探讨近十年北京市顺义区学龄前儿童血常规4项指标参考区间(RI)及其变化。

选择2012年7月至2022年9月，在北京儿童医院顺义妇儿医院完成入园、入学体检，并每隔3年采集1个年度体检数据，共计21 719例学龄前儿童纳入研究。根据体检时间，将其分为A组(n＝5 432，体检时间为2012年7月至2013年9月)，B组(n＝5 441，体检时间为2015年7月至2016年9月)，C组(n＝5 419，体检时间为2018年7月至2019年9月)；D组(n＝5 427，体检时间为2021年7月至2022年9月)4组。采用回顾性分析法，并遵循CLSI EP28-A3c美国标准化委员会RI建立准则，建立4组学龄前儿童白细胞计数(WBC)，红细胞计数(RBC)，血小板计数(PLT)及血红蛋白(Hb)水平4项血常规主要指标的RI。采用Kruskal-Wallis H检验及Mann-Whitney U检验，对4组学龄前儿童血常规4项指标RI的上、下限进行总体及两两比较。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》。所有学龄前儿童监护人签署临床研究知情同意书。

D组学龄前儿童WBC RI的上限为10.72×10⁹/L(10.63×10⁹/L，10.79×10⁹/L)，分别低于A、B、C组的12.49×10⁹/L(12.35×10⁹/L，12.60×10⁹/L)，12.77×10⁹/L(12.62×10⁹/L，12.90×10⁹/L)，12.41×10⁹/L(12.33×10⁹/L，12.58×10⁹/L)，并且差异均有统计学意义(Z＝－23.72、－32.98、－30.12，均为P<0.001)。D组学龄前儿童RBC与Hb水平的RI下限均分别高于A、B、C组，并且差异均有统计学意义(P<0.05)。4组学龄前儿童WBC RI下限、RBC及Hb水平RI上限比较，以及4组学龄前儿童PLT RI上、下限比较，差异均无统计学意义(P>0.05)。

检验报告的RI可能在不同时间段发生改变，应对其定期评估与更新，以助力于精准诊疗。

To explore the reference intervals (RI) and its dynamic changes of four indexes of preschool children′s blood routine test in the past ten years in Shunyi district, Beijing.

From July 2012 to September 2022, a total of 21 719 preschool children who completed physical examinations for admission and enrollment at Shunyi Women′s and Children′s Hospital of Beijing Children′s Hospital and annual children′s physical examination data were collected every 3 years were included in the study. According to when they took physical examination, they were divided into group A (n=5 432, physical examination time were from July 2012 to September 2013), group B (n=5 441, physical examination from July 2015 to September 2016), group C (n=5 419, physical examination from July 2018 to September 2019) and group D (n=5 427, physical examination from July 2021 to September 2022). By retrospective analysis method, and following CLSI EP28-A3c American Committee for Standardization RI establishment guidelines, the RI of four groups of preschool children′s white blood cell count (WBC), red blood cell count (RBC), platelet count (PLT), and hemoglobin (Hb) level were established. The Kruskal-Wallis H test and Mann-Whitney U test were used to overall and pairwise compare the upper and lower limits of the four RI indexes of preschool children′s blood routine test in four groups. This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed consents were obtained from guardians of all children.

The upper limit of the WBC RI in preschool children in group D was 10.72×10⁹/L (10.63×10⁹/L, 10.79×10⁹/L), which was lower than those of 12.49×10⁹/L (12.35×10⁹/L, 12.60×10⁹/L), 12.77×10⁹/L (12.62×10⁹/L, 12.90×10⁹/L) and 12.41×10⁹/L (12.33×10⁹/L, 12.58×10⁹/L) in group A, B and C, respectively, and the differences were statistically significant (Z=-23.72, -32.98, -30.12; all P<0.001). The lower limits of RBC and Hb level RI in group D were higher than those in group A, B and C, respectively, and the differences were statistically significant (P<0.05). There were no significant differences in the lower limit of WBC RI and upper limits of RBC and Hb level RI, and the upper and lower limits of PLT RI among four groups (P>0.05).

The RI of the clinical laboratory report may change at different time periods, and it should be regularly evaluated and updated to facilitate precise diagnosis and treatment.