拉薩市農(nóng)村99名0~5月齡嬰兒血紅蛋白水平分析#

1、中國(guó)科技論文在線- PAGE 6 - FORMTEXT 拉薩市農(nóng)村99名05月齡嬰兒血紅蛋白水平分析基金項(xiàng)目：高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金（20070698084）；美國(guó)中華醫(yī)學(xué)基金會(huì)項(xiàng)目（#02-778），國(guó)家自然科學(xué)基金項(xiàng)目（300771835）資助 FORMTEXT 康軼君， FORMTEXT 顏虹， FORMTEXT 李強(qiáng)， FORMTEXT 黨少農(nóng)， FORMTEXT 曾令霞， FORMTEXT 裴磊磊， FORMTEXT 張超作者簡(jiǎn)介：康軼君（1968-），男，高級(jí)實(shí)驗(yàn)師，博士在讀，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)通信聯(lián)系人：顏虹（1957-），男，教授，主要研究方向：婦幼營(yíng)養(yǎng)與

2、健康評(píng)價(jià)、疾病控制與健康促進(jìn)、衛(wèi)生管理統(tǒng)計(jì). E-mail: yanhongeSET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET bkCompanyEN Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaoton

3、g University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 71

4、0061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Heal

5、th Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061 * MERGEFORMATDepartment of Epidemiology and Health Statistics,School of Pub

6、lic Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University Coll

7、ege of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department o

8、f Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061;Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061SET bkCompanyCHN 西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;

9、西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061 * MERGEFORMAT西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061

10、;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061;西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061SET bkPostcode 710061;710061; * MERGEFORMAT710061;710061;SET bkMobile13991802320; * MERGEFORMA

11SET bkTelphone212 * MERGEFORMA212SET bkAddress 西安市雁塔區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室;西安市雁塔區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室; * MERGEFORMAT西安市雁塔區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室;西安市雁塔區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室;SET bkEmail tjkyj;yanhonge;tjlq;tjdsn;tjzlx; * MERG

12、EFORMATtjkyj;yanhonge;tjlq;tjdsn;tjzlx;SET bkIntroduction 康軼君（1968-），男，高級(jí)實(shí)驗(yàn)師，博士在讀，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)。;顏虹（1957-），男，教授，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)、疾病控制與健康促進(jìn)、衛(wèi)生管理統(tǒng)計(jì); * MERGEFORMAT康軼君（1968-），男，高級(jí)實(shí)驗(yàn)師，博士在讀，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)。;顏虹（1957-），男，教授，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)、疾病控制與健康促進(jìn)、衛(wèi)生管理統(tǒng)計(jì);SET bkAuthorCHN 康軼君;顏虹;李強(qiáng);黨少農(nóng);曾令霞;裴磊磊;張超 * MER

13、GEFORMAT康軼君;顏虹;李強(qiáng);黨少農(nóng);曾令霞;裴磊磊;張超SET bkAuthorEN KANG Yijun;YAN Hong;LI Qiang;DANG Shaonong;ZENG Lingxia;PEI Leilei;ZHANG Chao * MERGEFORMATKANG Yijun;YAN Hong;LI Qiang;DANG Shaonong;ZENG Lingxia;PEI Leilei;ZHANG ChaoSET bkContact 顏虹 * MERGEFORMAT顏虹SET version 1.5 * MERGEFORMAT1.5SET bkFund 高等學(xué)校博士學(xué)科點(diǎn)專

14、項(xiàng)科研基金（20070698084）；美國(guó)中華醫(yī)學(xué)基金會(huì)項(xiàng)目（#02-778），國(guó)家自然科學(xué)基金項(xiàng)目（300771835）資助 * MERGEFORMAT高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金（20070698084）；美國(guó)中華醫(yī)學(xué)基金會(huì)項(xiàng)目（#02-778），國(guó)家自然科學(xué)基金項(xiàng)目（300771835）資助SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERG

