高原地区不同民族新生儿红细胞增多症临床研究

目的 分析高海拔地区新生儿缺氧与红细胞增多症的关系,对高原世居藏族新生儿与移居高原汉族新生儿临床特点进行研究.方法 2005年1月1日至2006年10月31日,我院新生儿病房收治的739例患儿.对其中资料完整符合新生儿红细胞增多症者40例(其中藏族20例,汉族20例)进行了临床特点、检测经皮氧饱和度( TcSP02)、末梢血常规[血红蛋白(Hb)、红细胞(RBC)、红细胞压积(HCT)]和心肌酶谱研究分析.结果 汉族新生儿Hb为26.72±3.25、HCT为0.684±0.051、RBC为7.63±1.98三项值明显高于藏族新生儿的24.89±1.76、HCT 0.678±0.045、6.89±1.72,P≤0.05.汉族新生儿红细胞增多症者TcSP02浓度较藏族新生儿低82±5.882,P≤0.05,差异有统计学意义;汉族新生儿红细胞增多症患者末梢血常规血红蛋白(Hb)、红细胞( RBC)、红细胞压积(HCT)水平高于藏族新生儿,P≤0.05,藏族新生儿红细胞增多症末梢血常规血Hb、RBC、HCT治疗后均降至正常水平;心肌酶谱检测结果汉族组肌酸激酶同工酶( CKMB)治疗前与藏族组比较,F=171.41、P＜0.01,肌钙蛋白汉族组治疗前与藏族组比较,F=2.31、P＞0.01.肌红蛋白汉族组治疗前与藏族组比较,差异有统计学意义F=60.06、P＜0.01.藏汉族两组共同临床特征:呼吸急促,发绀、多血质外貌,易激惹、反射弱、低氧血症为主.缺氧为诱发因素;汉族组临床除以上共同特征外、以反应差、呼吸暂停、肌张力低下、神志淡漠、窒息为主要特征.40例新生儿红细胞增多症以低氧血症和心肌受损为主要表现.结论 高原新生儿红细胞增多症临床特征、TcSP02、末梢血常规和心肌酶谱变化特征对于指导新生儿红细胞增多症诊断治疗有一定的临床意义.移居高原者在高海拔地区更易发生新生儿红细胞增多症,且易导致其他器官,尤其是心脑功能受损.     

小儿感染性疾病红细胞内锌原卟淋测定及其临床意义

为了解小儿感染性疾病红细胞内锌原卟啉 (ZPP)值及其临床意义。方法 :对 6 1例小儿感染性疾病进行ZPP及血红蛋白 (Hb)、红细胞计数 (RBC)及平均红细胞体积 (MCV)的测定 ,以健康体检儿童作为对照。结果 :感染组儿童ZPP值明显高于对照组 (P <0 0 5 ) ,Hb、MCV值明显低于对照组 (P <0 0 5 ) ,RBC值无明显差异 (P<0 0 5 )。不同性别之间ZPP、Hb、RBC、MCV值无统计学差异 (P <0 0 5 )。肺炎、肺结核、肠炎的ZPP值较上呼吸道感染及皮肤感染患儿高 ,败血症患儿ZPP值最高 ,Hb、RBC、MCV值较低 ,但无统计学差异 (P <0 0 5 )。结论 :小儿感染性疾病存在铁代谢紊乱。应用ZPP筛查铁缺乏症时 ,应避免感染因素的干扰 ,ZPP也可作为儿童感染及感染严重程度的观察指标。     

