摘要
目的探讨新生儿期不同月龄屈光发育的特征及间接接触蓝光照射对屈光发育的影响。方法选择2016年1月至2020年6月于北京大学第三医院儿科因新生儿高胆红素血症曾行蓝光照射治疗的患儿82例(164只眼)和出生时健康的婴幼儿64例(128只眼)作为研究对象。其中,男性86例(172只眼),女性60例(120只眼);年龄6~36个月,平均年龄(31.1±6.7)个月。根据是否在新生儿期接受过蓝光治疗,分为光疗组和对照组。检查并记录所有患儿出生后6个月、12个月、18个月及24个月在非睫状肌麻痹状态下双眼的等效球镜度、球镜度、散光度及散光轴位。年龄以x±s表示,组间的比较采用t检验;性别为计数资料,以例数和百分比表示,组间的比较采用卡方检验。所有患儿各时间段内的等效球镜度、球镜度、散光度及散光轴位经正态性检验为偏态分布,屈光状态各参数均采用中位数和四分位距表示,组间比较采用Mann-Whitney U秩和检验。月龄与组别对屈光状态各值的影响采用混合效应模型分析。结果光疗组患儿80例(80只眼),对照组患儿74例(74只眼)。两组患儿月龄比较的差异无统计学意义(t=-1.1,P>0.05);性别比较的差异无统计学意义(χ^(2)=0.32,P>0.05)。光疗组患儿6月龄时的等效球镜度、球镜度、散光度及散光轴位分别为0.17(1.96)D、1.0(2.0)D、-1.25(1.0)D及75.5(155.3)°;对照组分别为-0.13(2.63)D、0.5(2.0)D、-1.20(1.0)D及93.5(138.0)°。经Mann-Whitney U检验,两组比较的差异均无统计学意义(Z=-0.89,-0.939,-1.721,-0.555;P>0.05)。光疗组患儿12月龄时的等效球镜度、球镜度、散光度及散光轴位分别为0.17(1.98)D、0.51(1.88)D、-0.67(1.0)D及73.5(105.0)°;对照组分别为0.13(1.92)D、0.25(0.92)D、-0.94(1.0)D及90.0(109.0)°。经Mann-Whitney U检验,两组等效球镜度和球镜度比较的差异均有统计学意义(Z=-2.634,-2.353;P<0.05);散光度和散光轴位比较的差异均无统计学意义(Z=-0.144,-1.445;P>0.05)。光疗组患儿18月龄时的等效球镜度、球镜度、散光度及散光轴位分别为0.25(1.25)D、0.75(1.50)D、-0.75(0.7)D及90.0(125.0)°;对照组分别为0.13(1.92)D、0.33(2.42)D、-0.58(0.67)D及98.0(105.3)°。经Mann-Whitney U检验,两组比较的差异均无统计学意义(Z=-0.213,-0.988,-1.404,-0.697;P>0.05)。光疗组患儿24月龄时的等效球镜度、球镜度、散光度及散光轴位分别为0.17(0.43)D、0.50(0.58)D、-0.50(0.42)D及92.5(90.5)°;对照组分别为0.15(1.33)D、0.42(1.47)D、-0.71(0.63)D及105.0(64.0)°。经Mann-Whitney U检验,两组比较的差异均无统计学意义(Z=-0.285,-0.544,-1.322,-1.472;P>0.05)。以月龄作协变量,组别作因子,经混合效应模型分析显示,二者对等效球镜度、球镜度、散光度及散光轴位比较的差异均无统计学意义(t=1.365,1.479,-0.668,-1.818;P>0.05)。月龄对散光度的影响有统计学意义(t=7.609,P<0.05);对等效球镜度、球镜度及散光轴位的影响均无统计学意义(t=0.282,-1.659,1.052;P>0.05)。结论婴幼儿出生后由高度远视眼向正视眼逐渐发展,在婴幼儿出生后早期接受蓝光照射治疗后,短期内的屈光发育状态不会受其影响。
Objective The aim of this study was to investigate the characteristics of refractive development at different months of age and effects of blue light exposure on it in infants during the neonatal period.Methods A retrospective clinical study was conducted on 82 infants(164 eyes)received phototherapy during the neonatal period and 64 healthy infants(128 eyes)born in Department of Pediatrics,Peking University Third Hospital from January 2016 to June 2020.Among of them,there were 86 males(172 eyes)and 60 females(120 eyes)with an average age of(31.1±6.7)months(ranged from 6 to 36 months).The infants were divided into phototherapy group and control groups,according to whether or not they had received phototherapy during the neonatal period.Binocular non-cycloplegic refraction of infants at 6,12,18 and 24 months old was examined and recorded,including spherical equivalent refraction(SER),spherical refraction,astigmatism,astigmatism axis.The age was expressed as x±s after normality test and compared by independent sample t test between groups;the gender was countable data,described as cases and perentage,and compared by Chi-square test.After normality testing,SER,spherical refraction,astigmatism,and astigmatism axis were skewed distribution in different time,described as median and interquartile range,and compared by Mann-Whitney U test rank sum test.The effect of age and groups on refractive development was analyed