摘要：目的：评价Sysmex XN-3000血液分析仪白细胞分类（WDF）通道和白细胞前体细胞（WPC）通道报警信息的可信性，验证并调整其报警阈值。 方法：用WDF和WPC通道同时检测61例无异常报警及521例有异常报警的EDTA-K2抗凝血液标本，仪器自动制作血涂片标本后人工镜检。以显微镜镜检结果为金标准，判断仪器报警信息的可靠性，验证厂商提供的初始报警阈值是否合理，结合实际工作要求，调整其阈值。 结果：WDF通道异型淋巴细胞（atypical lymph）、原始细胞/异常淋巴细胞（blasts/abn lymph）报警信息的敏感性较高（分别为95.8%、100%），特异性较低（分别为34.7%、23.5%），WPC通道的atypical lymph、blasts、abn lymph报警信息的敏感性较低（分别为81.3%、66.7%、76.5%），特异性较高（分别为61.9%、55.5%、88.3%）。经ROC曲线分析，除WPC通道的abn lymph报警信息镜检判断价值较差外，其他报警信息镜检判断价值均为中等。结合实际复检规则要求，WDF通道atypical lymph、blasts/abn lymph，WPC通道atypical lymph最佳临界阈值调整为120，WPC通道的blasts、abn lymph最佳临界阈值调整为140。 结论：采用敏感性较高的WDF通道筛查时出现报警信息后再用特异性较高的WPC通道复检可缩短检验结果回报时间，提高工作效率。厂商提供的初始报警阈值需验证并调整为最佳临界阈值以保证检测结果的准确性。
Abstract: Objective：To evaluate the creditability of warning message of white differential count (WDF) and white precursor cell (WPC) channels in Sysmex XN3000 hematology analyzer, and verify its optimal threshold and adjust the alarm threshold. Methods：A total of 61 EDTA-K2 anticoagulated blood samples without abnormal warning and 521 EDTA-K2 anticoagulated blood samples with abnormal warning were simultaneously detected in WDF and WPC channels. After the smear specimens of blood sample were automatically prepared by the instrument, microscopic examinations were performed manually. The results of microscopic examination were considered as the gold standard to determine the reliability of the warning message from the instrument and verify the reasonability of initial warning threshold value provided by the manufacture. Consequently, the threshold values were adjusted based on the requirements in practical work. Results：The warning messages of atypical lymphocytes and blasts/ abnormal lymphocytes in WDF channel were higher sensitive (95.8% and 100% respectively), but lower specific (34.7% and 23.5% respectively) compared with microscopic examination. The warning messages of atypical lymphocyte, blasts and abnormal lymphocytes in WPC channel were lower sensitive (81.3%, 66.7%, and 76.5% respectively) but higher specific (61.9%, 55.5% and 88.3 % respectively) compared with microscopic examination. According to the ROC curve analysis, the prognostic values of warning message of microscopic examination were of medium level, except the warning message for abnormal lymphocytes was poor compared with WPC channel. Combining the practical retest rules, the optimal critical threshold values of atypical lymphocytes and blasts/Abn lymph in WDF channel were adjusted as 120, and they were adjusted as 140 in WPC channel. Conclusion：The high sensitive WDF channel should first be used for screening, and the detectable warning message could be retested by using high specific WPC channel to shorten the turnaround time of the test results and improve the working efficiency. The initial critical warning threshold provided by the manufacture should be verified and adjusted to the optimum critical threshold in order to ensure the accuracy of test results.
曹科,郎家庆,罗小娟,王兰,李嘉辉,李飞,刘新刚,陈运生,马东礼. 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,(3):166-170复制