迈瑞BC-5380血细胞分析仪两项研究性参数临床应用的探讨

Study on Clinical Application of Two Research Parameters of Mindray BC-5380 Hematology Analyzer

目的探讨迈瑞BC-5380两项研究性参数异常淋巴细胞和巨大未成熟粒细胞异常时在过筛复检中的指导意义及两项参数的报警诊断的灵敏度和特异度。方法收集本院441例两项研究性参数异常的标本,涂片染色显微镜镜检分类。以显微镜法的结果为标准把441例异常结果分成七种类型,分别进行探讨。结果第一种类型:巨大未成熟粒细胞增高,149例用BC-5380检测巨大未成熟粒细胞增高的患者,与涂片显微镜法比较,BC-5380检测数值-x=9.8%,SD=7.3,显微镜法检测数值-x=6.5%,SD=6.5,两种方法检验结果差异有统计学意义(t=3.63,P<0.05),BC-5380检出巨大未成熟粒细胞灵敏度为100%,特异度为69.8%;第二种类型:异常淋巴细胞增高或异常淋巴细胞和巨大未成熟粒细胞同时增高。79例用BC-5380检测异常淋巴细胞增高的患者与涂片显微镜法比较,BC-5380检测数值-x=6.6%,SD=4.0,显微镜法检测数值-x=15.3%,SD=10.4,两种方法检验结果差异有统计学意义(t=5.03,P<0.05)。BC-5380检测异常淋巴细胞的灵敏度为68.0%,特异度为92.5%;第三种类型:24例患者因淋巴细胞比值减低:-x=8%,异常淋巴细胞显示***;第四种类型:27例患者因中性粒细胞比值减低:-x=7%,巨大未成熟粒细胞显示***,以上两种类型都是由于淋巴和中性粒细胞比值太低,不需复检;第五种类型:30例患者因白细胞数值太低:-x=1.0×109,两项研究性参数都显示***,这30例患者为低增生性白血病和白血病化疗后,镜检偶见原始和幼红细胞,需显微镜复检;第六种类型:60例血液病患者白细胞分类***,两项研究性参数都显示***,涂片显微镜分类原始幼稚细胞平均值大于36%;第七种类型:72例患者因为干扰导致白细胞散点图异常,白细胞分类、两项研究性参数都显示***,涂片显微镜法分类正常,72例患者中18例全血模式改成稀释模式进样可以分类。结论两项研究性参数异常淋巴细胞灵敏度差、特异度好;巨大未成熟粒细胞灵敏度好、特异度差。联合观察这两项指标是异常标本过筛、复检的关键性参数。本研究为针对BC-5380的复检标准制定提供了重要的参考资料。

Objective To study the significance of two research parameters of Mindray BC- 5380 Hematology Analyzer （BC- 5380）, abnormal lymphccytes （ALs） and huge immature granulocytes （HIGs）, in screening and recheck, to explore their sensitivity and specificity in alarm diagnosis. Methods A total of 441 specimens with ALs and/or HIGs were collected in the 331 Hospital of Zhuzhou and were classified into seven types by smear microscopic examination. Results The first type： in- creased number of HIGs. Test results of 149 specimens with increased HIGs detected by BC- 5380 were compared with those by microscopy. Detection by BC- 5380 revealed x = 9.8 %, SD = 7.3, while by microscopy x = 6.5 %, SD = 6.5, which was sig- nificantly different （P〈（0.05）. The sensitivity and specificity of HIGs detection by BC- 5380 is 100% and 69.8%. The second type： increased number of ALs or simultaneously increased numbers of ALs and HIGs. Test results of 79 specimens with in- creased ALs detected by BC - 5380 were compared with those by microscopy. Detection by BC - 5380 revealed x = 6.6 %, SD = 4.0, while by microscopy x = 15.3%, SD= 10.4, which was substantially different （P〈0.05）. The sensitivity and specificity of ALs detection by BC- 5380 is 68.0 % and 92.5 %. The third type： due to reduced ratio of lymphocytes in 24 specimens, x = 8 %. AI displayed ＊ ＊ ＊ . The fourth type： due to reduced ratio of neutrophils in 27 specimens, x = 7 %. HIGs displayed＊ ＊ ＊. The specimens in the third and fourth type did not need recheck for the ratios of lympholytes and neutrophils were too low. The fifth types： low white bleed cell （WBC） in 30 specimens, ~c = 1.0 x 109. Als and HIGs both displayed ~ ＊ ＊ . These 30 specimens were from patients with low proliferation leukemia or after leukemia chemotherapy. Blast cells and erythro- blasts were occasionally detected by microscopy examination. These specimens need recheck by microscope. The sixth type： Leu- kocyte classification of 60 specimens from patients with blood diseases showed ＊ ＊ ＊ , so did ALs and HIGs. Classification by smear microscopy demonstrated that the average percentage of blast cells and immature cells was greater than 36 %. The seventh types： abnormal WBC scatter diagram in 72 specimens due to interference. Leukocyte classification, ALs and HIGs all displayed ＊ ＊ ~ . Smear microscopy revealed normal classification. Leukocyte classification of 18 out of 72 specimens could be done by changing injection from whole blood model into diluted blood model. Conclusions The research parameter, abnormal lymphocytes, has poor sensitivity and good specificity, while another parameter, huge immature granulocytes, has good sensitivity and poor specificity. Joint observation of these two parameters is key point in unusual specimen screening and recheck. This study provides an important reference for framing BC- 5380 recheck standards.