以流式细胞术建立中国汉族健康儿童外周血淋巴细胞亚群相对计数的正常参考值

目的建立中国汉族健康儿童外周血淋巴细胞亚群的正常参考值范围。方法选取首都医科大学附属北京儿童医院入托、入学体检,或术前查体及术后复查(均为对免疫功能影响不大的疾病)的0～18岁汉族儿童为研究对象。按年龄分为婴儿组(28d至12个月),幼儿组(～3岁),学龄前组(～7岁),学龄组(～12岁)和青春期组(～18岁)。采集外周血以双色及四色荧光标记流式细胞术检测淋巴细胞亚群T细胞(CD3+CD19-)、CD4+T细胞(CD3+CD4+)、CD8+T细胞(CD3+CD8+)、B细胞(CD3-CD19+)和NK细胞(CD3-CD16+CD56+)相对计数及CD4+/CD8+比值。比较各年龄组不同性别淋巴细胞亚群分布的差异,建立正常参考值范围。结果由于青春期组所收集的标本数较少,将该研究对象组予以删除。最终纳入28d至12岁儿童592例。①婴儿组T细胞、CD8+T细胞百分比与CD4+/CD8+比值性别差异均有统计学意义,幼儿组CD4+T细胞、CD8+T细胞百分比与CD4+/CD8+比值性别差异均有统计学意义,学龄组CD4+T细胞百分比性别差异有统计学意义;②除了男童T细胞百分比各年龄组间差异无统计学意义外,男女儿童各年龄组间外周各血淋巴细胞亚群分布总体上差异均有统计学意义;进一步行男女儿童淋巴细胞亚群不同年龄组间两两比较,发现多个年龄组间差异有统计学意义;③男女儿童T细胞、CD8+T细胞和NK细胞百分比随年龄增长均呈逐渐升高趋势;CD4+T细胞、B细胞百分比及CD4+/CD8+比值随年龄增长均呈逐渐降低趋势;男女儿童T细胞、B细胞、NK细胞百分比和CD4+/CD8+比值升高或降低的程度略有不同;④中国汉族健康儿童淋巴细胞亚群分布特点与欧、美、非洲国家儿童相比存在相似的升高或降低的趋势,但数值上存在一定的差异。结论儿童淋巴细胞亚群分布存在年龄和性别的差异。本研究成功建立中国汉族28d至12岁健康儿童淋巴细胞亚群相对计数正常参考值范围。     

缺铁性贫血患儿血小板数目改变的分析研究

目的研究缺铁性贫血(IDA)儿童血小板(PLT)数目改变与血细胞、血清铁代谢参数之间的相关性。方法收集2014年1月—2017年12月我院诊断的214例IDA患儿初诊时血常规及血清铁代谢参数结果,统计学分析不同贫血程度IDA患儿中血小板数目的改变,以及和血清铁代谢参数之间的关系。结果 (1)本组病例中,PLT数增多171例(79.9%),正常37例(17.3%),减少6例(2.8%);(2)重度贫血组PLT数明显低于非重度贫血组(P=0.005);(3) PLT数目改变与血细胞及血清铁代谢参数无简单线性关系;(4) PLT数增多组中红细胞及血红蛋白均明显高于减少组(P=0.034,P 0.01),可溶性转铁蛋白受体明显低于减少组(P=0.013); PLT数正常组中转铁蛋白明显低于增多组(P=0.047);余血清铁代谢参数间差异无显著性。结论 (1) IDA患儿中,血小板数目具有双向模式改变特点,但与血细胞、血清铁代谢参数无简单线性关系;(2)血清铁代谢参数中可溶性转铁蛋白受体、转铁蛋白的改变与IDA患儿血小板数目改变有关。     

早期新生儿铁储备降低与孕妇缺铁的关系

近年来认为血清铁蛋白(SF)和红细胞内游离原卟啉(FEP)测定可反映机体早期隐性缺铁的情况。但有关新生儿期FEP的报道却很少见到。我们将105例早期健康新生儿进行了血红蛋白(Hb),红细胞计数(RBC)以及FEP的测定分析,从而了解新生儿铁储备与孕妇缺铁的关系。     

