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目的 以睫状肌麻痹验光结果作为近视诊断的金标准,比较常用近视检测指标的不同组合方法对儿童和青少年近视的预测效能.方法 采用诊断性试验研究方法,以2011～2012年“安阳儿童眼病研究”的2 739名小学一年级学生和1 797名初中一年级学生为研究对象,用质量分数1％环戊通点眼麻痹睫状肌后电脑验光的结果诊断近视(等效球镜度≥-0.5 D),对裸眼远视力(UCDVA)、自然瞳孔下电脑验光屈光度、眼轴长度(AL)和角膜屈光力4个指标进行随机组合,采用Logistic回归方法建立近视预测模型,评估各种模型对纳入学生近视预测的灵敏度、特异度、受试者特征曲线下面积(AUC)、阳性预测值和阴性预测值. 结果 采用单一指标模型时,UCDVA的近视预测效果最好,但在小学一年级学生中的灵敏度仅为39.18％,阳性预测值为78.35％.采用2种指标组合模型时,UCDVA+AL的预测效果最好,近视预测灵敏度和阳性预测值分别为48.46％和78.79％,其次是UCDVA+自然瞳孔下电脑验光屈光度,分别为45.08％和79.15％.采用3种指标模型时,UCDVA+AL+角膜屈光力的效果最好,近视预测灵敏度和阳性预测值分别为54.45％和85.45％,其次是UCDVA+AL+自然瞳孔下电脑验光屈光度,近视预测灵敏度和阳性预测值分别为52.12％和81.21％.采用全部4个指标模型可获得最佳预测效果,但提升幅度有限,近视预测灵敏度和阳性预测值分别为55.26％和84.57％.初中一年级学生中各种指标的灵敏度较高,为86.63％～97.73％,特异度则有所下降,为3.62％～90.52％. 结论 AL能够明显提高早期儿童和青少年近视预测的灵敏度,它为非侵入式检查且简便易行,是儿童和青少年眼球发育过程中不可逆性、与近视形成有关的重要指标,建议列为儿童和青少年近视筛查,乃至临床诊治的常规指标.“,”Objective To compare the effects of different combinations of common ocular parameters on the prediction of myopia in children and teenager,with the results of cycloplegia autorefraction as the gold standard for the diagnosis of myopia.Methods A diagnostic trial was adopted.Total of 2 739 first grade students in primary school and 1 797 grade 7 students in junior high school from the “Anyang Childhood Eye Study” were included from 2011 to 2012.Cycloplegic autorefraction using 1％ cyclopentolate was used to diagnose the myopia (spherical equivalent [SE] ≥＞-0.5 D).Uncorrected distant visual acuity (UCDVA),non-cycloplegic autorefraction,axial length (AL)and corneal power were combined randomly,and Logistic regression method was used to establish the prediction models on myopia and evaluate their sensitivity,specificity,positive predictive value and negative predictive value.This study followed the Declaration of Helsinki and this study protocol was approved by the Ethics Committee of Beijing Tongren Hospital.Results When using a single index,the effect of UCDVA was the best,but the sensitivity was only 39.18％ in the first grade of primary school students,and the positive predictive value was 78.35％.Some improvement could be obtained by using two indexes,the effect of UCDVA+AL was the best,the sensitivity was 48.46％,and the positive predictive value was 78.79％,followed by UCDVA + non-cycloplegic autorefraction,the sensitivity was 45.08％ and the positive predictive value was 79.15％.Three indices could further improve the effect of prediction model.The effect of UCDVA+AL+corneal power was the best,the sensitivity was 54.45％ and the positive predictive value was 85.45％,followed by UCDVA+AL+non-cycloplegic autorefraetion,the sensitivity was 52.12％ and the positive predictive value was 81.21％.The best results could be obtained by using all four indices,but the improvement was limited,the sensitivity was 55.26％,and the positive predictive value was 84.57％.In the grade 7 students,sensitivities of the various indices were generally higher (86.63％ to 97.73％),but the specificity was decreased (3.62％ to 90.52％).Conclusions AL can significantly improve the sensitivity of predicting myopia in children,it is non-invasive,simple and easy to perform,and it is an important indicator of eye development and myopia development in children.Therefore,we suggest that AL should be list as a routine indicator of myopia screening,as well as clinical diagnosis and treatment in children.