婴、幼儿营养性缺铁性贫血249例相关因素分析

目的探讨不同月龄婴、幼儿的营养性缺铁性贫血（nutritional iron deficiency anemia）发生情况及其相关因素。方法选择2004年1月1日至2006年12月31日在郑州市妇幼保健院儿童保健门诊接受规范4：2：1保健的1254例1～6个月（A组，n=540）、6～12个月（B组，n=360）、12～18个月（C组，n=354）儿童为研究对象（本研究遵循的程序符合郑州市妇幼保健院人体试验委员会所制定的伦理学标准，得到该委员会批准，分组征得受试对象监护人的知情同意，并与其签署临床研究知情同意书）。对其母乳喂养、辅食添加等情况进行问卷调查（自行设计），并采用世界卫生组织（WHO）推荐的氰化高铁法测定血红蛋白（hemoglobin，Hb）含量，同时回顾性追踪母亲孕期保健资料，对采集资料进行汇总、统计学处理和分析。结果营养性缺铁性贫血总检出率为19．86％（249／1254），其中A，B，C组儿童营养性缺铁性贫血检出率分别为26．11％（141／540），19．17％（69／360），11．02％（39／354），随年龄增加，营养性缺铁性贫血发生率下降。单因素分析显示，A组婴儿中，纯母乳喂养儿（n＝414）和非纯母乳喂养儿（n＝126）缺铁性贫血检出率分别为22．46％（93／414）和38．10％（48／126），两者比较，差异有显著意义（P〈0．05）。A组纯母乳喂养儿中，及时和过晚添加辅食儿（n=309 vs n=105）的营养性缺铁性贫血检出率分别为16．50％（51／309），40．00％（42／105），两者比较，差异有显著意义（P〈0．01）。母亲孕期保健资料回顾性分析结果显示，249例营养性缺铁性贫血婴、幼儿中，孕妇孕晚期缺铁性贫血为78例（31．5％）。结论婴、幼儿饮食结构不合理和母亲孕晚期缺铁性贫血，是导致婴、幼儿营养性缺铁性贫血的重要影响因素。加强围生期保健，提倡婴儿期母乳喂养的同时注意适时（4～6个月龄时）添加辅食，是减少婴儿期营养性缺铁性贫血的有效措施。

Analysis of 249 Cases With Nutritional and Iron Deficiency Anemia

Objective To discuss the incidence of the different-month-old infants and young children with nutritional iron deficiency anemia and its related factors. Methods From January 1, 2004 to December 31, 2006, 1 254 children whose ages were 1 - 6 months（group A, n= 540）, 6 - 12 months（group B, n= 360）, 12 -18 months （group C, n = 354） did regulation health convalescence in the Child Health Care Clinic of Zhengzhou Maternal and Child Health Hospital by the rate of 4 ： 2 - 1 process. Informed consent was obtained from all patients. The condition of breast-feeding, food supplement and nutritional iron deficiency anemia were investigated. The hemoglobin （Hb） level was tested by the hemiglobin-cyanide measurement method which was recommended by the World Health Organization（WHO）. Meanwhile, the information of health care during gestation was followed up and analyzed. Results The total rate of infants nutritional iron deficiency anemia was 19.86% （ 249/1 254）, among which the incidence rates of group A, group B, and group Cwere 26. 11% （141/540）, 19. 17% （69/360）and 11.02% （39/354）, respectively. The singlefactor analysis showed that there was a lower rate of nutritional iron deficiency anemia in the breast-fed infants （22.46%, 93/414） than non-breast-fed infants （38.10%, 48/126） in group A （P〈0.05）, and the gestational age and birth weight were related to nutritional iron deficiency anemia of infants. The rates of nutritional iron deficiency anemia of timely and late subsidiary food-fed were 16.50% and 40.00% in group A, respectively, which differed greatly （P〈0.01）. The information of health care during gestation showed that a total of 78 cases （31.5%） had iron deficiency anemia during late pregnancy. Conclusion The important factors causing nutritional iron deficiency anemia of infants are the irrational diet structure of infants and nutritional iron deficiency anemia in the late pregnancy of mothers. To enhance the prenatal health care, decrease the rate of infants with low birth weight, advocate breast-feeding during the infant period, as well as to add supplementary food timely and properly, the infants aged 4-6 months old are the powerful period for decreasing the prevalence of infant nutritional iron deficiency anemia.