by mixed effect model.Results At 6 months,SER,spherical refraction,astigmatism,and astigmatism axis of infants in the phototherapy group were 0.17(1.96)D,1.0(2.0)D,-1.25(1.0)D and 75.5(155.3),respectively;while those of the control group were-0.13(2.63)D,0.5(2.0)D,-1.20(1.0)D and 93.5(138.0),with non-significant difference between two groups(Z=-0.89,-0.939,-1.721,-0.555;P>0.05).At 12 months,SER,spherical refraction,astigmatism,and astigmatism axis in the phototherapy group were 0.17(1.98)D,0.51(1.88)D,-0.67(1.0)D and 73.5(105.0),respectively;while SER,spherical refraction,astigmatism,and astigmatism axis of infants in the control group were 0.13(1.92)D,0.25(0.92)D,-0.94(1.0)D and 90.0(109.0).There were significantly differences in SER and spherical refraction between two groups(Z=-2.634,-2.353;P<0.05).There were not statistically significant differences in astigmatism and astigmatism axis between two groups(Z=-0.144,-1.445;P>0.05).At 18 months,SER,spherical refraction,astigmatism,and astigmatism axis of infants in the phototherapy group were 0.25(1.25)D,0.75(1.50)D,-0.75(0.7)D and 90.0(125.0),respectively;while SER,spherical refraction,astigmatism,and astigmatism axis of infants in the control group were 0.13(1.92)D,0.33(2.42)D,-0.58(0.67)D and 98.0(105.3),with non-significant difference between two groups(Z=-0.213,-0.988,-1.404,-0.697;P>0.05).At 24 months,SER,spherical refraction,astigmatism,and astigmatism axis of infants in the phototherapy group were 0.17(0.43)D,0.50(0.58)D,-0.50(0.42)D and 92.5(90.5),respectively;while SER,spherical refraction,astigmatism,and astigmatism axis of infants in the control group were 0.15(1.33)D,0.42(1.47)D,-0.71(0.63)D and 105.0(64.0),with non-significant difference between two groups(Z=-0.285,-0.544,-1.322,-1.472;P>0.05).After the age used as covariate and group as factor,a mixed effects model for the analysis of these factors and refractive development found that there were not statistical significance differences(t=1.365,1.479,-0.668,-1.818;P>0.05);the analysis of the age and the level of astigmatism with statistically significant difference(t=7.609,P<0.05);the analysis of the age and SER,spherical refraction,astigmatism axis with non-significant difference(t=0.282,-1.659,1.052;P>0.05).Conclusions During the neonatal period,infants gradually develop from hyperopia to emmetropia.The blue light exposure may not have a noticeable impact on refractive development in infants after short period.
作者
张恺耘
刘子源
常艳美
邱伟强
Zhang Kaiyun;Liu Ziyuan;Chang Yanmei;Qiu Weiqiang(Department of Ophthalmology,Peking University Third Hospital,Beijing 100191,China;Department of Ophthalmology,Peking University Third Hospital,Beijing Key Laboratory of Restoration of Damaged Ocular Nerve,Beijing 100191,China;Department of Pediatrics,Peking University Third Hospital,Beijing 100191,China)
出处
《中华眼科医学杂志（电子版）》
2022年第1期18-23,共6页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
基金
首都临床特色应用研究(Z151100004015073)
中华国际医学交流基金会专项基金(Z-2018-40)。
关键词
蓝光
婴幼儿
屈光发育
正视化
Blue light
Infants
Refractive development
Emmetropization
