Hussain Sheikh Quyoom, Ashraf Mohd, Wani Juveria Gull, Ahmed Javid
Registrar, Department of Paediatrics, GB Pant Hospital, Government Medical College Srinagar, India .
Lecturer Pediatric Nephrology, Department of Paediatrics, GB Pant Hospital, Government Medical College Srinagar, India .
J Clin Diagn Res. 2014 Apr;8(4):PC01-3. doi: 10.7860/JCDR/2014/8387.4268. Epub 2014 Apr 15.
Acute lower respiratory tract infection is a major cause of death in under five years of age, and anemia is the commonest co-factor in pediatric patients seeking medical advice especially in developing countries.
To analyze whether a low hemoglobin level is a risk factor for acute lower respiratory tract infections (ALRTI) in children.
Prospective case control study on 220 children (110 cases and controls each) was carried out in our children's hospital (G.B. Pant Hospital), an associated hospital of Government Medical College Srinagar, of Kashmir Northern India. All patients between the age of 1 month to 5 years of age who fulfilled the inclusion criteria were included. We used WHO criteria to diagnose ALRTI among the cases, and age and sex matched patients who did not have respiratory complaints were kept as controls. Patients who had congenital heart diseases, tuberculosis, malignancies, or dysmorphic features were excluded from the study. All patients were subjected to detailed history and through clinical examination followed by investigations like complete blood count (CBC), peripheral blood film (PBF) smear, blood culture and sensitivity test, X-ray chest, serum iron and iron binding capacity were done in all cases.
Our study had slightly male preponderance 57.3% in study group and 59.1% in control group. Maximum number of children were between 3 months and 23 months both in the study (80.9%) as well as in the control (81.8%) group. In this study hemoglobin level <11 gm/dl was considered low. Mean Hb level was 8.8 gm/dl in the study group and 11.6 gm/dl in the control group. Anemia was found in 71 (64.5%) cases in the study group and in 31 (28.2%) cases in the control group. Anemic patients were found to be 4.6 times more susceptible to ALRTI in our study (Odds Ratio was 4.63), p-value <0.01. Iron deficiency was found in 78.9% of total anemic cases in the study group, p-value <0.01. In the study group, the mean serum iron level was 35.3 mcg/dl in the anemic cases and 57.1 mcg/dl in the non-anemic cases. while in the control group, these values were 52.4 mcg/dl and 62.6% mcg/dl respectively, (p-value ,<0.01).
Anemia, predominantly iron deficiency anemia, was significantly found in ALTRI patients, and these patients were found to be 4.6 times more susceptible to ALRTI. Early and accurate diagnosis of anemia in children suffering from various ailments in particular to ALRTI will serve the mankind in a better way.
急性下呼吸道感染是五岁以下儿童死亡的主要原因，而贫血是尤其是在发展中国家寻求医疗建议的儿科患者中最常见的共同因素。
分析低血红蛋白水平是否是儿童急性下呼吸道感染（ALRTI）的危险因素。
在印度北部克什米尔斯利那加政府医学院附属儿童医院（GB Pant医院）对220名儿童（每组110例病例和对照）进行了前瞻性病例对照研究。纳入所有符合纳入标准的1个月至5岁的患者。我们采用世界卫生组织标准诊断病例中的ALRTI，将年龄和性别匹配且无呼吸道症状的患者作为对照。患有先天性心脏病、结核病、恶性肿瘤或畸形特征的患者被排除在研究之外。所有患者均接受详细病史询问和全面临床检查，随后进行全血细胞计数（CBC）、外周血涂片（PBF）、血培养及药敏试验、胸部X线、血清铁和铁结合能力等检查。
我们的研究中男性略占优势，研究组为57.3%，对照组为59.1%。研究组和对照组中最大数量的儿童均在3个月至23个月之间，分别为80.9%和81.8%。本研究中血红蛋白水平<11 g/dl被视为低水平。研究组的平均血红蛋白水平为8.8 g/dl，对照组为11.6 g/dl。研究组71例（64.5%）病例存在贫血，对照组31例（28.2%）病例存在贫血。在我们的研究中，贫血患者患ALRTI的易感性是4.6倍（优势比为4.63），p值<0.01。研究组中78.9%的贫血病例存在缺铁，p值<0.01。研究组中，贫血病例的平均血清铁水平为35.3 mcg/dl，非贫血病例为57.1 mcg/dl。而对照组中，这些值分别为52.4 mcg/dl和62.6 mcg/dl，（p值<0.01）。
在ALTRI患者中显著发现贫血，主要是缺铁性贫血，且这些患者患ALRTI的易感性是4.6倍。对患有各种疾病尤其是ALRTI的儿童进行早期准确的贫血诊断将更好地造福人类。
