重庆地区学龄前和学龄后健康儿童常用肝肾功能检验项目参考区间的调查

Investigation on reference intervals of commonly used liver and renal function test items among healthy preschool and school-aged children in Chongqing

摘要:

目的：建立重庆地区学龄前和学龄后健康儿童常用肝肾功能检验项目的参考区间，更好地为临床诊断和治疗服务。方法：通过随机分层抽样筛选出545名健康学龄前（1～6周岁）和学龄后（7～12周岁）儿童（男320名，女225名）取静脉血，用日立7600全自动生化仪检测13项常用肝肾功能检验项目。正态分布资料按x±1.96 s计算参考区间；偏态分布资料按P2.5～P97.5计算参考区间。结果：（1）学龄前健康儿童与学龄后健康儿童除血清尿素氮（blood urea nitrogen，BUN）总体均数比较无显著性差异外，血清总胆红素（total bilirubin，TB）、直接胆红素（direct bilirubin，DB）、总蛋白（total protein，TP）、清蛋白（albumin，ALB）、丙氨酸转移酶（alanine aminotransferase，ALT）、天冬氨酸氨基转移酶（aspertate aminotransferase，AST）、碱性磷酸酶（alkaline phos－phatase，ALP）、r-谷氨酰转肽酶（gamma-glutamyl transpeptidas，GGT）、乳酸脱氢酶（lactate dehydrogenase，LDH）、肌酐（creatinine，CREA）、尿酸（uric acid，UA）和血糖（blood glucose，GLU）的总体均数均存在统计学差异。（2）不同性别学龄前儿童血清TB、DB、TP、ALB、ALT、AST、ALP、GGT、LDH、BUN、CREA、UA的总体均数比较无统计学差异，95%的参考区间分别为5.4~18.9 μmol/L、0~6.7 μmol/L、58~71 g/L、42~50 g/L、8.7~26 U/L、21~41 U/L、112~312 U/L、7.1~15.8 U/L、190~312 U/L、2.3~6.4 μmol/L、14~42 μmol/L、156~366 μmol/L；血清GLU有统计学差异：男童为3.7~6.0 mmol/L，女童为3.4~5.8 mmol/L。（3）不同性别学龄后健康儿童血清GLU、TB、DB、TP、ALB、AST、ALP、LDH、CREA、UA的总体均数比较无统计学差异，95%的参考区间分别为4.2~6.0 mmol/L，6.6~23.6 μmol/L，0~6.8 μmol/L，60~76 g/L，43~52 g/L，18~36 U/L，116~366 U/L，162~293 U/L，22~51 μmol/L，174~401 μmol/L；血清ALT、GGT和BUN有统计学差异：血清ALT95%的参考区间男童为8.9~28 U/L，女童为7.2~29.5 U/L，血清GGT95%的参考区间男童为8.8~21 U/L，女童为6.1~22.5 U/L，血清BUN95%的参考区间男童为2.8~7.0 μmol/L，女童为2.2~6.2 μmol/L。结论：建立了本地区学龄前和学龄后健康儿童13个常用肝肾功能检验项目的参考区间，为本地区儿童相关疾病的诊疗提供更准确的实验依据。

Abstract:

Objectives：To establish the reference intervals of commonly used liver and renal function test items among healthy preschool and school-aged children in Chongqing and to provide better references for clinical diagnosis and treatment. Methods：The stratified randomized cluster sampling method was used to select 545 healthy preschool（1-6 years old） and school-aged（7-12 years old）children（male：320，female：225）. Thirteen commonly used liver and renal function test items in venous blood were detected by the HITACHI 7600；data were analyzed by statistical method. Normal distribution data were used to calculate the reference intervals ac－cording to x±1.96 s and skewness distribution data were used to calculate the reference intervals according to P2.5-P97.5. Results：（1）The population means of liver and renal function test items between healthy preschool and school-aged children in Chongqing were significantly different except the blood urea nitrogen（BUN） item. （2）The population means of total bilirubin（TB），direct bilirubin（DB），total protein（TP），albumin（ALB），alanine aminotransferase（ALT），aspertate aminotransferase（AST），alkaline phosphatase（ALP），gamma-glutamyl transpeptidase（GGT），lactate dehy－drogenase（LDH），BUN，creatinine（CREA） and uric acid（UA） showed no significant difference except blood glucose（GLU） between dif－ferent genders among preschool children. The 95% reference intervals of serum TB，DB，TP，ALB，ALT，AST，ALP，GGT，LDH，BUN，CREA and UA were 5.4-18.9 μmol/L，0－6.7 μmol/L，58-71 g/L，42-50 g/L，8.7-26 U/L，21-41 U/L，112-312 U/L，7.1-15.8 U/L，190-312 U/L，2.3-6.4 μmol/L，14-42 μmol/L，156-366 μmol/L respectively. The 95% reference intervals of serum GLU based on gender were 3.7-6.0 mmol/L for male and 3.4~5.8 mmol/L for female. （3）The population means of Glu，TB，DB，TP，ALB，AST，ALP，LDH，CREA and UA showed no significant difference between different genders among school-aged children except ALT，GGT and BUN. The 95% reference intervals of GLU，TB，DB，TP，ALB，AST，ALP，LDH，CREA and UA were 4.2-6.0 mmol/L，6.6－23.6 μmol/L，0-6.8 μmol/L，60-76 g/L，43-52 g/L，18-36 U/L，116~366 U/L，162-293 U/L，22-51 μmol/L，174-401 μmol/L respectively. The 95% reference intervals based on gender were established as ALT：8.9-28 U/L for male，7.2-29.5 U/L for female；GGT：8.8-21 U/L for male，6.1-22.5 U/L for female；BUN：2.8-7.0 μmol/L for male，2.2-6.2 μmol/L for female. Conclusion：The reference intervals of thirteen commonly used liver and renal function test items are established by Hitachi 7600 system among healthy preschool and school-aged children in Chongqing；it can provide accurate experimental basis for clinical diagnosis and treatment in children.