应用血细胞分析仪检测网织血小板比率在肿瘤患者化疗中的临床应用

Measurement of immature platelet fraction using the automatic hematology analyzer and its clinical utility

目的应用SysmexXE-2100全自动血细胞分析仪XE—proIPFmaster软件定量检测外周血中的网织血小板比率（immature platelet fraction，IPF），对其进行方法学评价，以探讨IPF在监测肿瘤患者化疗时骨髓增生情况中的临床应用价值。方法随机选取临床新鲜全血标本高、中、低值，连续重复测定20次，计算变异系数（CV）评价批内精密度和重复性；用仪器配套质控品连续测定20d，评价批间精密度和重复性；同时评估其稳定性和携带污染率，并进行该方法与流式细胞术检测IPF的相关性研究。选择182名健康对照者以及130例肿瘤化疗患者，根据治疗后P¨的变化情况将肿瘤化疗患者分为化疗后PLT下降组和PLT恢复组，检测各组IPF值。结果该血细胞分析仪检测IPF的批内精密度高、中、低值的CV分别是4．71％、4．33％、4．95％，批问CV为4．1％，均小于5％。稳定性检测中值和低值24h内CV均小于5％，高值24h内CV小于10％。携带污染率取值范围为0．6％-2．7％，平均值为1．2％。与流式细胞仪检测IPF相关性较好（R2=0．7761，P〈0．01）。化疗后PLT下降组的IPF中位数为14．45％，PLT恢复组为7．35％，健康对照组为15．68％，3组间差异有统计学意义（H=49．032，P〈0．01）。PLT下降组的IPF值高于PLT恢复组（t=-5．681，P〈0．01），PLT恢复组的IPF值低于健康对照组（t=-6．662，P〈0．01）。结论应用SysmexXE-2100血细胞分析仪进行IPF检测精密度高，稳定性好；IPF可作为肿瘤化疗患者PLT生成情况的有效评估指标。

Objective The immature platelet fraction （IPF） could be detected quantificationally in Sysmex XE-2100 with the software of XE-pro and IPF master. The study aimed to perform the methodological evaluation of IPF detection and investigate the clinical significance for the monitoring for bone marrow hyperplasia in cancer chemotherapy patients. Methods The high-level, middle-level and low-level whole blood samples were randomly chosen for detection repeatly 20 times to obtain interrun coefficient of variation （CV） for evaluation of the precision and reproducibility. Integrated quality controls were determined for continuous 20 days to obtain intrarun CV, and the stability and carryover was investigated. Furthermore, the correlation between results from Sysmex XE-2100 and results from flow cytometry was assessed. 182 healthy subjects and 130 cancer patients undergoing chemotherapy were selected and the latter were divided into two groups according to platelet counts after therapy, one was normal PLT group, the other was decreased PLT group. The IPF of either group was measured and was compared with each other. Results The precision of IPF for high-level, middle-level and low-level were 4. 71%, 4. 33% and 4.95%, respectively, they were less than 5%. The interrun CV of IPF detection for middle-level and low-level were less than 5%. The interrun CV of IPF detection for high-level were less than 10%. The carryover ranged from 0. 6% to 2. 7%, and the average rate was 1.2%. A good correlation for IPF detection was shown between results from Sysmex XE-2100 and flow cytometry（r =0. 880 9 ,P 〈 0. 01 ）. Regarding clinical utility of IPF detection in treatment monitoring for chemotherapy effect, the median of IPF levels in decreased PLT group, normal PLT group, control group were 14.45% ,7. 35% and 15.68%, respectively. There was significant difference among the three groups （H = 49. 032, P 〈 0. 01 ）. The IPF level was higher in decreased PLT group than normal PLT group （ t = - 5. 681, P 〈 0. 01 ）, and was lower in normal PLT group after chemotherapy than the control group （t = -6. 662,P 〈 0. 01 ）. Conclusions The determination of IPF by the Sysmex XE-2100 owns high precision and good stability. IPF is an effective marker for evaluation of thrombopoietic condition in the cancer chemotherapy patients.