西藏自治区拉萨市0~6岁藏族儿童体格发育正常值的建立

目的建立拉萨市0~6岁藏族儿童体格发育的正常参考值。方法以横断面调查的方法,选取西藏自治区人民医院妇产科生后24~48 h的健康新生儿、西藏自治区人民医院妇幼保健院儿保科1~6岁和拉萨市5所幼儿园3~6岁的健康藏族儿童为调查对象。所有研究对象均为藏族常驻居民且无先天畸形。依据年龄分为新生儿、1、2、3、4、5和6岁组。估计每个年龄组男女至少各需300名。统一配置测量工具,参考《儿童保健学》提供的方法直接测量体重、身高(长)、头围(顶臀长)、坐高、胸围、上臂围和皮脂厚度7项体格发育指标,并间接计算BMI。对纳入分析的体格发育指标数据剔除极值数据。应用LMS软件构建不同性别年龄组的8个体格发育指标的百分位数及百分位数曲线图。按照2005年中国九城市城区儿童推荐的标准和2006年WHO推荐标准,采用标准统计量检定法(Z值法),分别计算各个体格发育指标的Z值。结果 2012年1月至2013年6月符合本文纳入标准的4 330名0~6岁藏族儿童30 310个体格发育指标数据进入分析,其中男童2 114名,女童2 216名。删除对模型干扰的极值数据84(0.28%)个。LMS法构建的百分位数曲线光滑,表明每组样本量基本满足拟合曲线要求。建立了拉萨市0~6岁藏族男、女童的8个体格发育指标的x珋±s及百分位数(P3~P97)。各年龄组男童有18个体格发育指标显著大于女童,女童有6个体格发育指标显著大于男童,总体上藏族男童的体格发育指标高于藏族女童。拉萨市藏族儿童的8个体格发育指标总体上落后于2006年WHO推荐标准,更落后于中国九城市城区儿童的体格发育水平。随年龄增长,藏族2~5岁儿童的BMI值逐渐走低。结论建立的0~6岁藏族儿童体格发育指标的x珋±s及百分位数将为藏族儿童临床科研实际应用和不同民族儿童体格发育指标之间的比较提供科学依据。

Establishment of growth reference values for children aged 0 to 6 years in Lhasa,Tibet

Objective To present the growth reference values for children aged 0 to 6 years in Lhasa. Methods Healthy neonates after birth within 24-48 h at the Obstetrical and Gynecological Department of People′s Hospital of the Tibet Autonomous Region, healthy children aged 1 to 6 years from the Maternal and Child Health Hospital of Tibet Autonomous Region and children aged 3 to 6 years from 5 kindergartens in Lhasa were included. Enrolled participants were divided into neonate, 1 year, 2 years, 3 years, 4 years, 5 years and 6 years groups including at least 600 participants (half were males and half were females) in each group. Unifing the measurement tools, weight, length/height, sitting height, head circumference, chest circumference, arm circumference and triceps skinfold were measured directly using the method described by "Child Health Care (Fourth Edition)" and BMI was calculated. Extreme values were deleted before establishing the growth standardized values. LMS software light version was used to construct the smoothed percentile curves of parameters by age and sex. All parameters were evaluated with China references in 2005 and WHO references in 2006 using Z-score, respectively. Results A total of 4 330 (2 114 males, 2 216 females ) normal Tibetan children from January 2012 to June 2013 were enrolled in the study. Deleted data only accounted for 0.28% of the total data. The number of participants was reliable for constructing the smoothed growth curves. The mean and standard deviation and the 3rd, 5th,10th, 25th, 50th, 75th, 85th, 90th, 95th, 97th smoothed percentile curves for each parameter were constructed, respectively. Eighteen parameters showed significantly larger values in Tibetan males than those in females, and only six parameters showed significantly larger values in Tibetan females than those in males. Generally, Tibetan males showed larger values than females in physical development indicators. BMI values of Tibetan children aged 2 to 5 years gradually declined with age. Tibetan children growth charts were slightly lower than WHO child growth standards, and significantly lower than China child growth standards. Conclusion The mean and standard deviation and percentile curves of each parameter could be applied to facilitate the standardization assessment of growth for Tibetan children in clinical pediatrics and public health.