中国学龄前儿童贫血现况与神经心理发育的相关性

王利红; 杨慧敏; 李瑞莉; 政晓果; 赵文华; 杨振宇; 张倩; 徐韬; 王玉英; 陈博文

doi:10.16835/j.cnki.1000-9817.2022.08.023

中国学龄前儿童贫血现况与神经心理发育的相关性

doi: 10.16835/j.cnki.1000-9817.2022.08.023

1.
首都儿科研究所儿童卫生与发展研究室，北京 100020
2.
中国疾病预防控制中心营养与健康所
3.
中国疾病预防控制中心妇幼保健中心

基金项目:

科技基础资源调查专项课题 2017FY101106

首都儿科研究所所级基金项目 QN-2020-21

详细信息

作者简介:
王利红(1972-)，女，北京市人，大学本科，主管技师，主要研究方向为儿童心理行为发育方向

通讯作者:
陈博文，E-mail：bowenc@126.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R446 R179 R725.5
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出版历程
- 收稿日期: 2022-05-05
- 修回日期: 2022-07-13
- 网络出版日期: 2022-08-24
- 刊出日期: 2022-08-25

Anemia in preschool children in China and its association with neuropsychological development

1.
Department of Child Health Development, Capital Institute of Pediatrics, Beijing(100020), China

摘要

摘要: 目的分析中国学龄前儿童贫血现况及其与不同能区及总体神经心理发育状况的相关关系。方法数据来源于“中国0~18岁儿童营养与健康系统调查与应用”项目，以14省28个调查点的3 261名2~6岁儿童及其家长为研究对象。儿童相关人口学特征由经过统一培训的调查员进行面对面调查。采用血红蛋白检测方法(Hemocue法)测定儿童全血血红蛋白，儿童的神经心理发育水平由经过培训的儿童保健人员采用《0~6岁儿童发育行为评估量表》(WS/T 580—2017)进行测查。结果儿童血红蛋白平均水平为(125.23±11.49)g/L，贫血率为10.30%。调整性别、年龄、民族、地区、喂养方式、母孕期情况等混杂因素之后，2~6岁贫血儿童在大运动(β=-2.15，95%CI=-3.89~-0.41)、精细动作(β=-2.46，95%CI=-4.12~-0.79)、适应能力(β=-2.59，95%CI=-4.42~-0.76)、语言(β=-3.65，95%CI=-5.53~-1.78)和社会行为(β=-3.11，95%CI=-4.94~-1.28)5个能区以及全量表(β=-2.79，95%CI=-4.10~-1.49)发育商水平均低于非贫血儿童(P值均 < 0.05)。结论 2~6岁儿童贫血与其总体发育商以及大运动、精细动作、适应能力、语言和社会行为五大能区发育商水平均呈负相关，建议积极开展学龄前儿童贫血监测、干预工作，进一步提高儿童的神经心理发育水平。
- 贫血 /
- 生长和发育 /
- 精神卫生 /
- 回归分析 /
- 儿童，学龄前
Abstract: Objective To explore the relationship between anemia and neuropsychological development in various domains among preschool children in China. Methods Data came from the National Nutrition and Health Systematic Survey for children in China, and 3 261 preschool children aged 2-6 years and their parents from 28 sites across 14 provinces were recruited in this study. Parental and child characteristics were obtained by interview-administrated questionnaires. Blood hemoglobin(Hb) concentration was determined by Hemocue method. Neuropsychological development quotients were assessed using the Development Scale for Children Aged 0-6 Years(WS/T 580-2017). Results The average Hb level was (125.23±11.49)g/L and the overall anemia prevalence was 10.30% among preschool children. After adjusting the confounding factors(sex, age, ethnicity, region, feeding mode, maternal status during pregnancy, etc), developmental quotients of gross motor(β=-2.15, 95%CI=-3.89--0.41), fine motor(β=-2.46, 95%CI=-4.12--0.79), adaptive behavior(β=-2.59, 95%CI=-4.42--0.76), language(β=-3.65, 95%CI=-5.53--1.78), personal-social behavior(β=-3.11, 95%CI=-4.94--1.28) and full-scale(β=-2.79, 95%CI=-4.10--1.49) among children with anemia were significantly lower than non-anemic infants(P < 0.05). Conclusion Anemia was negatively associated with developmental quotient, as well as five domains of gross motor, fine motor, adaptive behavior, language, and personal-social behavior in preschool children aged 2-6 years. It is suggested to carry out the work of anemia monitoring and intervention in preschool children to further improve their neuropsychological development.
- Anemia /
- Growth and development /
- Mental health /
- Regression analysis /
- Child, preschool
注释:

