Sysmex XN-9000血液分析仪淋巴细胞结构参数在筛查外周血异型淋巴细胞中的意义
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摘要
目的探讨Sysmex XN-9000血液分析仪检测的淋巴细胞结构参数在异型淋巴细胞报警时筛查外周血异型淋巴细胞的意义。方法选取2017年12月至2018年12月海军军医大学(第二军医大学)长海医院门诊和急诊Sysmex XN-9000血液分析仪检测时异型淋巴细胞报警的血液标本370例,记录淋巴细胞复杂程度(L-X)、淋巴细胞荧光强度(L-Y)、淋巴细胞大小(L-Z)、淋巴细胞复杂程度分布宽度(L-WX)、淋巴细胞荧光强度分布宽度(L-WY)和淋巴细胞大小分布宽度(L-WZ)6项淋巴细胞结构参数。根据显微镜下人工检测的异型淋巴细胞比例将370例血液标本分为异型淋巴细胞阳性组(异型淋巴细胞比例>5%,100例)和阴性组(异型淋巴细胞≤5%,270例),通过受试者工作特征(ROC)曲线评估淋巴细胞结构参数在异型淋巴细胞报警阳性时筛查异型淋巴细胞的价值,对其中准确度较高的参数进行logistic回归分析并评估这些参数联合筛查异型淋巴细胞的意义。结果淋巴细胞结构参数中L-WY、L-X、L-Z筛查异型淋巴细胞有较高价值,ROC曲线下面积分别为0.927、0.939、0.931。利用logistic回归分析生成L-WY、L-X、L-Z筛查异型淋巴细胞的联合预测因子,联合预测因子的ROC曲线下面积为0.979。联合预测因子的截断值为0.058 1时,其筛查异型淋巴细胞的灵敏度为100.0%、特异度为77.8%。结论在Sysmex XN-9000血液分析仪异型淋巴细胞报警时利用淋巴细胞结构参数L-WY、L-X、L-Z联合筛查异型淋巴细胞,可有效鉴别错误报警。
Objective To investigate the significance of lymphocyte structure parameters of Sysmex XN-9000 hematology analyzer in screening peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs. Methods From Dec. 2017 to Dec. 2018, 370 blood samples with positive alarm of atypical lymphocytes, which were detected by XN-9000 hematology analyzer in outpatient and emergency department of Changhai Hospital, Naval Medical University(Second Military Medical University), were collected in this study. Six lymphocyte structure parameters were recorded, including lymphocyte complexity(L-X), lymphocyte fluorescence intensity(L-Y), lymphocyte size(L-Z), dispersion width of lymphocyte complexity(L-WX), dispersion width of lymphocyte fluorescence intensity(L-WY) and dispersion width of lymphocyte size(L-WZ). According to the atypical lymphocyte proportion detected manually under microscope, the 370 samples were divided into 2 groups: atypical lymphocyte positive group(100 samples with an atypical lymphocyte proportion>5%) and atypical lymphocyte negative group(270 samples with an atypical lymphocyte proportion≤5%), and the significance of each lymphocyte structure parameter was evaluated by receiver operating characteristic(ROC) curve. Then the parameters with high accuracy for screening atypical lymphocytes were analyzed by logistic regression model to study the significance of their combination. Results The lymphocyte structure parameters L-WY,L-X and L-Z had high accuracies in screening atypical lymphocytes, with the ROC area under curve(AUC) being 0.927, 0.939 and 0.931, respectively. The combined predictor was generated using L-WY, L-X and L-Z by logistic regression analysis model, and the ROC AUC of combined predictor was 0.979. When 0.058 1 was selected as the cut-off value, the sensitivity was 100.0% and the specificity was 77.8%. Conclusion Lymphocyte structure parameters L-WY, L-X and L-Z detected by Sysmex XN-9000 hematology analyzer can effectively screen peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs.
