Reference intervals and its dynamic changes of four indexes of blood routine test of preschool children in Shunyi district, Beijing

doi:10.3877/cma.j.issn.1673-5250.2023.02.010

Objective

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.

Methods

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.

Results

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).

Conclusions

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.

Key words: Leukocyte count, Erythrocyte count, Platelet count, Hemoglobinometry, Reference values, Child, preschool

表1 北京市顺义区4组学龄前儿童血常规4项指标检测数据清洗离群值与有效数据量

组别	例数	WBC		RBC		Hb水平		PLT
组别	例数	离群值数	有效数据量	离群值数	有效数据量	离群值数	有效数据量	离群值数	有效数据量
A组	5 432	31	5 401	20	5 412	70	5 362	115	5 317
B组	5 441	20	5 421	46	5 395	47	5 394	64	5 377
C组	5 419	35	5 384	20	5 399	59	5 360	52	5 367
D组	5 427	126	5 301	47	5 380	8	5 419	78	5 349

表1 北京市顺义区4组学龄前儿童血常规4项指标检测数据清洗离群值与有效数据量

组别	例数	WBC		RBC		Hb水平		PLT
组别	例数	离群值数	有效数据量	离群值数	有效数据量	离群值数	有效数据量	离群值数	有效数据量
A组	5 432	31	5 401	20	5 412	70	5 362	115	5 317
B组	5 441	20	5 421	46	5 395	47	5 394	64	5 377
C组	5 419	35	5 384	20	5 399	59	5 360	52	5 367
D组	5 427	126	5 301	47	5 380	8	5 419	78	5 349

图1 北京市顺义区4组学龄前儿童血常规4项指标RI比较的箱式图注：A组为2012年7月至2013年9月进行体检的儿童；B组为2015年7月至2016年9月进行体检的儿童；C组为2018年7月至2019年9月进行体检的儿童；D组为2021年7月至2022年9月进行体检的儿童。每图的每组数据表示方式为，上、下最远端短横线分别为各指标数据集的97.5%(上限)与2.5%(下限)数据，箱图上下横线分别为各指标数据集的75.0%与25.0%数据；箱图中间横线为各指标数据集的50%数据。RI为参考区间，WBC为白细胞计数，RBC为红细胞计数，Hb为血红蛋白，PLT为血小板计数

表2 北京市顺义区4组学龄前儿童血常规4项指标的RI上、下限及4组比较

组别	WBC RI [×10⁹/L，M(Q₁，Q₃)]			RBC RI [×10¹²/L，M(Q₁，Q₃)]
组别	数据有效例数	下限	上限	数据有效例数	下限	上限
A组	5 401	4.96(4.86，5.04)	12.49(12.35，12.60)	5 412	4.09(4.07，4.11)	5.34(5.32，5.37)
B组	5 421	5.26(5.14，5.35)	12.77(12.62，12.90)	5 395	4.05(4.04，4.07)	5.27(5.26，5.30)
C组	5 384	5.16(5.08，5.24)	12.41(12.33，12.58)	5 399	4.09(4.07，4.11)	5.29(5.27，5.31)
D组	5 301	4.64(4.54，4.73)	10.72(10.63，10.79)	5 380	4.22(4.21，4.24)	5.24(5.22，5.25)
χ²值		0.19	7.15		6.23	0.19
P值		0.998	0.032		0.041	0.995
组别	Hb水平RI [g/L，M(Q₁，Q₃)]			PLT RI [×10⁹/L，M(Q₁，Q₃)]
组别	数据有效例数	下限	上限	数据有效例数	下限	上限
A组	5 362	108(107，108)	142(142，143)	5 317	172(164，175)	480(476，484)
B组	5 394	102(101，103)	139(139，140)	5 377	182(179，185)	509(505，513)
C组	5 360	103(103，103)	139(138，139)	5 367	154(150，158)	508(504，513)
D组	5 419	117(116，117)	144(144，144)	5 349	197(193，200)	429(425，433)
χ²值		5.19	0		0.06	0
P值		0.024	1.000		0.996	1.000

表2 北京市顺义区4组学龄前儿童血常规4项指标的RI上、下限及4组比较

组别	WBC RI [×10⁹/L，M(Q₁，Q₃)]			RBC RI [×10¹²/L，M(Q₁，Q₃)]
组别	数据有效例数	下限	上限	数据有效例数	下限	上限
A组	5 401	4.96(4.86，5.04)	12.49(12.35，12.60)	5 412	4.09(4.07，4.11)	5.34(5.32，5.37)
B组	5 421	5.26(5.14，5.35)	12.77(12.62，12.90)	5 395	4.05(4.04，4.07)	5.27(5.26，5.30)
C组	5 384	5.16(5.08，5.24)	12.41(12.33，12.58)	5 399	4.09(4.07，4.11)	5.29(5.27，5.31)
D组	5 301	4.64(4.54，4.73)	10.72(10.63，10.79)	5 380	4.22(4.21，4.24)	5.24(5.22，5.25)
χ²值		0.19	7.15		6.23	0.19
P值		0.998	0.032		0.041	0.995
组别	Hb水平RI [g/L，M(Q₁，Q₃)]			PLT RI [×10⁹/L，M(Q₁，Q₃)]
组别	数据有效例数	下限	上限	数据有效例数	下限	上限
A组	5 362	108(107，108)	142(142，143)	5 317	172(164，175)	480(476，484)
B组	5 394	102(101，103)	139(139，140)	5 377	182(179，185)	509(505，513)
C组	5 360	103(103，103)	139(138，139)	5 367	154(150，158)	508(504，513)
D组	5 419	117(116，117)	144(144，144)	5 349	197(193，200)	429(425，433)
χ²值		5.19	0		0.06	0
P值		0.024	1.000		0.996	1.000

表3 表2中4组比较结果差异有统计学意义指标进行4组间两两比较

两两比较(Z值/P值)	WBC RI上限	RBC RI下限	Hb水平RI下限
A组vs B组	0.12/0.886	0.01/0.990	0.03/0.018
A组vs C组	0.15/0.611	0.00/1.000	0.02/0.520
A组vs D组	－23.72/<0.001	－9.72/0.008	－26.11/<0.001
B组vs C组	0.20/0.555	0.01/0.990	0.01/0.500
B组vs D组	－32.98/<0.001	－2.96/0.006	－48.88/<0.001
C组vs D组	－30.12/<0.001	－9.17/0.008	－48.50/<0.001

表3 表2中4组比较结果差异有统计学意义指标进行4组间两两比较

两两比较(Z值/P值)	WBC RI上限	RBC RI下限	Hb水平RI下限
A组vs B组	0.12/0.886	0.01/0.990	0.03/0.018
A组vs C组	0.15/0.611	0.00/1.000	0.02/0.520
A组vs D组	－23.72/<0.001	－9.72/0.008	－26.11/<0.001
B组vs C组	0.20/0.555	0.01/0.990	0.01/0.500
B组vs D组	－32.98/<0.001	－2.96/0.006	－48.88/<0.001
C组vs D组	－30.12/<0.001	－9.17/0.008	－48.50/<0.001

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