XE-2100血液分析仪异常细胞警示标志的实际应用

目的通过对Sysmex XE-2100血液分析仪所提供的异常细胞警示标志与外周血细胞各类细胞对应关系的研究,评价其在实际应用中的价值。方法按临床标本的检测流程对925例门诊及住院标本进行全血血细胞分析后,进行手工细胞形态分类,运用受试者工作特征（ROC）曲线及其他统计学方法并对其进行分析。结果警示标志与手工镜检进行相应细胞一致性分析：IG（未成熟细胞）、Blasts（幼稚细胞）2项指标与手工镜检比较显示：Kappa值为0.461、0.431,显示两者一致性尚可;left shift（左移）、atypical Ly（异型淋巴细胞）、Abn Ly/L-Blasts（异型淋巴/原始淋巴）Kappa值分别为0.280、0.101、0.234,显示一致性不够理想;当多个警示标志联合出现时,对异常细胞检出阳性符合率升高,Blasts能对白血病细胞起到提示的作用,尤其当与其他标志同时出现时,应得到极高的重视。ROC曲线显示,当白细胞介于2.5×109/L~20×109/L（不含白血病）时,IG曲线下面积（area under the curve,以下简称Area）0.911,准确性较高,cutoff值可选在1.5处,此时IG能较准确预报患者核左移的情况。结论仪器提供的警示标志能起到很好的提示作用,但对血细胞形态的观察依然十分必要。实验室的复检规则应根据实验依据制定,以降低复片率,提高检验效率。

Application of the abnormal cell warning information of the XE-2100 hematology analyzer

Objective To investigate the clinical application of the abnormal cell warning information of the Sysmex XE-2100 hematology analyzer by studying the relationship with different types of peripheral blood cells.Methods A total of 925 whole blood samples were collected and analyzed by Sysmex XE-2100 hematology analyzer,and the manual microscopy was performed for morphology classification.The results were analyzed by receiver operating characteristic（ROC） curve and other statistical methods.Results Kappa values of immature granulocyte（IG）（0.461） and Blasts（0.431） had concordance by comparing with microscopy.However,kappa values of left shift,atypical lymphocyte（Ly） and Abn Ly/L-Blasts were 0.280,0.101 and 0.234,respectively,which were inconsistent with each other.As several warning information jointly,the positive coincidence rate of abnormal cell increased,and Blasts had the symptomatic effect on leukemia.When Blasts appearing with other warning information,it should be paid more attention.The results of the ROC curve showed that the area under ROC of IG was 0.911,when the range for white blood cell（WBC） count was 2.5×109/L to 20×109/L（except leukemia）.The accuracy was good,and the cut-off value should be at 1.5.In this condition,IG was sensitive and specific for measuring a degenerative left shift.Conclusions Although the abnormal cell warning information of the Sysmex XE-2100 hematology analyzer provides good information,manual microscopy for morphology classification is still necessary in order to improve examination efficiency.