白银地区502例小儿血红蛋白、红细胞计数测定结果总结

我院1991年3～5月对白银市所属的某托儿所502名健康小儿进行了血红蛋白(Hb)及红细胞计数(RBC)测定,其中男275名,女227名,年龄为2～7岁。经统计学处理,被调查儿童Hb、RBC、MCH总的均值分别为:142.49±18.61g/L、4.75±0.72×10~(12)/L、29.82±2.54pg。各年龄组的Hb、RBC、MCH均值相近,且男女比较Hb、RBC总的均值、各年龄组均值亦相近,P>0.05,说明无论年     

脐带血铁代谢指标研究：附113例临床分析

本组应用PI、TIBC、UIBC、TS、SF、Hb、Ht、FEP、FEP/Hb、FEP/PI等10项指标,在福州地区对113例脐带血和108例临产妇的铁营养状况和各项铁代谢指标之间的相互关系进行全面分析研究,脐带血的PI、TS、SF、Hb、Ht测定值比临产妇组高,而TIBC、UIBC、FEP、FEP/Hb、EPP/PI测定值则比临产妇组低,两组间各项指标测定结果经统计学处理皆有非常显著差异(P<0.01),发现贫血组的临产妇(Hb<110g/L)其配对的脐带血开始出现不同程度的铁减少状态。     

小儿感染性疾病红细胞内锌原卟淋测定及其临床意义

为了解小儿感染性疾病红细胞内锌原卟淋（ZPP）值及其临床。方法：对61例小儿感染性疾病进行ZPP及血红蛋白（Hb)，红细胞计数（RBC）及平均红细胞体积（MCV）的测定，以健康体检儿童作为对照，结果： 感染组儿童ZPP值明显高于对照组（P＜0．05），Hb、MCV值明显低于对照组（P＜0．05），RBC值无明显差异（P＜0．05）。不同性别之间ZPP、Hb、RBC、MCV值无统计学差异（P＜0．05）。肺炎、肺结核、肠炎的ZPP值较上呼吸道感染及皮肤感染患儿高，败血症患儿ZPP值最高，Hb、RBC、MCV值较低，但无统计学差异（P＜0．05）。结论：小儿感染性疾病存在铁代谢紊乱。应用ZPP筛查铁缺乏症时，应避免感染因素的干扰，ZPP也可作为儿童感染及感染严重程度的观察指标。     

过敏性疾病患儿外周血嗜碱性粒细胞百分比及活化率检测

目的探讨嗜碱性粒细胞在儿童过敏性疾病中的临床参考价值。方法应用流式细胞仪,采用识别CRTH2/CD63/CD4组合抗体,检测过敏性疾病患儿与正常儿童外周血中CRTH2阳性细胞和嗜碱性粒细胞百分比及其活化率,并将检测结果与血清总IgE、特异性IgE、皮肤点刺试验结果作比较,分析其内在联系。结果 68例过敏性疾病患儿外周血CRTH2阳性细胞百分比较25例正常儿童升高(P<0.05),嗜碱性粒细胞百分比及活化率均较正常儿童显著升高(P均<0.01)。Pearson直线相关分析显示嗜碱性粒细胞百分比与血清总IgE无相关性(r=0.085,P=0.493),嗜碱性粒细胞活化率与血清总IgE之间有轻度相关性(r=0.247,P=0.043)。Spearman等级相关分析显示嗜碱性粒细胞百分比与特异性IgE无相关性(r=0.259,P=0.192),嗜碱性粒细胞活化率与特异性IgE间也存在相关性(r=0.455,P=0.017)。SPT等级结果与嗜碱性粒细胞百分比作Spearman等级相关分析显示两者间无相关性(r=0.231,P=0.058),而嗜碱性粒细胞活化率与SPT等级间存在相关性(r=0.481,P<0.01)。...     

