儿童血常规检测中手工白细胞分类的重要性探讨

Importance of microscopic examination of blood routine test for children

目的对血液分析仪检测儿童血常规时细胞分类及警示标志的准确性加以评价，寻求准确、合理的复检方法，提高血常规的检验质量。方法针对0～14岁儿童，将132例稀释血标本在3分群血液分析仪（KX-21）上检测、123例全血标本在五分群血液分析仪（BECKMEN COULTER HMX）上检测，同时染色手工白细胞分类。采用ROC曲线检测KX-21血液分析仪中值细胞（MXD）的准确性，寻求灵敏度较高，特异性适中的复查临界点；以3岁为界将KX-21血液分析仪MXD结果、五分群血液分析仪BECKMEN COULTER HMX检测时出现的警示标志与手工分类对比分析。结果ROC曲线分布图：曲线下面积0．831，MXD为8时灵敏度100％；KX-21的MXD与染色涂片镜检结果可比性分析：0～3岁KX-21灵敏度78．6％、特异性57．7％；3～14岁灵敏度95．7％，特异性64．8％；HMX警示标志与染色涂片镜检结果可比性分析：0～3岁灵敏度为61．5％，特异性63．8％；3～14岁灵敏度94．1％、特异性71．9％。结论经ROC曲线评价后认为KX-21血液分析仪检测儿童血常规具有一定的准确性，但对中值细胞〉8的标本建议应予以手工分类复检；无论是KX-21还是HMX对0～3岁儿童异常增多细胞的检测灵敏度均较差，建议0～3岁儿童在检测血常规时，均应进行手工分类，以防止异型淋巴细胞、嗜酸性粒细胞、有核红细胞等病理性细胞的漏检。

Objective To study the importance of microscopic examination for children blood routine test and to find a proper way for accurate results on completing blood counts. Methods 132 children patients＇ blood were examined by three-classification blood cell（KX-21 ） analyzer with prodiluents, and 123 children patients＇ blood were examined by automatic five-classification blood cell （BECKMEN COULTER HMX）analyzer, and all the specimens were taken microscopic examinations of blood smear. Test the accuracy of MXD of KX-21 with RC）C Curve to find a cut - dot with good sensitivity and specificity. Compare the blood results examined by KX-21 and HMX analyzer with the results taken by microscopic examination. Results RC）C Curve： the area of ROC curve was 0. 831, when MXD was 8, the sensitivity was 100 %. Diagnostic sensitivity of KX- 21 and HMX in 0-3 years old children patients were 78.6% and 61.5%, diagnostic specificity of them were57.7% and 63.8%. Diagnostic sensitivity of KX-21 and HMX in 3 to14 years old children patients were 95. 7% and 94.1%, diagnostic specificity of them were 64.8% and 71.9%. Conclusion By ROC Curve, two blood cell analyzers have accuracy, but when MXD 〉 8, microscopic examination should be taken. They were lower for children aged 0 - 3 either tested by KX - 21 or HMX . So for children aged 0 - 3, the microscopic examinations should be taken; so as not to miss lymphocyte, EOS, NRBC, etc.