海拔校正对中国婴幼儿血红蛋白的影响及校正值研究

Influence of altitude on hemoglobin levels and determination of the adjusting values

目的建立6~23月龄婴幼儿血红蛋白(hemoglobin,Hb)与海拔高度关系,并获得Hb的海拔高度校正值。方法采用贫困地区儿童营养改善项目数据进行分析研究,按省分层、多阶段抽样、PPS抽样和随机等距抽样相结合的方法在项目覆盖地区抽取6~23月龄婴幼儿为监测对象,采用问卷调查采集数据,包括婴幼儿及家庭、家长喂养行为和营养知识。使用婴幼儿智能体检仪测量儿童体重和身长,采集婴幼儿指尖血HemoCue法检测血红蛋白,海拔高度为婴幼儿居住地的海拔。对Hb及海拔数据进行线性回归分析,并确定Hb海拔校正值,与美国疾病预防控制中心、Dirren研究组校正结果进行比较。结果2018年监测19个省140个县42938名6~23月龄婴幼儿,其中男童22207人,占51.7%,女童20731人,占48.3%;身长(77.6±6.2)cm,体重(9.91±1.62)kg,平均Hb水平为11.9 g/dL;海拔高度分布为10~4236 m,平均893.4 m。贫血率与采用美国疾病预防控制中心、Dirren及本研究方法校正后的贫血率分别为18.9%、27.5%、22.7%和20.3%,校正效应明显。所得1000、2000、3000和4000 m对应的Hb海拔校正值分别为0.1、0.3、0.6和1.2 g/dL,明显低于WHO推荐值。结论中国6~23月龄婴幼儿Hb校正值与普遍使用的Hb海拔校正值可能有所差别。

OBJECTIVE To establish the relationship between hemoglobin level of 6-23 month infants and altitude of their living places,and to determine the adjusting hemoglobin values for infants in high altitude areas.METHODS Conduct this study by using available data from Improvement of Nutrition in Children in Poor Rural Regions.6-23 months infants were sampled with the method of combined multi-stage stratified cluster,PPS and random equidistant.Questionnaires were used to collect data of infants and their families,feeding practices and nutrition knowledge of caretakers.The weight and length were measured by the intelligent physical examination instrument.Hemoglobin was tested by HemoCue method with blood drop from finger tips.Altitude was checked by the residence regions.Linear regressions were used to analyze the relation quotation of hemoglobin and altitude,adjusting hemoglobin values were determined with the quotation.A comparison was observed among adjusting method of CDC,Dirren and the established.RESULTS A total of 24938 infants at age of 6-23 months were sampled from 140 counties,in 19 provinces in 2018.Data were from 22207 male accounting for 51.7%and 20731 female,48.3%.The weight,height and hemoglobin were(77.6±6.2)cm,(9.91±1.62)kg and 11.9 g/dL respectively.The altitude ranges from 10 m to 4236 m,averagely 893.4 m.Anemia rates of the infants and adjusted with method from CDC,Dirren and this study were 18.9%,27.5%,22.7%and 20.3%,showing remarkable adjusting effect.This study obtained adjusting Hb value for 1000,2000,3000 and 4000 m were 0.1,0.3,0.6 and 1.2 g/dL respectively and noticeably lower than that of suggested by WHO.CONCLUSION Adjusting hemoglobin values of 6-23 months were different from the used values.