骨髓涂片细胞形态学室间质量评价体系的建立与应用

Establishment of an external quality assessment scheme for cell morphological interpretation of bone marrow smears and its application

目的研究骨髓涂片细胞形态学室间质量评价(EQA)方法、标准,探讨其临床应用价值。方法用已确诊的骨髓涂片附临床资料及实验室有关检查结果,定期发放至参评单位进行细胞形态学室间质量评价。结果诊断完全符合率逐年提高,1988年50%,2005年提高到85.8%(P<0.01)。其中急性髓细胞白血病首次28.3%,历年总体均值提高到56.6%,亚型符合率也从39.6%提高到70.0%(P<0.01)。其他血液病的诊断符合率均有显著提高。结论以细胞形态学检查为主,结合临床资料,全面综合分析作出实验室诊断的骨髓涂片EQA体系,能有效提高血液病细胞形态学检查技术与诊断水平。

Objective To establish an external quality assessment （EQA） scheme for cell morphological interpretation of bone marrow smears and investigate its application value. Methods The Laboratories taking part in the assessment were periodically provided with diagnosed bone marrow smears, clinical data and other examination results for cell morphological interpretation of EQA. Results The coincidence rate was improved year after year from 50% in 1988 up to 85.8% in 2005 （ P 〈 0. 01 ）. The coincidence rate for acute myeloid leukemia （AML） was 28. 3% at first time and its whole average coincidence rate was increased up to 56.6%. The subgroup coincidence rates were also elevated from 39. 6% to 70. 0% （ P 〈 0, 01 ）. The coincidence rates of other blood diseases were also significantly improved, Conclusion The system of external quality assessment in which the bone marrow cell morphology serves as the main examination means and the clinical data are combined to make the experimental diagnosis after the comprehensive analysis can effectively improve the level of diagnosis and treatment of the hematological diseases.