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表 1 不同年龄组男女童血红蛋白水平比较/(x±s，g·L^-1)

Table 1. Comparison of hemoglobin level in boys and girls by age group/(x±s, g·L^-1)

年龄/岁	男童		女童		总体
年龄/岁	人数	血红蛋白	人数	血红蛋白	人数	血红蛋白
2	381	122.09±11.01	408	121.37±10.46	789	121.72±10.73
3	379	124.63±11.88	411	123.57±10.87	790	124.08±11.37
4	433	126.42±11.76	441	126.94±10.95	874	126.68±11.36
5~6	400	128.14±11.63	408	128.28±11.27	808	128.21±11.44
合计	1 593	125.39±11.78	1 668	125.07±11.22	3 261	125.23±11.49
F值		19.54		34.42		52.34
P值		< 0.01		< 0.01		< 0.01

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表 2 不同年龄组男女童贫血检出率比较

Table 2. Comparison of anemia prevalence in boys and girls by age group

年龄/岁	男童		女童		总体
年龄/岁	人数	贫血	人数	贫血	人数	贫血
2	381	51(13.39)	408	52(12.75)	789	103(13.05)
3	379	36(9.50)	411	38(9.25)	790	74(9.37)
4	433	37(8.55)	441	30(6.80)	874	67(7.67)
5~6	400	47(11.75)	408	45(11.03)	808	92(11.39)
合计	1 593	171(10.73)	1 668	165(9.89)	3 261	336(10.30)
χ²值		6.00		9.23		14.81
P值		0.11		0.03		< 0.01
注： ()内数字为贫血率/%。

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表 3 不同组别儿童各能区平均发育商得分比较(x±s)

Table 3. Comparison of developmental quotient of scores in children among different groups(x±s)

组别	选项	人数	统计值	大运动	精细动作	适应能力	语言	社会行为	总分
年龄/岁	2	789		101.60±14.22	91.64±16.51	97.76±14.30	96.09±17.98	97.40±14.82	96.90±11.91
	3	790		112.44±16.78	98.04±16.72	101.54±17.92	103.41±18.66	106.06±17.81	104.28±13.33
	4	874		113.52±15.34	101.56±13.47	102.90±16.56	104.77±16.12	106.50±16.27	105.85±12.01
	5~6	808		108.43±11.53	98.89±11.14	100.98±13.88	101.61±12.43	102.62±13.12	102.52±9.31
			F值	110.36	67.68	15.57	43.48	58.55	89.89
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01
是否贫血	是	336		105.68±14.04	93.74±14.34	96.64±15.08	96.02±18.38	98.70±15.67	98.13±12.19
	否	2 925		109.51±15.41	98.09±15.05	101.33±15.89	102.20±16.46	103.75±15.97	102.98±12.09
			t值	-4.35	-5.04	-5.15	-6.44	-5.49	-6.95
			P值	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01	< 0.01

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表 4 儿童贫血与不同能区发育商的多元线性回归分析[β值(β值95%CI)，n=3 261]

Table 4. Linear regression analysis of anemia and developmental quotient in children[β(β 95%CI), n=3 261]

