快速流式细胞术用于外周血原始细胞检测性能临床评价

doi:10.3969/j.issn.1673-8640.2017.05.017

摘要/Abstract

摘要：

目的探讨应用快速流式细胞术进行外周血原始细胞检测性能的临床价值。方法选取2015年4月—2016年3月在上海交通大学医学院附属瑞金医院血液科就诊的976例患者为研究对象。采集静脉血后应用血液分析仪、快速流式细胞术和形态学计数的方法进行白细胞（WBC）分类。以形态学计数结果为标准,比较血液分析仪、快速流式细胞术与形态学计数之间WBC分类计数的相关性。同时,分别比较血液分析仪原始细胞报警及快速流式细胞术原始细胞检出率与标准方法的一致性。结果快速流式细胞术每小时可完成约20个标本的检测,其中手工操作约15 min。快速流式细胞术、血液分析仪与形态学计数之间关于WBC分类的结果均具有良好的相关性。快速流式细胞术与形态学计数原始细胞的r为0.959,中性粒细胞、淋巴细胞、单核细胞、嗜酸性粒细胞、嗜碱性粒细胞和未成熟粒细胞的r值分别为0.938、0.893、0.871、0.962、0.833和0.786。血液分析仪与形态学计数中性粒细胞、淋巴细胞、单核细胞、嗜酸性粒细胞、嗜碱性粒细胞和未成熟粒细胞的r值分别为0.902、0.750、0.436、0.860、0.758和0.678。以形态学计数原始细胞>1%作为临界值,976例标本中原始细胞阳性标本235例,血液分析仪出现原始细胞报警283例,其敏感性为75.7%、特异性为85.8%、阳性预测值为62.9%、阴性预测值为91.8%。快速流式细胞术检出原始细胞（临界值>1%）239例,敏感性为100.0%、特异性为99.5%、阳性预测值为98.3%、阴性预测值为100.0%。结论快速流式细胞术以1%为临界值用于检测外周血原始细胞敏感性高、特异性好,具有准确、快捷、方便的优点,能满足临床对疾病早期发现及疗效监测的需求,快速流式细胞术用于检测外周血原始细胞具有广阔前景。

关键词: 快速流式细胞术, 原始细胞, 细胞形态学

Abstract:

Objective To investigate the performance of CytoDiff flow cytometry for determining blasts in peripheral blood. Methodse A total of 976 patients were enrolled in Hematology Department of Ruijin Hospital from April 2015 to March 2016. White blood cell （WBC） differentiation was performed by hematology analyzer,CytoDiff flow cytometry and morphology differentiation. The consistency was analyzed between hematology analyzer and CytoDiff flow cytometry with morphology differentiation as standard method. Results The average time required to analyze 20 samples was approximately 60 min for CytoDiff flow cytometry,and the manual operation time was about 15 min. The correlations of WBC differentiation were good among hematology analyzer,CytoDiff flow cytometry and morphology differentiation. The r was 0.959 between CytoDiff flow cytometry and morphology differentiation,and the r of neutrophils,lymphocytes,monocytes,eosinophils,basophils and immature granulocytes were 0.938,0.893,0.871,0.962,0.833 and 0.786. The r between hematology analyzer and morphology differentiation were 0.902,0.750,0.436,0.860,0.758 and 0.678,respectively. When >1% was set as the cut-off value of blasts on morphology differentiation,there were 235 positive cases among 976 samples,the hematology analyzer appeared "blasts" in 283 samples,and the sensitivity,specificity,positive predictive value and negative predictive value of hematology analyzer were 75.7%,85.8%,62.9% and 91.8%,respectively. When >1% was set as the cut-off value on CytoDiff flow cytometry,there were 239 positive cases,and the sensitivity,specificity,positive predictive value and negative predictive value of CytoDiff flow cytometry were 100.0%,99.5%,98.3% and 100.0%,respectively. Conclusions A cut-off value of 1% of blasts is recommended for CytoDiff flow cytometry,which is a sensitive,specific,accurate and rapid method for determining blasts. CytoDiff flow cytometry meets the demand of clinic for the early determination and the monitor of curative effects,and it has prospect in blast determination.