15、EFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET version 1.5 * MERGEFORMAT1.5SET bkReferencesInfo 1*|*技術(shù)報(bào)告*|*World Health Organization: Nutriti

16、on for Health and Development: A global agenda for combating malnutrition, Document WHO/NHD/00.6.Geneva:WHO,2000.2*|*技術(shù)報(bào)告*|*CDC.Altitude hemoglobin curve and CDC anemia criteria which uses the altitude adjustment,CDC.19953*|*技術(shù)標(biāo)準(zhǔn)*|*Penelope Nestel.Adjusting Hemoglobin Values in program Surveys.INACG

17、 Steering Committee.20024*|*專著*|*薛辛東主編.兒科學(xué)M.北京:人民衛(wèi)生出版社,2005,378-3865*|*期刊*|*Zlothin S.Clinical Nutrition,8.The role of nutrition in the prevention of iron deficiency anemia in infents,children and adolescentsJ.Can Med Assoc J,2003,168:59-636*|*期刊*|*中華兒科雜志編輯委員會(huì).兒童缺鐵和缺鐵性貧血防治建議J.中華兒科雜志,2008,46(7):502-5

18、04.7*|*專著*|*楊曉光,翟鳳英主編.中國(guó)居民營(yíng)養(yǎng)與健康狀況調(diào)查報(bào)告三M.北京,人民衛(wèi)生出版社,2006,1708*|*期刊*|*黨少農(nóng),顏虹,王學(xué)良.西藏地區(qū)3歲以下兒童血紅蛋白水平及高海拔下貧血患病率調(diào)查J.中華流行病學(xué)雜志,2003,24(12):1108-11119*|*專著*|*WHO/UNICEF/UNU.Iron deficiency anemia:assessment prevention,and control M.Geneva,World Health Organization,2001(WHO/NHD/01.3) * MERGEFORMAT1*|*技術(shù)報(bào)告*|*Wo

19、rld Health Organization: Nutrition for Health and Development: A global agenda for combating malnutrition, Document WHO/NHD/00.6.Geneva:WHO,2000.2*|*技術(shù)報(bào)告*|*CDC.Altitude hemoglobin curve and CDC anemia criteria which uses the altitude adjustment,CDC.19953*|*技術(shù)標(biāo)準(zhǔn)*|*Penelope Nestel.Adjusting Hemoglobin

20、 Values in program Surveys.INACG Steering Committee.20024*|*專著*|*薛辛東主編.兒科學(xué)M.北京:人民衛(wèi)生出版社,2005,378-3865*|*期刊*|*Zlothin S.Clinical Nutrition,8.The role of nutrition in the prevention of iron deficiency anemia in infents,children and adolescentsJ.Can Med Assoc J,2003,168:59-636*|*期刊*|*中華兒科雜志編輯委員會(huì).兒童缺鐵和缺鐵

21、性貧血防治建議J.中華兒科雜志,2008,46(7):502-504.7*|*專著*|*楊曉光,翟鳳英主編.中國(guó)居民營(yíng)養(yǎng)與健康狀況調(diào)查報(bào)告三M.北京,人民衛(wèi)生出版社,2006,1708*|*期刊*|*黨少農(nóng),顏虹,王學(xué)良.西藏地區(qū)3歲以下兒童血紅蛋白水平及高海拔下貧血患病率調(diào)查J.中華流行病學(xué)雜志,2003,24(12):1108-11119*|*專著*|*WHO/UNICEF/UNU.Iron deficiency anemia:assessment prevention,and control M.Geneva,World Health Organization,2001(WHO/NHD/

22、01.3)SET bkAuthorsInfo |1|康軼君|KANG Yijun|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|康軼君（1968-），男，高級(jí)實(shí)驗(yàn)師，博士在讀，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)。|西安市雁塔區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室|710061|tjkyj|029-8265

23、5104-212|2|顏虹|YAN Hong|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|顏虹（1957-），男，教授，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)、疾病控制與健康促進(jìn)、衛(wèi)生管理統(tǒng)計(jì)|西安市雁塔區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室|710061|yanhonge|029

