目的： 调查毕节市儿童青少年2021年至2025年近视流行特征及变化趋势，为制定区域近视防控策略提供科学依据。

方法：纵向横断面研究。采用分层整群抽样方法从毕节市各区县城乡学校抽取48所小学、25所中学、8所高中在校学生，于2021年至2025年每年进行裸眼视力、戴镜视力、角膜曲率、屈光度、眼轴长度、眼底等检查，同时采用问卷收集视觉健康影响因素相关信息。近视定义为电脑验光等效球镜度(SE)≤-0.50 D。采用多因素Logistic回归模型分析儿童青少年近视状况及影响因素。

结果：2021年至2025年，经年龄、性别构成标准化后毕节地区儿童青少年近视率分别为42.37%、44.57%、47.32%、49.98%、52.91%，呈现逐年显著上升趋势(P<0.001)，整体近视患病率为47.61%。随着学段增高，近视率增高(P<0.001)； 5 a间女生近视率均高于男生(P<0.001)。多因素Logistic回归分析发现，性别(女vs男：OR=1.17，95%CI：1.15-1.19)、学段(初中vs小学，OR=2.14，95%CI：2.09-2.19； 高中vs小学，OR=3.60，95%CI：3.53-3.68)、每日户外活动时长<2 h(OR=3.25，95%CI：2.98-3.54)、父母双方均近视(OR=2.87，95%CI：2.63-3.13)、每日近距离用眼时间≥4 h(OR=2.56，95%CI：2.35-2.79)、电子产品使用时间≥2 h/d(OR=2.18，95%CI：2.01-2.37)、读写姿势不正确(OR=3.94，95%CI：3.87-4.02)、喀斯特地貌区(OR=1.32，95%CI：1.18-1.48)、学校视力筛查无专业设备(OR=1.27，95%CI：1.15-1.41)是影响近视的危险因素(均P<0.001)。

结论： 2021年至2025年，毕节市儿童青少年近视率呈逐年上升趋势，近视防控形势较严峻，具有低龄化、高度近视化趋势，需构建政府主导、多部门协作、学校家庭联动的防控体系，针对性开展健康宣教与干预措施。

METHODS:This was a longitudinal cross-sectional study. Stratified cluster sampling method was used to select students from 48 primary schools, 25 middle schools, and 8 high schools from urban and rural districts and counties of Bijie. From 2021 to 2025, annual examinations were performed, including uncorrected visual acuity, corrected visual acuity, corneal curvature, refractive error, axial length, and fundus examination. Questionnaires were also administered to collect information on visual health-related influencing factors. Myopia was defined as spherical equivalent refraction(SE)≤-0.50 D under non-cycloplegic autorefraction. The multivariate logistic regression model was used to analyze the myopia status and its influencing factors among children and adolescents.

RESULTS: From 2021 to 2025, the age- and sex-standardized myopia prevalence rates among children and adolescents in Bijie were 42.37%, 44.57%, 47.32%, 49.98%, and 52.91%, respectively, showing a significant upward trend year by year(P<0.001). The overall standardized myopia prevalence rate was 47.61%. The myopia rate increased with higher educational stage, and the differences were statistically significant(P<0.001). The myopia rates in girls were higher than those in boys over the 5 y, with statistically significant differences(P<0.001). Multivariable logistic regression analysis identified gender(female vs male: OR=1.17, 95%CI: 1.15-1.19), school stage(junior high school vs primary school: OR=2.14, 95%CI: 2.09-2.19; senior high school vs primary school: OR=3.60, 95%CI: 3.53-3.68), daily outdoor activity time <2 h(OR=3.25, 95%CI: 2.98-3.54), both parents with myopia(OR=2.87, 95%CI: 2.63-3.13), daily near work time ≥4 h(OR=2.56, 95%CI: 2.35-2.79), electronic screen use ≥2 h/d(OR=2.18, 95%CI: 2.01-2.37), incorrect reading and writing posture(OR=3.94, 95%CI: 3.87-4.02), residence in a karst landform region(OR=1.32, 95%CI: 1.18-1.48), and absence of professional equipment in school vision screening(OR=1.27, 95%CI: 1.15-1.41)as risk factors for myopia(all P<0.001).

CONCLUSION: From 2021 to 2025, the myopia rate among children and adolescents in Bijie shows an increasing trend, indicating a severe situation for myopia prevention and control, with tendencies toward younger age of onset and higher myopia. It is necessary to establish a prevention and control system led by the government, with multi-departmental collaboration and school-family linkage, and to carry out targeted health education and intervention measures.