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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (3): 164-169.

• 论著 • 上一篇    下一篇

西藏地区2~14岁藏族儿童血常规和血清铁参考值的建立

德吉美朵1，5，姜袁2，5，次旦卓嘎1，次旦旺姆1，索朗卓玛1，刘治娟1，仁晖晖3，郑晓玲1，罗珍1，俄地1，严卫丽2，惠晓莹4   

  1. 1西藏自治区人民医院妇幼保健院儿童保健科拉萨，850000；2 复旦大学附属儿科医院临床流行病学研究室上海，201102；3 西藏自治区人民医院妇幼保健院检验中心拉萨，850000；4 复旦大学附属儿科医院免疫科上海，201102；5 共同第一作者
  • 收稿日期:2017-06-25 修回日期:2017-06-25 出版日期:2017-06-25 发布日期:2017-06-25
  • 通讯作者: 德吉美朵

Establishment of reference values of blood routine and serum iron in children aged 2~14 years in Tibet

DEJI Mei-duo1，5, JIANG Yuan2，5, CIDAN Zhuo-ga1, CIDAN Wang-mu1, SUOLANG Zhuo-ma1, LIU Zhi-juan1, REN Hui-hui3, ZHENG Xiao-ling1, LUO Zhen1, E Di 1, YAN Wei-li2, HUI Xiao-ying4   

  1. 1 Child Healthcare Department, Maternity & Child Health Hospital, People's Hospital of Tibet Autonomous Region, Lhasa 850000, China; 2 Epidemiological Research Office, Children's Hospital of Fudan University, Shanghai 201102, China; 3 Clinical Laboratory, Maternity & Child Health Hospital, People's Hospital of Tibet Autonomous Region, Lhasa 850000, China; 4. Immunology Department, Children's Hospital of Fudan University, Shanghai 201102, China; 5 Co-first author
  • Received:2017-06-25 Revised:2017-06-25 Online:2017-06-25 Published:2017-06-25
  • Contact: DEJI Mei-duo

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摘要：

目的：建立西藏地区藏族2~14岁儿童血常规和血清铁参考值。 方法：在西藏拉萨市选取西藏自治区人民医院妇幼保健院（我院）儿童保健科作为学龄前儿童数据采集现场，选取西藏自治区江孜县和隆子县3所小学作为学龄儿童数据采集现场，藏族儿童是指父母均为藏族、且世代居住在藏区；行体格检查时采集的儿童的静脉血，统一在我院临床检验科行血常规和血清铁检测，检验值直接从相关仪器导出用于本文分析。依据检测指标分布特点，采用百分位数法（P2.5~P97.5）或±1.96 s确定其双侧参考值范围，采用LMS program软件（版本：1.35），拟合血常规和血清铁依年龄变化的百分位数曲线。 结果：2016年1月1日至12月31日2~14岁3 881（藏族3 137和汉族744）名健康儿童进入本文分析。学龄前儿童血标本3 253份，学龄儿童血标本628份。2~6岁组分别为546、1 878、475、270和111例，7~14岁组36~101例，藏、汉族儿童不同年龄段性别差异均无统计学意义（P均＞0.05）。较平原地区RBC、Hb和PLT参考值范围整体右移， 运铁蛋白饱和度（UIBC）、血清总铁结合力（TIBC）参考值范围更宽；WBC参考值范围左移，中性粒细胞计数（NEUT#）、淋巴细胞计数（LYMPH#）、单核细胞计数（MONO#）和嗜酸性粒细胞百分比（EO%）参考值范围更宽，嗜碱性粒细胞百分比（BASO%）参考值范围稍小。就绝对计数来看，NEUT#参考值范围左移，LYMPH#、MONO#、嗜酸性粒细胞计数（EO#）和BASO#参考值范围更窄。Hb、RBC比容（HCT）、平均PLT容积（MPV）、RBC平均Hb量、浓度和体积（MCH、MCHC和MCV）和RBC分布宽度（RDWSD）随年龄呈上升趋势，PLT、淋巴细胞百分比（LYMPH%）和BASO%随年龄呈下降趋势，中性粒细胞百分比（NEUT%），PLT比容（PCT）随年龄增长先升后降。除TIBC、MCH和PCT外，余指标在藏族与汉族儿童中差异均有统计学意义。其中，汉族儿童WBC、RBC、血清铁、Hb、HCT、PLT和MCV水平高于藏族儿童；藏族儿童MCHC、RDW-CV、PLT分布宽度（PDW）、UIBC、MPV和RDW-SD水平高于汉族儿童。 结论：与平原地区比较，西藏高海拔地区血常规和血清铁参考值随儿童年龄的变化趋势与平原在区基本一致，RBC、Hb和PLT等参考值范围整体右移且范围更宽，WBC及其分属参考值范围左移且范围更宽,西藏高海拔地区血常规和血清铁应以当地参考值作为参照。

关键词: 参考值, 儿童, 高海拔, 西藏, 血常规, 血清铁

Abstract:

Objective: To establish the reference values of blood routine and serum iron in children aged 2~14 years in Tibet. Methods: Child Care Department, Maternity and Child Health Hospital of the People's Hospital of Tibet Autonomous Region was chosen in Tibet city of Lhasa (our hospital) as study site for preschool children. Three primary schools in Jiangzi County and Rerong Township, Lhunze County were chosen as study site for schoolage children data. In this study, the parents of Tibetan children were Tibetans, and they lived for generations in Tibetan areas; the parents of Han children were Han nationality, and they had worked and lived in Tibet for a long time. The peripheral blood samples were collected from the children during the physical examination, and the blood routine and serum iron were tested in the clinical laboratory of our hospital. The test values were extracted from the relevant instruments and analyzed. LMS program software (version: 1.35) was used to fit the percentile curve of each index according to age. Results: From Jan.1 to Dec.1 2016, 3 137 Tibetan and 744 Han healthy children aged 2 to 14 years were enrolled in this study. A total of 3 253 blood samples has been collected from preschool children and 628 blood samples from school aged children. There were no significant differences in gender between Tibetan and Han children at each age stage (P>0.05). Compared with the plain area, the reference ranges of RBC, Hb and PLT shifted right on the whole, both transferrin saturation(UIBC) and total iron binding capacity(TIBC) had a wider reference range; the reference range of WBC shifted left, and the reference ranges of neutrophil count (NEUT#), lymphocyte count (LYMPH#), monocyte count (MONO#) and the percentage of eosinophils (EO%) were wider, while that of basophil (BASO%) was narrower. As for absolute values, the reference range of NEUT# shifted left, and the reference ranges of LYMPH#, MONO#, eosinophil count (EO#) and BASO# were narrower. As age was increased, Hb, HCT, MPV, MCV, MCH, and RDWSD showed an upward trend, PLT, LYMPH, BASO and LYMPH# showed a downward trend, while NEUT，NEUT# and PCT rose at first and then fell. There were significant differences in all 27 indexes except TIBC, MCH and PCT, between the Tibetan and Han children. WBC, RBC, Fe, Hb, HCT, PLT and MCV were higher in Han children than Tibetan children, MCHC, RDWCV, PDW, UIBC, MPV, RDWSD were just the opposite. Conclusion The reference values of blood routine and serum iron of Tibetan children changed with age mainly in the same way as Han children. The range of RBC, Hb and PLT, were wider and had a whole right shift, while the range of WBC was wider and had a whole left shift. The estimation of blood routine and serum iron in Tibetan children should be based on the local normal value.

Key words: Blood routine, Children, High altitude, Reference value, Serum iron, Tibet