.054，P<0.001)、经常持续用眼30-40 min(以“几乎没有”为参照，β=-0.030，P=0.038)、早产(β=-0.023，P=0.044)、母亲近视(β=-0.028，P=0.020)，休息日完成作业时间(β=-0.035，P=0.041)的影响； 散光检出率受到母亲近视(OR=1.130，P=0.039)、男生(OR=0.773，P<0.001)、学习日睡眠时间较短(OR=0.909，P=0.028)、休息日睡眠时间较短(OR=0.937，P=0.046)、早产(OR=1.382，P=0.012)、经常过度低头(OR=1.216，P=0.045)、休息日完成作业时间(OR=1.043，P=0.046)、球镜度数高(OR=0.891，P<0.001)以及较高平均角膜曲率(OR=1.188，P<0.001)的影响。
结论：上海市杨浦区幼儿园到高中儿童青少年散光的程度和检出率与学段有关，小学可能为散光防控的关键时期。男性、母亲近视、早产、高强度近距离工作与睡眠不足等可能与散光的发生发展有关。建议教育及卫生部门在小学阶段加强视觉健康筛查； 同时，在不同学段中推广科学用眼与充足睡眠等行为干预，以延缓散光的发生与发展。
AIM:To investigate the current status of astigmatism and its associated factors among children and adolescents from kindergarten through senior high school in Yangpu District, Shanghai, and to provide scientific evidence for the prevention and control of refractive errors.
METHODS:A cluster sampling method was employed. From September to November 2024, students from 14 randomly selected schools in Yangpu District, Shanghai, were enrolled as study subjects. Autorefraction and ocular biometry were performed under non-cycloplegic conditions, and questionnaire surveys were administered. Comparisons of astigmatism degree, detection rate, and axis were made across age groups, educational stages, and sexes. Multiple linear and logistic regression analyses were conducted to identify factors associated with astigmatism.
RESULTS:A total of 7 233 students aged 4-18 y were enrolled including 3 731 males, 3 502 females, with the mean age 10.13±4.18 y, astigmatism -0.76±0.82 D, and the detection rate(≤-1.00 D)was 29.23%. Both the degree and detection rate of astigmatism were correlated with age and educational stage, peaking in senior high school, with the most pronounced changes observed during primary school. Besides age, astigmatic refractive power was influenced by spherical equivalent(β=0.105, P<0.001), mean keratometry(β=-0.118, P<0.001), sex(with boys as the reference, girls: β=0.054, P<0.001), frequent sustained near work for 30-40 min(with “almost never” as the reference, β=-0.030, P=0.038), preterm birth(β=-0.023, P=0.044), maternal myopia(β=-0.028, P=0.020), and homework completion time on rest days(β=-0.035, P=0.041). The detection rate of astigmatism was associated with maternal myopia(OR=1.130, P=0.039), male sex(OR=0.773, P<0.001), shorter sleep duration on school days(OR=0.909, P=0.028), shorter sleep duration on rest days(OR=0.937, P=0.046), preterm birth(OR=1.382, P=0.012), frequent excessive head lowering(OR=1.216, P=0.045), homework completion time on rest days(OR=1.043, P=0.046), higher spherical equivalent(OR=0.891, P<0.001), and higher mean keratometry(OR=1.188, P<0.001).
CONCLUSION:The degree and detection rate of astigmatism among children and adolescents from kindergarten to senior high school in Yangpu District, Shanghai are correlated with educational stage, and primary school may represent a critical period for astigmatism prevention and control. Male sex, maternal myopia, preterm birth, high-intensity near work, and insufficient sleep and other factors may be associated with the onset and progression of astigmatism. It is recommended that education and health departments strengthen visual health screening during primary school, while promoting behavioral interventions such as scientific eye-use habits and adequate sleep across different educational stages to delay the onset and progression of astigmatism.