24、-826550013|李強(qiáng)|LI Qiang|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|tjlq|4|黨少農(nóng)|DANG Shaonong|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health

25、 Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|tjdsn|5|曾令霞|ZENG Lingxia|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|tjzlx|6|裴磊磊|PEI

26、Leilei|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|7|張超|ZHANG Chao|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xi

27、an Jiaotong University College of Medicine,Xian 710061| * MERGEFORMAT|1|康軼君|KANG Yijun|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|康軼君（1968-），男，高級(jí)實(shí)驗(yàn)師，博士在讀，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)。|西安市雁塔

28、區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室|710061|tjkyj212|2|顏虹|YAN Hong|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|顏虹（1957-），男，教授，主要研究方向：婦幼營(yíng)養(yǎng)與健康評(píng)價(jià)、疾病控制與健康促進(jìn)、衛(wèi)生管理統(tǒng)計(jì)|西安市

29、雁塔區(qū)，雁塔西路76號(hào)，西安交大醫(yī)學(xué)院衛(wèi)生統(tǒng)計(jì)教研室|710061|yanhonge13991802320|3|李強(qiáng)|LI Qiang|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|tjlq|4|黨少農(nóng)|DANG Shaonong|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西

30、安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|tjdsn|5|曾令霞|ZENG Lingxia|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University Co

31、llege of Medicine,Xian 710061|tjzlx|6|裴磊磊|PEI Leilei|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|7|張超|ZHANG Chao|西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061|Department of Epidemiology an

32、d Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061|SET bkTitleInfo 拉薩市農(nóng)村99名05月齡嬰兒血紅蛋白水平分析|Study on the status of Hemoglobin levels among infant 05 months old in rural Lhasa|高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金（20070698084）；美國(guó)中華醫(yī)學(xué)基金會(huì)項(xiàng)目（#02-778），國(guó)家自然科學(xué)基金項(xiàng)目（300771835）資助 * M

33、ERGEFORMAT拉薩市農(nóng)村99名05月齡嬰兒血紅蛋白水平分析|Study on the status of Hemoglobin levels among infant 05 months old in rural Lhasa|高等學(xué)校博士學(xué)科點(diǎn)專項(xiàng)科研基金（20070698084）；美國(guó)中華醫(yī)學(xué)基金會(huì)項(xiàng)目（#02-778），國(guó)家自然科學(xué)基金項(xiàng)目（300771835）資助（西安交通大學(xué)醫(yī)學(xué)院公共衛(wèi)生系流行病與衛(wèi)生統(tǒng)計(jì)教研室,西安，710061）SET bkTitleInfo * MERGEFORMAT SET bkAuthorsInfo * MERGEFORMAT 摘要： FORMTEXT

34、 目的：了解拉薩市農(nóng)村05月齡嬰兒血紅蛋白（hemoglobin, Hb）水平和高海拔地區(qū)貧血患病狀況。方法：采用橫斷面研究設(shè)計(jì)與分層多階段整群隨機(jī)抽樣獲取樣本。用B-Hemoglobin血紅蛋白儀，取嬰兒指末梢血10ul測(cè)量Hb含量。運(yùn)用美國(guó)CDC法對(duì)Hb進(jìn)行海拔調(diào)整，按照我國(guó)小兒血液病會(huì)議的標(biāo)準(zhǔn)判斷05月齡嬰兒貧血的界值，估計(jì)貧血患病率。結(jié)果：調(diào)查了拉薩市農(nóng)村05月齡嬰兒99名， Hb水平為120.718.9 g/L，協(xié)方差分析控制海拔因素后，嬰兒在新生兒期的Hb水平（141.130.5g/L）明顯高于嬰兒13月齡Hb水平（117.216.7g/L）和45月齡Hb水平（120.215.6g