Objective To investigate the significance of lymphocyte structure parameters of Sysmex XN-9000 hematology analyzer in screening peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs. Methods From Dec. 2017 to Dec. 2018, 370 blood samples with positive alarm of atypical lymphocytes, which were detected by XN-9000 hematology analyzer in outpatient and emergency department of Changhai Hospital, Naval Medical University(Second Military Medical University), were collected in this study. Six lymphocyte structure parameters were recorded, including lymphocyte complexity(L-X), lymphocyte fluorescence intensity(L-Y), lymphocyte size(L-Z), dispersion width of lymphocyte complexity(L-WX), dispersion width of lymphocyte fluorescence intensity(L-WY) and dispersion width of lymphocyte size(L-WZ). According to the atypical lymphocyte proportion detected manually under microscope, the 370 samples were divided into 2 groups: atypical lymphocyte positive group(100 samples with an atypical lymphocyte proportion>5%) and atypical lymphocyte negative group(270 samples with an atypical lymphocyte proportion≤5%), and the significance of each lymphocyte structure parameter was evaluated by receiver operating characteristic(ROC) curve. Then the parameters with high accuracy for screening atypical lymphocytes were analyzed by logistic regression model to study the significance of their combination. Results The lymphocyte structure parameters L-WY,L-X and L-Z had high accuracies in screening atypical lymphocytes, with the ROC area under curve(AUC) being 0.927, 0.939 and 0.931, respectively. The combined predictor was generated using L-WY, L-X and L-Z by logistic regression analysis model, and the ROC AUC of combined predictor was 0.979. When 0.058 1 was selected as the cut-off value, the sensitivity was 100.0% and the specificity was 77.8%. Conclusion Lymphocyte structure parameters L-WY, L-X and L-Z detected by Sysmex XN-9000 hematology analyzer can effectively screen peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs.
引文
[1]刘成玉.白细胞形态检查[M]//刘成玉,罗春丽.临床检验基础.5版.北京:人民卫生出版社,2012:57-67.
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[4]李璐,林菲,贾莹,梁京津,胥婕.成人EB病毒和巨细胞病毒混合感染相关性单核细胞增多症的临床分析[J].中华医学杂志,2017,97:3068-3071.
[5]中华人民共和国卫生部医政司.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:16-25.
[6]CLARICE C S H,ABEYSURIYA V,DE MEL S,UVINDU THILAKAWARDANA B,DE MEL P,DEMEL C,et al.Atypical lymphocyte count correlates with the severity of dengue infection[J/OL].PLoS One,2019,14:e0215061.doi:10.1371/journal.pone.0215061.
[7]中华医学会检验分会全国血液学复检专家小组,中华检验医学杂志编辑委员会.全国血液学复检专家小组工作会议纪要暨血细胞自动计数复检标准释义[J].中华检验医学杂志,2007,30:380-382.
[8]曹科,郎家庆,罗小娟,王兰,李嘉辉,李飞,等.Sysmex XN-3000血液分析仪WDF和WPC通道报警阈值的验证及调整策略[J].临床检验杂志,2018,36:166-170.
[9]LOU A H,ELNENAEI M O,SADEK I,THOMPSON S,CROCKER B D,NASSAR B.Evaluation of the impact of a total automation system in a large core laboratory on turnaround time[J].Clin Biochem,2016,49(16/17):1254-1258.
[10]樊笑霞,吴飞,王凌.EDTA-K2对异型淋巴细胞检测的干扰[J].第二军医大学学报,2009,30:595-596.FAN X X,WU F,WANG L.Interference of atypical lymphocyte examination by EDTA-K2[J].Acad J Sec Mil Med Univ,2009,30:595-596.
[11]SALE S,CARONE A E,FUMI M,PANCIONEY,ROCCO V.Detection of apoptotic lymphocytes through Sysmex XN-1000 as a diagnostic marker for mononucleosis syndrome[J].J Clin Lab Anal,2016,30:779-793.
