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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x±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。
Objective To establish blood and serum iron reference values for Tibetan children aged 2-14 years in Tibet. Methods Children’s health department of People’s Hospital of People’s Hospital of Tibet Autonomous Region was selected as data collection site for preschool children in Lhasa, Tibet. Three primary schools in Gyantse and Lonzai counties of Tibet Autonomous Region were selected as data collection sites for school-age children. Tibetan children refer to Both parents are Tibetan and live in Tibetan areas for generations. The blood collected from children during physical examination is unified with the blood routine and serum iron test in the clinical laboratory of our hospital. The test values are directly derived from the relevant instruments for analysis. According to the distribution of detection indexes, the bilateral reference value range was determined by the percentile method (P2.5 ~ P97.5) or x ± 1.96 s, and the blood routine and serum were fitted by LMS program software (version: 1.35) Iron varies according to age percentile curve. Results From January 1 to December 31, 2016, 3,881 healthy children aged 3 to 8 (Tibetan 3 137 and Han 744) entered the study. There were 3 253 blood samples of preschool children and 628 blood samples of school-age children. There were 546, 1878, 475, 270 and 111 cases in the 2 ~ 6 years old group and 36 ~ 101 cases in the 7 ~ 14 years old group respectively. There was no significant difference in sex between Tibetan and Han children at different ages (P> 0.05). The RBC, Hb and PLT reference values were shifted to the right as a whole in the plain, with a wider range of UIBC and TIBC values; the WBC reference range shifted to the left, the neutrophil count (NEUT #), lymphocyte count (LYMPH #), monocyte count (MONO #) and eosinophil percentage (EO%), a wider reference range, basophil percentage (BASO%) Slightly smaller. In terms of absolute counts, the NEUT # reference range shifted to the left with narrower LYMPH #, MONO #, Eos # and BASO # reference ranges. Hb, HCT, MPV, RBC average Hb, concentration and volume (MCH, MCHC and MCV) and RBC distribution width (RDW-SD) increased with age. PLT and lymphocyte Percentages (LYMPH%) and BASO% decreased with age. Neutrophil percentage (NEUT%) and PLT specific volume (PCT) increased first and then decreased with age. Except for TIBC, MCH and PCT, the remaining indicators have statistical significance in Tibetan and Han children. Among them, the levels of WBC, RBC, serum iron, Hb, HCT, PLT and MCV in Han children were higher than those in Tibetan children. The levels of MCHC, RDW-CV, PDW, UIBC, MPV and RDW- child. Conclusion Compared with plain areas, the reference values of blood and serum iron in Tibet at high altitude are basically the same as those in the plain in the altitude. The range of reference values such as RBC, Hb and PLT are shifted to the right and wider in scope. WBC and its The reference value range is shifted to the left and the range is wider. The blood and serum iron in Tibet at high altitude should be referenced to the local reference value.