儿童血常规复检规则的制订及应用评价

Establishment and evaluation of blood cell analysis review criteria in children

目的建立Sysmex XS-800i血液分析仪适用于儿童血常规的复检规则。方法参照国际血液学复检专家组推荐的41条复检规则和首都医科大学昌平教学医院检验科(以下简称"我科")现行的复检规则,结合儿童的生理病理特点,参照血液分析仪异常报警信息,建立适合儿童血常规复检规则。采用Sysmex XS-800i五分类血液分析仪检测623例标本,同时进行血涂片人工镜检,建立并评估儿童血常规复检规则。选取230例标本用于本复检规则有效性验证。结果试行儿童血常规复检规则复检率为64.7%,假阳性率为54.9%。假阳性标本占第1位的是异型淋巴。本研究应用ROC曲线(受试者工作曲线)评估异型淋巴Q-Flags报警及OTHER的特异性及灵敏度,调整异型淋巴Q-Flags报警阈值为225,OTHER阈值为0.85,为复片临界点。优化后的儿童血常规复检规则复检率为31.4%,假阳性率为20.4%,假阴性率为3.5%,且无血液恶性肿瘤漏诊。验证优化后的儿童血常规复检规则的有效性,结果为复检率为35.2%,假阳性率为26.1%,假阴性率为4.8%,且无血液病漏检。结论我科建立的儿童血常规复检规则经过评估和验证,证明适合儿童血常规复检要求,既保证报告质量,又提高了工作效率,为临床诊断提供了快速有力的依据。

Objective To establish proper review criteria for XS-800i automated hematology analyzer in children. Methods According to 41 rules of ISLH and XS-800i hematology analyzer current review rules of Department of Clinical Laboratory, Changping Teaching Hospital, Capital Medical University, based on children＇s physiological and pathological characteristics,, proper review criteria for blood cell analysis in children were validated. 623 blood specimens were detected by Sysmex XS-800i automated hematology analyzer, and were examined artificially under microscopy at the same time, the children＇s blood routine review criteria were established and evaluated. 230 blood specimens were used for verification. Results The review rate of initial review criteria was 64,7%. The false positive rate was 54.9%. Atypical lymphocytes was mostly the cause in false positive samples, In the study, Q-Flags for atypical lymphocytes and specificity and sensitivity of OTHER were evaluated by ROC curve. The alarm threshold of Q-Flags for atypical lymphocytes was adjusted to 225 and OTHER was 0.85. After optimization, the re-examination rate was 31.4%, the false positive rate was 20.4%, the false negative rate was 3.5% and no diagnosis of malignant tumors was missed. Eval- uation data of new review criteria showed that re-examination rate was 35.2%; the false positive rate was 26.1%; the false negative rate was 4.8% and no diagnosis of malignant tumors was missed. Conclusion Revise hematology review rule not only basically meets the re-examination rule characteristics in children but also improves work efficiency. It provides rapid and effective support for clinical diagnosis.