[12]谢晓英,林向华,何健,黄松音,代鑫露,李红玉.淋巴细胞参数LYMPH-Y在EB感染的传染性单核细胞增多症患儿中的变化及应用价值[J].中华医院感染学杂志,2015,25:4111-4113.
[13]FURUNDARENA J R,URANGA A,SAINZ M R,GONZáLEZ C,URESANDI N,ARGOITIA N,et al.Usefulness of the lymphocyte positional parameters in the Sysmex XN haematology analyser in lymphoproliferative disorders and mononucleosis syndrome[J].Int J Lab Hematol,2018,40:41-48.
[14]URRECHAGA E,BóVEDA O,AGUIRRE U.Role of leucocytes cell population data in the early detection of sepsis[J].J Clin Pathol,2018,71:259-266.
[2]PALMER L,BRIGGS C,MCFADDEN S,ZINIG,BURTHEM J,ROZENBERG G,et al.ICSHrecommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features[J].Int J Lab Hematol,2015,37:287-303.
[3]DUNMIRE S K,HOGQUIST K A,BALFOUR HH.Infectious mononucleosis[J].Curr Top Microbiol Immunol,2015,390(Pt 1):211-240.
[4]李璐,林菲,贾莹,梁京津,胥婕.成人EB病毒和巨细胞病毒混合感染相关性单核细胞增多症的临床分析[J].中华医学杂志,2017,97:3068-3071.
[5]中华人民共和国卫生部医政司.全国临床检验操作规程[M].4版.北京:人民卫生出版社,2015:16-25.
[6]CLARICE C S H,ABEYSURIYA V,DE MEL S,UVINDU THILAKAWARDANA B,DE MEL P,DEMEL C,et al.Atypical lymphocyte count correlates with the severity of dengue infection[J/OL].PLoS One,2019,14:e0215061.doi:10.1371/journal.pone.0215061.
[7]中华医学会检验分会全国血液学复检专家小组,中华检验医学杂志编辑委员会.全国血液学复检专家小组工作会议纪要暨血细胞自动计数复检标准释义[J].中华检验医学杂志,2007,30:380-382.
[8]曹科,郎家庆,罗小娟,王兰,李嘉辉,李飞,等.Sysmex XN-3000血液分析仪WDF和WPC通道报警阈值的验证及调整策略[J].临床检验杂志,2018,36:166-170.
[9]LOU A H,ELNENAEI M O,SADEK I,THOMPSON S,CROCKER B D,NASSAR B.Evaluation of the impact of a total automation system in a large core laboratory on turnaround time[J].Clin Biochem,2016,49(16/17):1254-1258.
[10]樊笑霞,吴飞,王凌.EDTA-K2对异型淋巴细胞检测的干扰[J].第二军医大学学报,2009,30:595-596.FAN X X,WU F,WANG L.Interference of atypical lymphocyte examination by EDTA-K2[J].Acad J Sec Mil Med Univ,2009,30:595-596.
[11]SALE S,CARONE A E,FUMI M,PANCIONEY,ROCCO V.Detection of apoptotic lymphocytes through Sysmex XN-1000 as a diagnostic marker for mononucleosis syndrome[J].J Clin Lab Anal,2016,30:779-793.
[12]谢晓英,林向华,何健,黄松音,代鑫露,李红玉.淋巴细胞参数LYMPH-Y在EB感染的传染性单核细胞增多症患儿中的变化及应用价值[J].中华医院感染学杂志,2015,25:4111-4113.
[13]FURUNDARENA J R,URANGA A,SAINZ M R,GONZáLEZ C,URESANDI N,ARGOITIA N,et al.Usefulness of the lymphocyte positional parameters in the Sysmex XN haematology analyser in lymphoproliferative disorders and mononucleosis syndrome[J].Int J Lab Hematol,2018,40:41-48.
[14]URRECHAGA E,BóVEDA O,AGUIRRE U.Role of leucocytes cell population data in the early detection of sepsis[J].J Clin Pathol,2018,71:259-266.