血细胞分析复检规则的临床应用评价

Clinical application of renew criteria for complete blood analysis

目的 对血细胞分析复检规则进行临床应用的分析评价.方法 应用Sysmex XE-2100血细胞分析仪检测四川大学华西医院8820例患者的静脉血标本,并同时进行双盲法人工显微镜检查（镜检）.根据中华医学会检验医学分会XE-2100血细胞分析仪复检标准制定协作组制定的Sysmex XE-2100自动血细胞分析和白细胞分类复检规则进行统计分析,计算检测的真假阳性率、真假阴性率、灵敏性、特异性、阳性预测值、阴性预测值、总有效率、检验效能和复检率,同时分析四川大学华西医院实验医学科根据实际情况进行适当调整后的复检规则的临床效能.结果 8820 份标本检测的真阳性率为13.0%（1149 份）,假阳性率27.2%（2397份）,真阴性率55.3%（4876份）,假阴性率4.5%（398份）,灵敏性74.3%,特异性67.0%,阳性预测值32.4%,阴性预测值92.5%,总有效率68.3%,检验效能21.2%,复检率40.2%.对复检规则进行调整后,复检率下降至33.8%,总有效率提高至74.7%.8820份标本中2069份需镜检人工白细胞分类,占23.5%,其中847份标本发现非正常细胞,未发现白血病细胞的漏检.结论 Sysmex XE-2100自动血细胞分析和白细胞分类复检规则对临床工作有很大帮助.各实验室在制定血常规检测复检规则时应根据患者来源、仪器性能等对复检规则进行一定的调整,以更好地满足临床应用.

Objective To evaluate the review criteria for complete blood analysis.Methods A total of 8820 blood samples taken at our hospital were detected both by the Sysmex XE-2100 automated blood cell analyzer and double-blind method microscopy.The performance of two review criteria were evaluated by statistical analysis.The parameters,such as true and false positive rates,true and false negative rates,sensitivity,specificity,positive predictive value,negative predictive value,total effective rate,test effectiveness and re-examination rate were calculated according to the criteria of XE-2100 hematology analyzer re-examination standards coordination group of Society of Laboratory Medicine of Chinese Medical Association.And a study was conducted to determine the improved clinical effectiveness over the criteria.Results The values of true and false positive rates,true and false negative rates,sensitivity,specificity,positive predictive values,negative predictive value,total effective rate,test effectiveness and reexamination rate were 13.0%,27.2%,55.3%,4.5%,74.3%,67.0%,32.4%,92.5%,68.3%,21.2%,and 40.2% respectively.The re-examination rate decreased to 33.8% and the total effective rate increased to 74.7% according to our improved review criteria.And there Was no missed diagnosis of leukemic cells.It was found that 2069 samples （23.5%） needed manual microscopy for WBC differential analysis,847 had abnormal cells and no leukemia was missed.Conclusions The automatic blood cell analyzer and WBC differential analysis review criteria have great clinical utilities.The review criteria of blood cell analysis may be improved according to patient source and instrument performance so as to better meet the needs of clinical application.