福建省儿童铁缺乏症流行病学调查报告

目的 　了解我省儿童铁营养的现状 ,为使儿童缺铁性贫血的患病率在 2 0 0 0年的基础上下降 1 / 3掌握基数。方法 　在全省范围分三个层次九个流调点对 2 584名儿童作Hb(血红蛋白 )、ZPP(锌原卟啉 )及SF(血清铁蛋白 )的测定。结果 　我省儿童总的铁缺乏症发生率 37 2 3% ;铁减少发生率 2 2 87% ;缺铁性贫血发生率 1 4 36 %。结论 　铁缺乏、铁减少及缺铁性贫血的发生率 ,与饮食的合理性有密切关系。     

Red Cell Distribution Width in the Diagnosis of Iron Deficiency Anemia

Objective: 1. To compare peripheral smear (PS) and Red cell distribution width (RDW) in diagnosis of Iron deficiency anemia (IDA) in various grades. 2. To study the changes in RDW and PS after therapy.Methods : Children in the age group of six months to five years with microcytic (MCV < 80fl) anemia (Hemoglobin < 11g%) were evaluated. Those who had received blood transfusion and /or were already on iron therapy were excluded. Evaluation included clinical examination, complete blood count (CBC), RDW estimation microscopic examination of peripheral smear, measurement of serum iron and transferrin saturation. Children with IDA were treated with oral iron for 8 weeks and PS, CBC including RDW were repeated.Result: Of the 100 children evaluated, 89 had IDA. 48% had mild, 42% had moderate and 10% had severe anemia. Transferrin saturation correlated with severity of anemia. Peripheral smear showed microcytosis and hypochromia in all cases with severe anemia, 61.5% and 22.5% of those with moderate and mild anemia respectively. RDW was suggestive of iron deficiency in 100%, 82.05% and 100% of patient with mild, moderate and severe anemia respectively.Conclusion : In the diagnosis of mild and moderate iron deficiency anemia, RDW had a higher sensitivity than PS. Red cell morphology, Hb, PCV and RDW showed significant improvement after iron-therapy     

β-珠蛋白生成障碍性贫血患儿血常规参数和基因检测结果分析

目的检验泸州地区β-珠蛋白生成障碍性贫血(β-地贫)患儿血常规参数和基因突变类型分布,探讨血常规参数在β-地贫筛查中的应用价值。方法 50例β-地贫患儿,根据临床表现和实验室检查分为重型组(18例)和轻型组(32例),提取外周血DNA,采用反向斑点杂交法进行β-地贫基因突变位点分析。选择同期儿保门诊健康儿童20例作为正常对照组,采用全自动血细胞分析仪分别检测三组儿童血常规红细胞数(RBC)、血红蛋白量(Hb)、平均红细胞体积(MCV)、平均血红蛋白含量(MCH)、平均血红蛋白浓度(MCHC)、红细胞分布宽度(RDW)和网织红细胞比率(RET)等指标,并进行统计学分析。结果 50例患儿共检测出7种基因突变类型,其中以CD17(A→T)、CD41/42(-TTCT)和IVS-Ⅱ-654(C→T)最多见。轻型组和重型组β-地贫患儿RBC、Hb、MCV和MCH均较正常对照组明显降低,RET明显升高,差异有统计学意义;而MCHC和RDW与正常对照组比较差异无显著性。结论 MCV、MCH和RET等血常规参数可作为β-地贫的联合筛查指标。     

Red Blood Cell Distribution Width and the Platelet Count in Iron-deficient Children Aged 0.5–3 Years

Early detection of iron deficiency (ID) and iron deficiency anemia (IDA) in young children is important to prevent impaired neurodevelopment. Unfortunately, many biomarkers of ID are influenced by infection, thus limiting their usefulness. The aim of this study was to investigate the value of red blood cell distribution width (RDW) and the platelet count for detecting ID(A) among otherwise healthy children. A multicenter prospective observational study was conducted in the Netherlands to investigate the prevalence of ID(A) in 400 healthy children aged 0.5–3 years. ID was defined as serum ferritin (SF) <12 μg/L in the absence of infection (C-reactive protein [CRP] <5 mg/L) and IDA as hemoglobin <110 g/L combined with ID. RDW (%) and the platelet count were determined in the complete blood cell count. RDW was inversely correlated with SF and not associated with CRP. Calculated cutoff values for RDW to detect ID and IDA gave a relatively low sensitivity (53.1% and 57.1%, respectively) and specificity (64.7% and 69.9%, respectively). Anemic children with a RDW >14.3% had a 2.7 higher odds (95% confidence interval [CI]: 1.2–6.3) to be iron deficient, compared with anemic children with a RDW <14.3%. The platelet count showed a large range in both ID and non-ID children. In conclusion, RDW can be helpful for identifying ID as the cause of anemia in 0.5- to 3-year-old children, but not as primary biomarker of ID(A). RDW values are not influenced by the presence of infection. There appears to be no role for the platelet count in diagnosing ID(A) in this group of children.     