35、/L）（P0.001和P=0.002）, 運(yùn)用美國(guó)CDC法對(duì)Hb進(jìn)行海拔調(diào)整后，嬰兒貧血患病率為65.7%，男嬰（66.7%）略高于女嬰（64.1%）（P=0.793），嬰兒在新生兒期、13月齡和45月齡貧血患病率分別為88.9%、57.1%和70.7%，3個(gè)月齡段之間未發(fā)現(xiàn)統(tǒng)計(jì)學(xué)差異（P=0.123）。結(jié)論：拉薩市農(nóng)村05月齡嬰兒貧血患病率可能較高，用美國(guó)CDC法對(duì)嬰兒Hb水平進(jìn)行調(diào)整后可能高估了該人群貧血患病率。高海拔地區(qū)嬰兒貧血標(biāo)準(zhǔn)應(yīng)引起重視。關(guān)鍵詞： FORMTEXT 血紅蛋白；05月齡嬰兒；拉薩市農(nóng)村中圖分類號(hào)： FORMTEXT R174+6SET bkAuthorsInfo *

36、MERGEFORMAT SET bkTitleInfo * MERGEFORMAT FORMTEXT Study on the status of Hemoglobin levels among infant 05 months old in rural Lhasa FORMTEXT KANG Yijun, FORMTEXT YAN Hong, FORMTEXT LI Qiang, FORMTEXT DANG Shaonong, FORMTEXT ZENG Lingxia, FORMTEXT PEI Leilei, FORMTEXT ZHANG Chao(Department of Epide

37、miology and Health Statistics,School of Public Health,Xian Jiaotong University College of Medicine,Xian 710061)Abstract: FORMTEXT Objective: To study the hemoglobin (Hb) status of infant under the age of 05 months and the prevalence of anemia at High altitude. Methods: Cross-sectional study and rand

38、om cluster sampling were used. Blood was collected on tip of finger and the level of Hb was measured using B-Hemoglobin photometer.We adjusted the Hb based on altitude using method of U.S.CDC and then estimated the prevalence of anemia. Anemia to determine the standards developed by the Conference i

39、n accordance with Chinas blood disease diagnostic criteria for anemia in infants. Results: In 2010, 99 infants of age 05 months living at 36083776 meters above sea level in rural Lhasa were examined. The findings indicated that the average Hb was about 120.718.9 g/L. Analysis of covriance indicated,

40、 after controlling the factor of altitude, the mean of Hb level at newborn (141.130.5 g/L) the highest than age at 13 months (117.216.7 g/L) and 45 months (120.215.6 g/L). According to method of CDC and then adjusted the Hb, The anemia prevalence was 65.7% (66.7% of baby boys, 64.1% of baby girls).

41、There was no significant difference for Hb between baby boys and baby girls. Comparison of anemia prevalence of infant among three ages range showed anemia prevalence at newborn was highest, and 13 months was lowest. There was no significant difference for anemia prevalence between different age gro

42、ups. Conclusion: The prevalence of anemia in infant might be higher, but current Hb correction methods might not be suitable for correcting hemoglobin of Tibetan infant. It is important to develop anemia standards in infants at high altitude in rural Lhasa.Key words: FORMTEXT Hemoglobin; infants of

43、age 05 months; rural Lhasa引言體內(nèi)鐵缺乏致使Hb合成減少而導(dǎo)致的營(yíng)養(yǎng)性缺鐵性貧血是世界上許多國(guó)家的公共衛(wèi)生問(wèn)題，尤其在非洲和亞洲地區(qū)1。Hb水平是評(píng)價(jià)嬰幼兒營(yíng)養(yǎng)狀況重要的指標(biāo)。Hb具有攜氧的生理功能，其含量受到外界環(huán)境的影響，隨著海拔高度的增加環(huán)境氧分壓逐漸降低，這將促使人體發(fā)生適應(yīng)性的生理變化，研究表明隨著海拔上升，特別是海拔超過(guò)1000米以后，Hb含量明顯增加2,3。研究報(bào)道足月新生兒從母親所獲得的鐵足夠其生后45個(gè)月內(nèi)之用4，為了研究中國(guó)高海拔地區(qū)嬰兒Hb的水平，我們于2010年78月調(diào)查了拉薩市農(nóng)村嬰幼兒Hb水平和相關(guān)情況，本文只報(bào)道05月齡的嬰兒。1 對(duì)象與

