中小学生高度近视发生风险预测模型:基于巢式病例对照研究  

Risk Prediction Model for High Myopia in Primary and Secondary School Students:Based on Nested Case-control Study

作　　者：陈胜蓝 郑永韬 胡旺成 倪作为 夏冰[3] 叶春梅 杜持新[2] 陈晓丹[2] CHEN Shenglan;ZHENG Yongtao;HU Wangcheng;NI Zuowei;XIA Bing;YE Chunmei;DU Chixin;CHEN Xiaodan(Department of Surveillance,Xiaoshan District Center for Disease Control and Prevention,Hangzhou 310000,China;Nursing Department,the First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Quality Control,Zhejiang Xiaoshan Hospital,Hangzhou 310000,China;Department of Immunization Planning and Management,Linping District Center for Disease Control and Prevention,Hangzhou 310000,China)

机构地区：[1]浙江省杭州市萧山区疾病预防控制中心监测科,310000 [2]浙江大学医学院附属第一医院护理部,浙江省杭州市310000 [3]浙江萧山医院质管科,浙江省杭州市310000 [4]浙江省杭州市临平区疾病预防控制中心免疫规划管理科,310000

出　　处：《中国全科医学》2025年第9期1115-1121,共7页Chinese General Practice

基　　金：浙江省自然科学基金重点项目(LZ24H120002);浙江省教育厅一般科研项目(Y202354011)。

摘　　要：背景中小学生由于学习压力、电子产品普及以及不良用眼习惯,视力健康问题日益严重,成为近视的高发群体,高度近视作为近视的严重阶段,已成为全球范围内的公共卫生问题。尽管现有诸多研究对近视的危险因素进行了探讨,但鲜有研究针对性阐明风险因素与高度近视发生的复杂非线性关系,本研究结合巢式病例对照研究和限制性立方样条,开发一个中小学生高度近视风险预测模型,通过早期识别高风险个体,延缓或阻止高度近视的发展,实现近视的三级预防,对中小学生的学业和生活质量有积极意义。目的探究中小学生高度近视的流行现状及危险因素,构建风险预测模型,为中小学生高度近视防控提供科学依据。方法采用巢式病例对照研究,于2023年选取杭州市12所学校中度近视的学生作为研究对象建立队列,按照全国学生常见病和健康影响因素监测与干预工作方案,对纳入研究的中小学生开展近视状况监测,研究期间进展为高度近视的中小学生作为高度近视发生组,其余未进展为高度近视的中小学生作为对照组,对两组研究对象开展视力保健行为进行调查。采用Lasso回归筛选特征变量后进行多因素Logistic回归分析探究中小学生高度近视发生的影响因素,并采用列线图对风险预测模型可视化,同时采用Hosmer-Lemeshow检验、受试者工作特征(ROC)曲线、Calibration曲线、决策曲线分析(DCA)对模型性能进行评估,最后采用限制性立方样条进一步明确年龄与高度近视发生风险的关系。结果12所中小学校共纳入2468名学生,未进展为高度近视的学生1293名,中度近视进展为高度近视的学生1175名,高度近视发生率为47.61%(1175/2468)。两组学生年龄、年级、BMI、每日入睡时间、地区、户外活动时间、电子产品使用时间、课后作业时间、家用台灯比较,差异有统计学意义(P<0.05)。Lasso回归筛Background The vision health of primary and secondary school students has become a growing concern due to increasing academic pressure,the widespread use of electronic devices,and poor eye care habits.High myopia,as an advanced stage of myopia,emerging as a global public health issue.While many existing studies have explored the risk factors for myopia,few have specifically addressed the complex non-linear relationships between these factors and the development of high myopia.This study combines a nested case-control study with restricted cubic splines to develop a risk prediction model for high myopia in primary and secondary school students.By identifying high-risk individuals early,this model aims to delay or prevent the progression of high myopia,contributing to tertiary prevention of myopia,and positively impacting the academic and life quality of students.Objective To investigate the prevalence and risk factors of high myopia in primary and secondary school students,and conduct a risk prediction model to provide a scientific basis for myopia prevention.Methods A nested case-control study was conducted in 2023,involving students with moderate myopia from 12 schools in Hangzhou to establish a cohort.Myopia status among the students was monitored in accordance with the National Monitoring and Intervention Program for Common Diseases and Health-Related Factors in Students.Students who progressed to high myopia were classified as the case group,while the others formed the control group,vision care behaviors were surveyed for both groups.Lasso regression was used to select feature variables,followed by multivariate logistic regression analysis to identify factors influencing the development of high myopia among primary and secondary school students.A Nomogram was employed to visualize the risk prediction model.The model's performance was evaluated using the Hosmer-Lemeshow test,receiver operating characteristic(ROC)curve,calibration curve,and decision curve analysis(DCA).Additionally,restricted cubic splines were

关 键 词：近视 学生 高度近视 巢式病例对照研究 限制性立方样条 预测模型 

分 类 号：R778.11[医药卫生—眼科]