Key words: CytoDiff flow cytometry, Blasts, Morphology

中图分类号:

R446.1

郭平, 陈骊婷, 宋卫星, 石厚荣, 王剑飚. 快速流式细胞术用于外周血原始细胞检测性能临床评价[J]. 检验医学, 2017, 32(5): 421-426.

GUO Ping, CHEN Liting, SONG Weixing, SHI Hourong, WANG Jianbiao. Performance of CytoDiff flow cytometry for determining blasts in peripheral blood[J]. Laboratory Medicine, 2017, 32(5): 421-426.

图/表 6

参考文献 13

[1]	NOVIS D A,WALSH M,WILKINSON D,et al.Laboratory productivity and the rate of manual peripheral blood smear review: a college of American pathologists Q-probes study of 95 141 complete blood count determinations performed in 263 institutions[J]. Arch Pathol Lab Med,2006,130(5):596-601.
[2]	BARNES P W,MCFADDEN S L,MACHIN S J,et al.The international consensus group for hematology review:suggested criteria for action following automated CBC and WBC differential analysis[J]. Lab Hematol,2005,11(2):83-90.
[3]	Clinical and Laboratory Standards Institute. Reference leukocyte (WBC) differential count (proportional) and evaluation of instrumental methods[S]. H20-A2,CLSI,2007.
[4]	FUENTES-ARDERIU X,GARCIA-PANYELLA M,DOT-BACH D.Between-examiner reproducibility in manual differential leukocyte counting[J]. Accred Qual Assur,2007,12(12):643-645.
[5]	ROUSSEL M,BENARD C,LY-SUNNARAM B,et al.Refining the white blood cell differential: the first flow cytometry routine application[J]. Cytometry A,2010,77(6):552-563.
[6]	FAUCHER J L,LACRONIQUE-GAZAILLE C,FRéBET E,et al. "6 markers/5 colors" extended white blood cell differential by flow cytometry[J]. Cytometry A,2007,71(11): 934-944.
[7]	BJÖRNSSON S,WAHLSTRÖM S,NORSTRÖM E,et al. Total nucleated cell differential for blood and bone marrow using a single tube in a five-color flow cytometer[J]. Cytometry B Clin Cytom,2008,74(2):91-103.
[8]	CHERIAN S,LEVIN G,LO W Y,et al.Evaluation of an 8-color flow cytometric reference method for white blood cell differential enumeration[J]. Cytometry B Clin Cytom,2010,78(5):319-328.
[9]	刘雪凯,王建中,邢莹,等. 单管10色流式细胞术分类计数外周血白细胞[J]. 中华检验医学杂志,2011,34(5):395-402.
[10]	VAN DE GEIJN G J,VAN REES V,VAN PUL-BOM N,et al. Leukoflow: multiparameter extended white blood cell differentiation for routine analysis by flow cytometry[J]. Cytometry A,2011,79(9):694-706.
[11]	SHAFER J A.Blood and marrow morphology in acute leukemia patients receiving chemotherapy: a photo-essay[J]. Am J Med Technol,1983,49(2):77-90.
[12]	JO Y,KIM S H,KOH K,et al.Reliable,accurate determination of the leukocyte differential of leukopenic samples by using hematoflow method[J]. Korean J Lab Med,2011,31(3):131-137.
[13]	LACOMBE F,ARNOULET C,MAYNADIé M,et al.Early clearance of peripheral blasts measured by flow cytometry during the first week of AML induction therapy as a new independent prognostic factor:a GOELAMS study[J]. Leukemia,2009,23(2):350-357.

仪器报警	形态学计数
仪器报警	+	-
+	178	105
-	57	636
合计	235	741

仪器报警	形态学计数
仪器报警	+	-
+	178	105
-	57	636
合计	235	741

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