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临床输血与检验

临床输血与检验 ›› 2023, Vol. 25 ›› Issue (6): 828-834.DOI: 10.3969/j.issn.1671-2587.2023.06.019

• 临床检验 • 上一篇    下一篇

高海拔地区儿童血铅水平对其血液学参数的影响*

强雪芹1, 罗恒2, 李素芳3, 熊雪4, 赵鑫1, 田燕5, 郭靓1   

  1. 1成都市第七人民医院检验科,四川成都 610041;
    2西安空军军医大学第一附属医院外科手术室,陕西西安 710032;
    3成都市第七人民医院内分泌与代谢性疾病科,四川成都 610041;
    4成都市第七人民医院心血管内科,四川成都 610041;
    5甘孜州白玉县人民医院检验科,四川甘孜 627100
  • 收稿日期:2023-10-22 出版日期:2023-12-20 发布日期:2024-01-15
  • 通讯作者: 郭靓,主要从事临床免疫学检验方面研究,（E-mail）4795261@qq.com。
  • 作者简介:强雪芹,主要从事临床免疫学检验方面研究,（E-mail）2659739939@qq.com。
  • 基金资助:
    *本课题受2020年度成都医学院—成都市第七人民医院（附属肿瘤医院）联合科研基金（No.2020LHJYPJ-03）;国家自然科学基金青年科学基金项目（No.82000373）资助

The Effect of Blood Lead Levels on Hematological Parameters in 591 Children with Severe Lead Poisoning

QIANG Xueqi, LUO Heng, LI Sufang, et al   

  1. Department of Clinical Laboratory, Chengdu Seventh People's Hospital, Chengdu 610041
  • Received:2023-10-22 Online:2023-12-20 Published:2024-01-15

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摘要： 目的 探讨高海拔地区重度铅中毒儿童血铅水平（blood lead levels,BLLs）与其血液学参数之间的关系,以了解高海拔地区高BLLs对儿童血液学参数的影响。方法 选取2021年7月—2022年5月某医院门诊及住院铅中毒儿童591例为研究组,另选取477例健康体检儿童作为对照组。收集两组的白细胞计数（WBC）、红细胞计数（RBC）、血红蛋白（HGB）、红细胞压积（HCT）、红细胞平均体积（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）、血小板计数（PLT）和BLLs指标,分析BLLs与血液学参数之间的关系,评估高BLLs对血液学参数的影响。结果 研究组的RBC、HGB、HCT、MCV和MCH低于对照组,而RDW高于对照组,差异均具有统计学意义（P<0.05）。研究组的BLLs与RBC（rs=-0.10,P=0.012）、HGB（rs=-0.24,P<0.001）、HCT（rs=-0.22,P<0.001）、MCV（rs=-0.20,P=0.002）、MCHC（rs=-0.18,P<0.001）及MCH（rs=-0.23,P<0.001）呈Spearman秩负相关,与RDW（rs=0.28,P<0.001）呈Spearman秩正相关。Logistic回归分析显示,在调整混杂因素后铅中毒儿童BLLs是HGB、HCT、MCV、MCH和MCHC降低及RDW升高的独立影响因素（P<0.05）。BLLs≥700 μg/L组的儿童出现HGB、HCT、MCV、MCH及MCHC降低的风险可能是BLLs<700 μg/L组的1.34、0.91、0.87、1.61及1.25倍。与BLLs<700 μg/L的儿童相比,BLLs≥700 μg/L的儿童RDW升高的风险在1.47倍左右。BLLs最高四分位数（>711.9 μg/L）的儿童的HGB、HCT及MCH降低的风险可能是BLLs最低四分位数（<522.1 μg/L）的儿童的2.16、1.03及1.81倍。与BLLs最低四分位数（<522.1 μg/L）的儿童相比,BLLs最高四分位数（>711.9 μg/L）的儿童RDW增加的风险在1.47倍左右。结论 高海拔地区重度铅中毒儿童的高血铅水平会影响血液系统造血功能,导致红细胞携氧能力降低,进而影响儿童生长发育及生存质量。

关键词: 铅中毒, 血铅水平, 血液学参数, 高海拔

Abstract: Objective To investigate the relationship between blood lead levels（BLLs） and hematological parameters in children with severe lead poisoning,so as to explore the effect of high blood lead level on hematological parameters at high altitudes. Methods A total of 591 patients with lead poisoning in a hospital in Sichuan from July 2021 to May 2022 were selected. 475 children with healthy physical examination were selected as the control group. The leukocyte count（WBC）,red blood cell count（RBC）,hemoglobin（HGB）,hematocrit（HCT）,mean corpuscular volume（MCV）,mean corpuscular hemoglobin（MCH）,mean corpuscular hemoglobin concentration（MCHC）,width of red blood cell distribution（RDW）,platelet count（PLT）and blood lead levels（BLLs）were collected.The correlation between blood lead level and hematological parameters was analyzed,to assess the effect of high blood lead levels on hematological parameters. Results The RBC,HGB,HCT,MCV and MCH of the lead poisoning group were significantly lower than those of the control group,while the RDW of the lead poisoning group was significantly higher than that of the control group（P<0.05）. The BLLs of the lead poisoning group was negatively correlated with RBC（rs=-0.10,P=0.012）,HGB（rs=-0.24,P<0.001）,HCT（rs=-0.22,P<0.001）,MCV（rs=-0.20,P=0.002）,MCHC（rs=-0.18,P<0.001）and MCH（rs=-0.23,P<0.001）,and positively correlated with RDW（rs=0.28,P<0.001）. Logistic regression analyses showed that BLLs were significantly associated with decreased HGB,HCT,MCV,MCH,MCHC and increased RDW after adjusting for potential confounders. The children with BLLs ≥700 μg/L were 1.34,0.91,0.87,1.61 and 1.25 times more likely to achieve decreased HGB,HCT,MCV,MCH and MCHC,respectively,compared to those with BLLs < 700 μg/L. Compared with children with BLLs<700 μg/L,those with BLLs≥700 μg/L were 1.47 times more likely to show increased RDW. The individuals with BLLs of the highest quartile were 2.16,1.03,and 1.81 times more likely to exhibit decreased HGB,HCT and MCH,respectively,than the children with BLLs of the lowest quartile. Compared with children with BLLs of the lowest quartile,those with BLLs of the highest quartile were 1.47 times more likely to show increased RDW. Conclusions High blood lead levels in children with severe lead poisoning at high altitudes have affected the hematopoietic function of the blood system,resulted in a decrease in the oxygen-carrying capacity of red blood cells,which in turn affected children's growth and development and quality of life.

Key words: Lead poisoning, Blood lead level, Hematological parameters, High attitude

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