变量	全量表发育商	大运动	精细动作	适应能力	语言	社会行为
是否贫血
是	-2.79(-4.10~-1.49)^**	-2.15(-3.89~-0.41)^*	-2.46(-4.12~-0.79)^**	-2.59(-4.42~-0.76)^**	-3.65(-5.53~-1.78)^**	-3.11(-4.94~-1.28)^**
性别
女	2.50(1.73~3.26)^**	2.20(1.18~3.22)^**	3.12(2.14~4.09)^**	1.91(0.84~2.98)^**	2.61(1.51~3.71)^**	2.63(1.56~3.71)^**
年龄	1.72(1.50~1.94)^**	2.48(2.18~2.77)^**	1.66(1.37~1.94)^**	0.87(0.56~1.18)^**	1.68(1.36~1.99)^**	2.63(1.56~3.71)^**
民族
少数民族	-3.25(-4.65~-1.86)^**	1.20(-0.66~3.06)	-3.70(-5.48~-1.92)^**	-5.65(-7.61~-3.70)^**	-5.21(-7.21~-3.21)^**	-2.89(-4.84~-0.94)^**
是否早产儿
是	-0.86(-2.15~0.43)	-0.45(-2.17~1.26)	-2.02(-3.66~-0.38)^*	-0.53(-2.33~1.27)	-0.16(-2.00~1.69)	-1.15(-2.95~0.65)
是否高危新生儿
是	-2.07(-3.75~-0.39)^*	-2.25(-4.49~-0.02)^*	-1.40(-3.54~0.74)	-2.90(-5.26~-0.55)^*	-2.95(-5.36~-0.54)^*	-0.85(-3.20~1.50)
喂养方式
人工喂养	-2.12(-3.15~-1.09)^**	-2.93(-4.30~-1.55)^**	-2.26(-3.57~-0.95)^**	-1.92(-3.37~-0.48)^**	-1.56(-3.04~-0.09)^*	-1.95(-3.39~-0.51)^**
混合喂养	0.65(-0.35~1.65)	0.48(-0.85~1.81)	-0.23(-1.51~1.04)	0.99(-0.41~2.38)	1.38(-0.05~2.81)	0.63(-0.77~2.02)
母孕期增重	0.04(-0.00~0.08)	0.06(0.00~0.12)^*	0.04(-0.01~0.10)	-0.01(-0.07~0.05)	0.04(-0.02~0.10)	0.06(0.00~0.12)*
地区
东北	6.00(4.61~7.38)^**	3.25(1.40~5.09)^**	5.18(3.42~6.95)^**	4.32(2.39~6.26)^**	8.54(6.56~10.53)^**	8.71(6.77~10.64)^**
华东	0.72(-0.69~2.12)	0.72(-1.15~2.59)	-0.36(-2.15~1.43)	-1.49(-3.45~0.48)	2.15(0.14~4.16)^*	2.59(0.62~4.55)^**
华中	-1.71(-3.19~-0.23)^*	-4.44(-6.41~-2.47)^**	-4.49(-6.38~-2.61)^**	-0.02(-2.09~2.06)	0.47(-1.65~2.59)	-0.08(-2.15~1.99)
华南	5.80(3.91~7.68)^**	0.15(-2.36~2.66)	10.30(7.89~12.70)^**	6.12(3.48~8.76)^**	6.54(3.83~9.24)^**	5.89(3.26~8.53)^**
西南	1.59(0.15~3.03)^*	1.00(-0.92~2.92)	3.16(1.33~5.00)^**	-0.78(-2.80~1.23)	0.22(-1.85~2.28)	4.39(2.37~6.40)^**
西北	-5.28(-6.64~-3.92)^**	-2.68(-4.49~-0.88)^**	-4.84(-6.57~-3.11)^**	-9.26(-11.17~-7.36)^**	-6.14(-8.09~-4.20)^**	-3.46(-5.36~-1.56)^**
注： P < 0.05，*P < 0.01。

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