全科医学临床与教育

目的 分析徐州地区儿童贫血的病因。方法 选取徐州市儿童医院诊断为贫血的患儿651例，根据年龄大小将其分为六组(1个月～、4个月～、6个月～、1岁～、3岁～、6岁～16岁)。所有患儿当日抽取静脉血，采用全自动血球分析仪检测患儿的红细胞、血红蛋白、红细胞压积、红细胞平均体积、红细胞平均血红蛋白量、红细胞平均血红蛋白浓度水平。并采用全自动化学发光法检测患儿血清铁蛋白、叶酸、维生素B₁₂水平。结果 651例贫血患儿中，男性355例(54.53%)，女性296例(45.47%),1个月～组55例(8.45%),4个月～组75例(11.52%),6个月～组220例(33.79%),1岁～组201例(30.88%),3岁～组61例(9.37%),6岁～16岁组39例(5.99%)。轻度贫血329例(50.54%)、中度贫血309例(47.47%)、重度贫血12例(1.84%)、极重度贫血1例(0.15%)。651例血红蛋白降低的患儿中，378例铁蛋白降低，12例维生素B₁₂降低，6例铁蛋白合并叶酸缺乏，108例铁蛋白合并维生素B₁₂缺乏，147例由其他病因导致贫血。血红蛋白降低的患儿大多表现为小细胞低色素性贫血，其次是小细胞性贫血，其他表现不典型。378例缺铁性贫血儿童血清铁蛋白、平均红细胞体积、平均血红蛋白含量、血红蛋白值随缺铁程度的严重程度呈下降趋势，差异均有统计学意义(F分别=65.41、123.58、78.47、135.89,P均<0.05)。结论 徐州地区患儿贫血发生率男性高于女性，发病率最高的年龄段是6～12个月，其次是1～3岁，贫血主要以轻中度贫血为主。贫血病因主要是铁缺乏引起，其次是维生素B₁₂缺乏。血液检验各指标对于贫血病因、贫血鉴别和临床诊治均具有重要的临床意义。

Objective To analyze the etiology of anemia in children in Xuzhou.Methods A total of 651 children with one month to 16 years old who diagnosed with anemia by Xuzhou children's hospital were selected and divided into six groups(1 month-,4 months-,6 months-,1 year-,3 years-,6-16 years old) according to their age.Venous blood was drawn,and the levels of red blood cells(RBC),hemoglobin(HB),hematocrit(HCT),mean corpuscular volume(MCV),mean corpuscular hemoglobin(MCH),and mean corpuscular hemoglobin concentration(MCHC),serum ferritin(SF),folate,and vitamin B₁₂ levels were detected.Results Of 651 children with anemia,355(54.53%) were males and296(45.47%) were females,55(8.45%) cases were 1-4 months old,75(11.52%) cases were 4-6 months old,220(33,79%) cases were 6-12 months old,201(30.88%) cases were 1-3 years old,61(9.37%) cases were 3-6 years old,39(5.99%) cases were 6-16 years old.Totally 329(50.54%) patients had mild anemia,309(47.47%) patientshad moderate anemia,12(1.84%) patients had severe anemia,and 1(0.15%) patient had very severe anemia.Of the 651 children with decreased hemoglobin,378 had decreased ferritin,12 had decreased vitamin B₁₂,6 had ferritin combined with folic acid deficiency,108 had ferritin combined with vitamin B₁₂ deficiency,and 147 had anemia caused by other etiologies.Children with reduced hemoglobin mostly presented with microcytic hypochromic anemia,followed by microcytic anemia with atypical other manifestations.The values of SF,MCV,MCH and HB in anemia patients decreased with the degree of iron deficiency(F=65.41,123.58,78.47,135.89,P<0.05).Conclusion In Xuzhou,the incidence of anemia in affected children is higher in males than females,and the age group with the highest incidence is 6-12 months old,followed by 1-3years old,and the anemia is mainly mild to moderate.The anemia etiology is mainly caused by iron deficiency,followed by vitamin B₁₂ deficiency,and there are also partial anemias caused by other etiologies.The blood test indexes have important clinical significance for the cause of anemia,the differentiation of anemia,and the clinical diagnosis and treatment.