44、方法1.1 研究對(duì)象西藏自治區(qū)拉薩市農(nóng)村05月齡的藏族嬰兒，并且，監(jiān)護(hù)人溝通和理解能力正常。本課題獲得西安交通大學(xué)醫(yī)學(xué)倫理委員會(huì)審核通過(guò)。1.2 研究方法1.2.1 調(diào)查問(wèn)卷和實(shí)施 研究采用橫斷面調(diào)查設(shè)計(jì)，采用自行設(shè)計(jì)的問(wèn)卷。內(nèi)容包括：家庭一般情況、嬰兒喂養(yǎng)、患病情況以及Hb水平和人體測(cè)量。采用分層多階段整群隨機(jī)抽樣法，調(diào)查了拉薩市達(dá)孜縣和曲水縣05月齡的嬰兒99名。調(diào)查對(duì)象均獲得其監(jiān)護(hù)人的口頭知情同意。1.2.2 Hb測(cè)量Hb的測(cè)量采用瑞典HemoCue AB 公司生產(chǎn)的B-Hemoglobin血紅蛋白儀，精度0.1g/dl，一律采手指末梢血測(cè)量。測(cè)量時(shí)采用德國(guó)生產(chǎn)的一次性無(wú)菌羅康全樂(lè)采采血

45、針在無(wú)名指指腹側(cè)方刺破皮膚，棄去前兩滴血，使用專用采血杯取第3滴血約10ul，隨后將采血杯放入B-Hemoglobin血紅蛋白儀中測(cè)量，約3050秒后讀取Hb值。血紅蛋白儀每次使用前以標(biāo)準(zhǔn)片按要求校正。1.2.3 Hb海拔校正方法Hb水平隨著海拔的上升而增加，估計(jì)高海拔地區(qū)人群的貧血患病率應(yīng)當(dāng)調(diào)正海拔的影響。我們采用常用的美國(guó)CDC調(diào)正公式2,3（CDC法）：Hb=-0.032(Alt3.3)+0.022(Alt3.3)2，Hb是以海平面為基礎(chǔ)隨海拔上升的Hb的校正量（g/dl），Alt是海拔高度（km）。1.2.4 貧血診斷標(biāo)準(zhǔn)05月齡嬰兒貧血的界定：我國(guó)小兒血液會(huì)議4：Hb在新生兒期145

46、 g/L，13個(gè)月時(shí)90 g/L，45個(gè)月時(shí)100 g/L診斷為貧血。1.2.5 質(zhì)量控制調(diào)查員由拉薩市衛(wèi)生系統(tǒng)中認(rèn)真負(fù)責(zé)的藏族婦幼工作者組成，由西安交通大學(xué)的專家對(duì)其進(jìn)行統(tǒng)一培訓(xùn)，合格后方可上崗工作。主要方法有：使用統(tǒng)一標(biāo)準(zhǔn)化問(wèn)卷、統(tǒng)一問(wèn)卷口徑及對(duì)各種指標(biāo)的理解，統(tǒng)一測(cè)量?jī)x器；問(wèn)卷完成后對(duì)調(diào)查問(wèn)卷進(jìn)行三次審核（當(dāng)場(chǎng)調(diào)查員本人審核、調(diào)查員交換審核和調(diào)查隊(duì)負(fù)責(zé)人審核）。1.3 統(tǒng)計(jì)學(xué)分析采用EpiData3.02軟件建立數(shù)據(jù)庫(kù)，數(shù)據(jù)進(jìn)行雙錄入和邏輯檢錯(cuò)分析。用SPSS13.0統(tǒng)計(jì)軟件進(jìn)行所有統(tǒng)計(jì)分析，Hb的水平用 表示，患病率用構(gòu)成比表示，統(tǒng)計(jì)分析方法采用協(xié)方差分析、t檢驗(yàn)、單因素方差分析和卡方

