学龄前儿童血铅与血细胞、铁代谢多参数的相关性

Correlation between blood lead and blood cells and iron metabolism parameters in preschool children

目的研究血铅对血细胞及铁参数的影响。方法选择于2016年10月至2017年1月由东莞市儿童医院在东莞市石龙镇幼儿园对1 521例学龄前儿童进行血铅、血细胞相关参数及铁代谢等检测,根据美国国家疾病控制中心(CDC)血铅中毒分组标准,按血铅含量将儿童分成正常组(n=1 421)与铅中毒组(n=106),统计分析不同组别儿童血细胞及铁参数的变化及相关关系。结果血细胞相关参数中,铅中毒组儿童的平均红细胞血红蛋白含量(MCH)、平均红细胞体积(MCV)均下降,而红细胞分布宽度(RDW)上升,与正常组比较差异均具有统计学意义(P<0.05);两组血铅浓度与MCH、MCV呈负相关(r=-0.067,-0.063),与RDW呈正相关(r=0.076),与血红蛋白(HGB)无相关关系(P>0.05)。铁代谢参数中,铅中毒组儿童总铁结合力(TIBC)升高,与正常组比较差异具有统计学意义(P<0.05);两组儿童的血铅浓度与铁四项参数无相关关系(P>0.05)。结论血铅浓度超标的儿童血红细胞相关参数MCH与MCV降低、RDW升高,铁代谢相关参数TIBC升高,提示铅中毒儿童虽然血红蛋白水平没有明显下降(贫血症状),但已引起红细胞血红蛋白的代谢指标变化,并且影响了红细胞生成原料铁的代谢,应该在血红蛋白仍未变化时及时进行早期干预。

Objective To study the influences of blood lead on blood cells and iron metabolism parameters. Methods A total of 1 521 preschool children in Dongguan Shilong Town Kindergarten undergoing blood lead, blood cell parameters and iron metabolism in Dongguan Children＇s Hospital were selected from Oct. 2016 to Jan. 2017. According to the blood lead-poisoning＇s standard of American National Centers for Disease Control （CDC）, they were divided into normal group （n=1421） and lead poisoning group （n=106）. The changes of blood cell and iron parameters in different groups of children and their correlation were analyzed. Results Compared with normal group, the mean erythrocyte hemoglobin content （MCH）, the mean erythrocyte volume （MCV） of blood cell related parameters in lead poisoning group was decreased, but erythrocyte distribution width （RDW） was increased, with statistically significant difference （P〈0.05）. Blood lead concentration had a negative correlation with MCH, MCV （r=-0.067, -0.063）, a positive correlation with RDW （r=0.076）, but no correlation with hemoglobin （HGB） （P〉0.05）. As for the data in iron metabolism, total iron binding capacity （TIBC） of lead poisoning group increased significantly compared with that of normal group （P〈 0.05）. There was no correlation between blood lead concentration and four parameters of iron metabolism in the two groups. Conclusion The relative parameters of erythrocyte MCH and MCV decreased, RDW increased, and TIBC of iron metabolism increased in children whose blood lead concentration exceeded the standard. The results showed that although the hemoglobin level of children with lead poisoning did not decrease obviously （anemia symptom）, it had caused the change of erythrocyte hemoglobin metabolism index and affected the metabolism of iron. Early intervention should be made in time when hemoglobin remains unchanged.