眼轴与角膜曲率半径比值在学龄前儿童近视评估中的诊断价值  

Diagnostic value of axial length to corneal radius ratio in myopia assessment of preschool children

作　　者：侯锦 张宛侠 焦永红 米雪景 陈巍[2] 浦佳宁 马张芳 Hou Jin;Zhang Wanxia;Jiao Yonghong;Mi Xuejing;Chen Wei;Pu Jianing;Ma Zhangfang(Beijing Tongren Eye Center,Beying Tongren Hospital,Capital Medical University,Beiing Key Laboratory of Ophthalmology and Visual sciences,Beijing 100730,China;Haidian District Maternal and Child Health Care Hospital,Beijing 100080,China)

机构地区：[1]首都医科大学附属北京同仁医院,北京同仁眼科中心,眼科学与视觉科学北京市重点实验室,北京100730 [2]北京市海淀区妇幼保健院,北京100080

出　　处：《眼科》2025年第1期36-39,共4页Ophthalmology in China

基　　金：首都卫生发展科研专项(首发2024-2G-2057)。

摘　　要：目的探究眼轴与角膜曲率半径比值在3~6岁学龄前儿童近视评估中的诊断价值。设计横断面研究。研究对象采用整群抽样法选取2020年12月至2021年8月就读于北京市海淀区27所幼儿园的1878名3~6岁的儿童作为研究人群。方法所有受试儿童双眼睫状肌麻痹后验光检查,记录等效球镜度数(SE),采用光学相干生物测量仪测量眼轴(AL)、角膜曲率(K),并计算角膜曲率半径(CR)和轴率比(AL/CR)。以SE≤-0.50 D为近视诊断标准,AL/CR>3为可疑近视。数据行正态性检验,秩相关分析,采用受试者工作特征(ROC)曲线分析AL/CR对3~6岁儿童近视的预测效能。主要指标SE、AL/CR、灵敏度、特异度、ROC曲线下面积。结果SE与AL/CR均呈正态分布,平均SE为(1.15+0.94)D,AL/CR为(2.86+0.07)。相关性分析显示,SE与AL/CR呈负相关(r=-0.324,P<0.01)。以SE≤-0.50 D为金标准,AL/CR>3诊断近视的灵敏度为0.375,特异度为0.985,准确度95.7%,Kappa系数为0.956,ROC曲线下面积为0.862。当AL/CR=2.928时,Youden指数最大,其诊断近视的灵敏度为73.90%,特异度为85.30%。结论AL/CR在学龄前儿童近视诊断方面具有较高的特异度和准确度,对预测近视的发生具有一定的临床价值。Objective To investigate the diagnostic value of the axial length-to-corneal radius(AL/CR)ratio for assessing myopia in preschool children aged 3 to 6 years.Design A cross-sectional study.Participants Cluster sampling was used to select 1878 children aged 3 to 6 years from 27 kindergartens in Haidian District,Beijing from December 2020 to August 2021.Methods After cycloplegia,refraction was measured in both eyes to determine the spherical equivalent(SE).Axial length(AL)and corneal curvature(K)were measured using optical biometry,with the corneal radius(CR)and the axial length-to-corneal radius ratio(AL/CR)calculated.Myopia was defined as SE≤-0.50 D,and AL/CR>3 was considered indicative of suspected myopia.Data were analyzed using normality tests,rank correlation analysis,and receiver operating characteristic(ROC)curves to evaluate the predictive value of AL/CR for myopia in children aged 3 to 6 years.Main Outcome Measures SE,AL/CR,sensitivity,specificity,and the area under the ROC curve.Results Both SE and AL/CR values followed a normal distribution,with average SE at(1.15±0.94)D and average AL/CR at(2.86±0.07).Correlation analysis revealed a negative association between SE and AL/CR(r=-0.324,P<0.01).Compared with the results from cycloplegic refraction(SE≤-0.50 D),the sensitivity of the AL/CR ratio>3 for diagnosing myopia was 0.375,with a specificity of 0.985,an accuracy of 95.7%,and a Kappa coefficient of 0.956.The area under the ROC curve was 0.862.At an AL/CR cutoff of 2.928,the Youden index was maximized,yielding a sensitivity of 73.90%and a specificity of 85.30%for diagnosing myopia.Conclusion The AL/CR ratio demonstrates high specificity and accuracy in diagnosing myopia in preschool children,indicating its significant clinical value for predicting the onset of myopia.

关 键 词：近视 学龄前儿童 眼轴 AL/CR 比值 ROC 曲线 

分 类 号：R778.11[医药卫生—眼科]