西藏地区3岁以下儿童血红蛋白水平及高海拔下贫血患病率调查

Study on the hemoglobin levels of children under the age of three years and the prevalence of anemia at high altitude in Tibet of China

目的 了解西藏地区 3岁以下儿童的血红蛋白 (Hb)水平及高海拔下贫血患病情况。方法 采用横断面调查设计与分层多阶段随机抽样法获取样本 ,采用B Hemoglobin血红蛋白仪 ,取指末梢血 10 μl测量Hb含量。运用CDC法、Dirren法和Dallman法分别对Hb进行海拔调整 ,计算贫血患病率。结果 ①共检测 112 7名 3岁以下儿童 ,Hb的平均水平为 12 0g/L。男女儿童间的差异无显著性 ,城市儿童Hb为 12 3.3g/L ,显著高于农村儿童 (119.9g/L)。协方差分析控制海拔因素后 ,城市仍高于农村 ,大年龄组儿童高于小年龄组 ,地区之间差异较大 ,以拉萨和日喀则最高 ,那曲和阿里最低。而农、牧区间没有差别。②使用 3种Hb校正方法校正后贫血患病率显著上升 ,但各方法结果差距较大 ,以CDC法校正的贫血率最高 ,可达到 90 .4 %。Dirren法为 72 .3% ,Dallman法贫血率最低 ,为6 5 .0 %。结论 海拔对Hb有显著影响 ,该地区 3岁以下儿童贫血患病率可能较高 ,但目前使用的 3种校正方法难以准确地反映该地区的情况 ,提示藏族人的Hb与海拔高度的关系可能有别于上述 3种方法中的人群。建议以该地区正常儿童为基础确定Hb与海拔的关系。

Objective To study the hemoglobin status of children under the age of three years and the prevalence of anemia at high altitude. Methods Cross-sectional study and randomly sampling were used. Blood was collected on tip of finger and the level of hemoglobin was measured using B-Hemoglobin photometer. We adjusted the hemoglobin based on altitude, using three methods of CDC, Direen's and Dallman's and then estimated the prevalence of anemia. Results (1) 1 127 children were examined. The findings indicated that the average hemoglobin was about 120 g/L . There was no significant difference for Hb between boys and girls. Urban children had a higher hemoglobin level ( 123.3 g/L ) than rural children ( 119.9 g/L ). Analysis of covariance indicated that, after controlling the factor of altitude, the mean content of hemoglobin of rural children was lower than that of urban children and hemoglobin varied among districts. (2)Different method used for correction of hemoglobin caused different prevalence rates of anemia but they were higher than un-corrected prevalences: 90.4 % for CDC method, 72.3 % for Dirren's method and 65.0 % for Dallman's method respectively. Conclusion Higher altitude seemed to affect the levels of hemoglobin significantly. The prevalence of anemia in children might be higher, but current hemoglobin correction methods might not be suitable for correcting hemoglobin of Tibetan children. So we suggested that it was imperative to establish a relationship between altitude and hemoglobin of Tibetan children.