目的：探讨学龄前儿童近视的影响因素，为学龄前儿童的近视防治提供依据。

方法：回顾性病例对照研究。纳入2021年9月至2023年9月于青岛大学附属医院眼科就诊的学龄前儿童168人168眼(选取视力较差眼入组； 双眼视力相同时，选取右眼入组)。分组标准：电脑验光结果等效球镜>0 D且视力为该年龄段正常视力(3-5岁≥0.5； 6-7岁≥0.7)儿童直接纳入非近视组； 电脑验光结果等效球镜<0 D儿童使用1%硫酸阿托品凝胶散瞳，每天3次，连续使用3 d，散瞳后进行睫状肌麻痹验光若等效球镜≤-0.50 D且视力无法达到该年龄的正常视力(3-5岁<0.5； 6-7岁<0.7)纳入近视组，每组各84人84眼。所有儿童均进行视力、眼压、验光、眼生物学参数的测量，并在就诊时由父母或其监护人填写影响因素问卷调查，内容包括每日户外活动时长、每日单次电子设备使用及读写时长、父母近视度数及近视年龄、分娩方式、是否足月。

结果：两组儿童裸眼视力、球镜、等效球镜、眼轴比较均有差异(均P<0.05)。两组儿童每日睡眠时间、每日睡眠时长、每日单次作业读书时长、分娩方式、是否足月比较均无差异(均P>0.05)，每日户外活动时长、每日单次电子设备使用时长、母亲近视度数、父亲近视度数、母亲近视年龄、父亲近视年龄比较均有差异(均P<0.05)。Logsitic回归分析结果显示每日户外活动不足2 h、每日单次电子设备使用时间超过60 min、母亲近视度数、母亲近视年龄、父亲患有高度近视以及父亲为早发性近视均是影响学龄前儿童近视风险增加的因素。儿童性别与近视影响因素对学龄前儿童等效球镜的交互作用分析显示父亲近视度数、母亲近视年龄、父亲近视年龄与儿童性别对学龄前儿童等效球镜的交互作用显著(P<0.05)，进一步简单效应分析结果显示如果父亲为早发性近视或母亲为早发性近视或父亲为高度近视家庭中的女孩近视程度均高于男孩(P<0.05)。

结论：每日户外活动时长低于1 h、每日单次电子产品使用超过60 min、父母近视均为影响学龄前儿童发生近视的因素。女孩的屈光状态与父母屈光情况有关。

METHODS:This is a retrospective case-control study. A total of 168 preschool-aged children(168 eyes)were enrolled from the ophthalmology department at Affiliated Hospital of Qingdao University between September 2021 and September 2023, selecting the eye with poorer vision for inclusion; the right eye was selected when both eyes had equal vision. Grouping criteria: Children with spherical equivalent(SE)>0 D and age-appropriate normal visual acuity(≥0.5 for ages 3-5; ≥0.7 for ages 6-7)were directly assigned to the non-myopia group. Children with SE <0 D underwent cycloplegic refraction after 3 days of 1% atropine sulfate gel application(three times daily). Those with SE ≤-0.50 D and failure to achieve age-normal visual acuity(<0.5 for ages 3-5; <0.7 for ages 6-7)were assigned to the myopia group, with 84 children(84 eyes)in each group. All participants underwent measurements of visual acuity, intraocular pressure, refraction, and ocular biometric parameters. Parents or guardians completed risk factor questionnaires during the visit, covering daily outdoor activity duration, daily electronic device usage/reading time, parental myopia status, maternal delivery mode, and full-term birth status.

RESULTS:Significant differences were observed in uncorrected visual acuity, spherical power, SE, and axial length between the two groups of children(all P<0.05). No statistically significant differences were found in daily sleep duration, daily reading/homework time, maternal myopia status, mode of delivery, or full-term delivery status(all P>0.05). However, significant differences existed in daily outdoor activity time, daily electronic device usage duration, maternal myopia degree, paternal myopia degree, maternal age of myopia onset, and paternal age of myopia onset(all P<0.05). Logistic regression analysis identified the following risk factors for myopia in preschool children: daily outdoor activity under 2 h, daily electronic device use exceeding 60 min, maternal myopia degree, maternal early-onset myopia, paternal high myopia, and paternal early-onset myopia. Analysis of interaction effects children gender and myopia-related factors on SE revealed significant interactions of children gender with paternal myopia degree, maternal and paternal age of myopia onset(P<0.05). Simple effects analysis further demonstrated that girls exhibited higher degree of myopia than boys in families with paternal early-onset myopia, maternal early-onset myopia, or paternal high myopia(P<0.05).

CONCLUSION:Insufficient daily outdoor activity time(under 1 h), daily electronic device use exceeding 60 min, and parental myopia are significant risk factors for myopia development in preschool children. Among these children, girls' refractive status was particularly associated with parental refractive status.