47、檢驗(yàn)。假設(shè)檢驗(yàn)的水平均設(shè)定為=0.05。2 結(jié)果2.1 調(diào)查樣本的基本特征調(diào)查嬰兒所在村的海拔平均為3688 m，最低的村海拔為3608 m，最高的村為3776 m。共調(diào)查05月齡的藏族嬰兒99名，平均年齡為3.2月齡，最小0.3月齡，最大5.9月齡；男女嬰兒性別比為153.8:100，嬰兒近兩周患病率為28.3%，嬰兒所在家庭人均年收入的中位數(shù)約為2100.0元，孩子母親平均年齡為26.0歲，母親上學(xué)年限平均為5.1年，以小學(xué)畢業(yè)的母親為主（55.6%）；母親在孕期做過(guò)產(chǎn)前檢查的比例為98.0%，其中產(chǎn)前檢查做過(guò)57次的母親占54.5%（表1）。表1，拉薩市農(nóng)村99名05月齡嬰兒不同特征的H

48、b水平相關(guān)因素人數(shù)（%）實(shí)測(cè)值根據(jù)海拔調(diào)整后（CDC法）Hb（g/L，）P值Hb（g/L，）P值性別男60（60.6）121.319.00.70692.619.10.684女39（39.4）119.719.091.019.2近兩周是否患病是28（28.3）118.518.30.43289.918.10.510否71（71.7）121.519.292.819.5母親文化文盲19（19.2）127.523.70.23698.923.60.211小學(xué)55（55.6）119.316.690.516.8初中及以上25（25.2）118.519.489.919.5家庭人均年收入180036（36.4）12

49、0.318.80.83591.619.10.858180043（43.4）121.820.293.020.2600020（20.2）118.916.990.217.0孩子數(shù)1個(gè)53（53.5）120.219.40.630 91.619.70.4912個(gè)37（37.4）122.719.794.019.73個(gè)9（9.1）114.911.085.711.4使用鐵鍋是70（70.7）119.219.60.320 90.319.70.190否29（29.3）124.316.995.917.0產(chǎn)前檢查5次23（23.2）120.522.70.60991.822.70.7275次7次54（54.5）121.

50、919.893.120.08次22（22.2）117.811.489.311.8合 計(jì)99（100.0）120.718.992.019.1：協(xié)方差分析控制海拔因素后分組比較；t檢驗(yàn)或方差分析Hb水平和貧血患病率估計(jì)調(diào)查嬰兒的Hb水平實(shí)測(cè)值為120.718.9 g/L，男女嬰間無(wú)統(tǒng)計(jì)學(xué)差異。以海拔為協(xié)變量進(jìn)行協(xié)方差分析后，嬰兒Hb水平在嬰兒近兩周是否患病、母親文化程度分組、家庭人均收入分組、家庭孩子數(shù)分組、家庭是否使用鐵鍋和母親在孕期做產(chǎn)前檢查的次數(shù)分組之間沒(méi)有發(fā)現(xiàn)統(tǒng)計(jì)學(xué)差異。用CDC法進(jìn)行海拔調(diào)正后估計(jì)嬰兒Hb水平平均為92.019.1 g/L，同樣在以上各因素之間未發(fā)現(xiàn)統(tǒng)計(jì)學(xué)差異（表1）。本

51、調(diào)查發(fā)現(xiàn)當(dāng)?shù)貗雰涸谛律鷥浩贖b水平實(shí)測(cè)值為141.130.5 g/L，Hb水平在145 g/L及以上的嬰兒占44.4%，根據(jù)海拔調(diào)整后Hb水平為112.831.2 g/L，貧血患病率高達(dá)88.9%。13月齡嬰兒Hb水平實(shí)測(cè)值為117.216.7 g/L，Hb水平在90.0g/L及以上的嬰兒占95.9%，根據(jù)海拔調(diào)整后Hb水平為88.616.8 g/L，貧血患病率為57.1%。45月齡的嬰兒Hb水平實(shí)測(cè)值為120.215.6 g/L，Hb水平在100 g/L及以上的嬰兒占92.7%，根據(jù)海拔調(diào)整后Hb水平為91.415.6 g/L，貧血患病率為70.7%。以海拔為協(xié)變量控制后，嬰兒在新生兒期的H