Profile of bone marrow iron stores in childhood iron deficiency anemia

To demonstrate the importance of bone marrow iron stores, we examined the complete hemogram, serum iron (SI), serum iron-binding capacity (SIBC), transferrin saturation (TS), serum ferritin and bone-marrow-stored iron in 31 children with iron deficiency (ID). The ages of the patients ranged from one to 14 years (mean 3.7 +/- 3.9). Laboratory findings of the 31 patients were as follows: hemoglobin (Hb) 8.5 +/- 2.4 g/dl, hematocrit (Hct) 27.8 +/- 6.3 percent, mean corpuscular volume (MCV) 58.6 +/- 8.6 fl, red blood cell count (RBC) 4 +/- 0.8 10(12)/L, red cell distribution width (RDW) 19.3 +/- 4.9, SI 17.2 +/- 9.3 microg/dl, SIBC 311 +/- 50.5 microg/dl, TS 5.5 +/- 2.8 percent and ferritin 6.7 +/- 7.3 ng/dl. In the bone marrow smears with iron stains, all patients' scores were zero for iron stores, which shows that bone-marrow-stored iron in childhood is easily affected. Because of the traumatic effect of bone marrow aspiration, it is recommended that it not be done routinely. The diagnosis of ID could be especially difficult in patients with low SI levels but normal SIBC levels and in patients with chronic inflammatory diseases. In those conditions, illustration of bone marrow stores could be of particular assistance for diagnosis of iron deficiency.     

基于北京市儿童川崎病6年流行病学资料的实验室指标分析

摘要 目的 川崎病（KD）缺乏特异性诊断方法，部分患儿为不完全性KD临床表现，本文拟对KD患儿实验室检查指标中的ESR、CRP、PLT、血浆白蛋白（ALB）、ALT、Hb和WBC进行分析，探讨各项实验室指标异常协助临床诊断的意义及与冠状动脉损害和IVIG抵抗的关系。方法 根据KD的诊断标准，对北京小儿川崎病流行病学调查协作组45家医院2000至2005年收治的急性期KD患儿的实验室资料进行汇总，将各指标同冠状动脉损害和IVIG抵抗行Pearson卡方检验和Logistic回归分析。结果 共收集KD患儿1 745例，依据纳入和排除标准有1 335例进入分析，其中男868例，女467例。 本组患儿ESR、CRP、PLT和WBC增高，ALB减低和Hb降低的发生率分别为96.0%、90.0%、92.2%和80.4%，45.7%和48.8%。Hb降低的发生率在不同的年龄组中存在明显差异，ALB和Hb降低与冠状动脉损害有相关性（P﹤0.05），CRP、ALB、ALT、Hb和WBC计数与IVIG抵抗有相关性（P﹤0.05）。Logistic回归显示ALB、Hb降低与冠状动脉损害有相关性，CRP升高、Hb降低、ALT和WBC升高与IVIG抵抗存在相关性（P﹤0.05）。结论 KD急性期ESR增快、CRP升高、外周血PLT、WBC计数增高的发生率均>90%,可协助KD急性期临床诊断。对于ALB和Hb降低的KD患儿应注意是否存在冠状动脉损害，对于CRP、ALT、WBC升高和Hb降低的患儿应注意出现IVIG抵抗的可能。     