52、b水平明顯高于嬰兒13月齡和45月齡的Hb水平（P0.001和P=0.002），嬰兒13月齡時(shí)Hb水平最低，但是和嬰兒45月齡的Hb水平相比沒(méi)有發(fā)現(xiàn)統(tǒng)計(jì)學(xué)差異（P=0.365），根據(jù)海拔調(diào)正后，分析各年齡段之間Hb水平的差異出現(xiàn)了同樣的結(jié)果，總的貧血患病率達(dá)65.7%，男嬰為66.7% 略高于女嬰64.1%（=0.069，P=0.793）。貧血患病率由高到低依次為新生兒期（88.9%）、45月齡（70.7%）和13月齡（57.1%），3個(gè)年齡段之間沒(méi)有發(fā)現(xiàn)統(tǒng)計(jì)學(xué)差異（=4.198，P=0.123）（表2和表3）表2，拉薩市農(nóng)村99名05月齡嬰兒Hb水平實(shí)測(cè)值分布年齡組（月）人數(shù)（名）Hb(g/

53、L, )P值Hb（g/L）分布構(gòu)成比（%）6090100120145合計(jì)09 141.430.50.0010.011.111.133.3 44.4 100.01349 117.216.74.18.253.128.6 6.1 100.04541 120.215.62.44.939.048.8 4.9 100.0合 計(jì)99 120.718.93.07.143.437.4 9.1 100.0：協(xié)方差分析控制海拔因素后分組比較表3，美國(guó)CDC法調(diào)整后拉薩市農(nóng)村99名05月齡嬰兒Hb水平和貧血患病率年齡組（月）人數(shù)（名）Hb(g/L, )P值Hb（g/L）分布構(gòu)成比（%）貧血患病率（%）P值606090

54、10012014509 112.831.20.0020.0 22.20.033.3 33.3 11.1 88.90.1231349 88.616.84.1 53.124.514.3 4.1 0.0 57.14541 91.415.62.4 41.526.824.4 4.9 0.0 70.7合 計(jì)99 92.019.13.0 45.523.220.2 7.1 1.0 65.7：方差分析分組比較；卡方檢驗(yàn)3 討論研究表明，嬰兒缺鐵不僅可以引起貧血，對(duì)其體能、智力、免疫和消化功能等均有影響，增加?jì)雰夯疾『退劳龅娘L(fēng)險(xiǎn)，并且，貧血對(duì)嬰兒智能的影響是不可逆的5。因此預(yù)防嬰兒貧血比治療貧血顯得更為重要。足月新生兒體內(nèi)總鐵量約75 mg/kg，其中25%為儲(chǔ)存鐵。生后由于“生理性溶血”釋放的鐵較多，隨后是“生理性貧血”期造血相對(duì)較低下，加之從母親獲取的鐵一般能滿足4個(gè)月之需，故嬰兒早期不易發(fā)生缺鐵。約4月齡以后，從母親獲取的鐵逐漸耗盡，加上此期生長(zhǎng)發(fā)育迅速，造血活躍，因此對(duì)膳食鐵的需要增加，故6月齡開(kāi)始應(yīng)在母乳喂養(yǎng)的基礎(chǔ)上添加含鐵豐富的輔食。近年研究表明，如孕母嚴(yán)重缺鐵，可影響胎兒獲取鐵量4，6。調(diào)查地區(qū)05月齡嬰兒的Hb水平為120.718.9 g/L，根據(jù)CDC法海拔調(diào)正后估計(jì)嬰兒Hb水平為92.019.1 g/L，均低于20