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??Abstract??Objective To explore the risk factors in children with coronary artery lesion ??CAL?? complication in Kawasaki disease??KD??. Methods Retrospective analyses of the clinical data from 143 children with KD from 2009 to 2011 in Shandong Provincial Hospital were performed in terms of 11 aspects including the fever duration??hemoglobin ??Hb????erythrocyte sedimentation rate ??ESR????C-reaction protein ??CRP????white blood cell count ??WBC????blood platelet ??PLT????and the patients??gender and age. 143 children were divided into two groups according to whether these KD patients were with or without CAL.Both single factor and multivariate logistic regression analyses were performed. Results Single factor analysis showed that fever duration over 10 days??ESR??PLT??CRP??ALB??cTnI and NT-porBNP were risk factors to KD complicated with CAL ??P??0.05 or P??0.01??.Multivariate logistic regression analysis showed that a fever duration over 10 days??decrease of ALB and increase of cTnI were significant risk factors to KD complicated with CAL??P??0.05??. Conclusion Fever duration over 10 days??decrease of ALB and increase of cTnI are important risk factors to KD complicated with CAL.     

红细胞体积分布宽度和平均红细胞体积诊断小儿潜在性缺铁临床价值探讨

目的　研究潜在性缺铁的诊断方法 ,以便早诊断、早防治。方法　对 4 11例 6个月至 6岁小儿进行血红蛋白 (Hb)、红细胞体积分布宽度 (RDW )、平均红细胞体积 (MCV)、血清铁蛋白 (SF)及红细胞游离原卟啉(FEP)检测 ,分析RDW、MCV与SF、FEP之间有无相关性。结果　RDW与SF呈负相关 ,与FEP呈正相关 ;MCV与SF呈正相关 ,与FEP呈负相关。结论　在铁缺乏症的高发群体中 ,基层医院用RDW与MCV代替SF与FEP作为粗略判断潜在性缺铁的检测指标具有一定的临床应用与推广价值。     

The effects of acute infection on hematological parameters

This study was undertaken to investigate the effects of acute infections (e.g., upper respiratory tract infection, acute gastroenteritis, urinary tract infection) on total blood count, the relation of these effects with acute phase reactants, and the level of improvement in the total blood count after the resolution of acute infection. A total of 113 previously healthy children between the ages of 6 months and 12 years were enrolled in the study. The control group consisted of 43 healthy children with proper age and gender distribution. A total of 55.7% of the patients had a decrease of 0.10-2.40 g/dL in Hb values on the 3rd day of acute infections. The comparisons of the 1st, 3rd, and 15th day Htc, RBC, MCV, MCHC, RDW values of the study and control groups revealed no significant differences. The 1st day SI, SIBC, and TS values of the study group were low in majority of the patients. Then they gradually increased, finally reaching at their normal levels on the 15th day. There was no significant difference between the sTfR and sTfR/log ferritin values of the study and control groups.     

Diagnosing iron deficiency in cyanotic heart disease

Objective : To determine the incidence of iron deficiency in children with CCHD by noninvasive, inexpensive and easy laboratory methods.Methods : Forty four children with cyanotic congenital heart disease (CCHD), aged 6 to 48 months were included in this study. The patients were categorized as iron deficient (n:28) and iron sufficient group (n:16). Children with CCHD who had iron deficiency were treated with iron for 3 months.Result : Iron sufficient patients were followed during 3 months without giving iron preparation. Mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), red cell distribution width (RDW), serum iron (SI), total iron binding capacity (TIBC) and serum ferritin levels were measured in all patients at the beginning and at the end of the study.Conclusion : In children with CCHD, hemoglobin (Hb), hematocrit (Hct) and red blood cell (RBC) counts were not considered significant parameters in the diagnosis of iron deficiency. Determination of MCV, MCH, RDW values is relatively easy and inexpensive method requiring small amount of blood for the diagnosis of iron deficiency during the follow-up of patients with CCHD