剩余稀释标本涂片复检在末梢血预稀释模式三分群血常规检查中的应用价值

摘要

目的 探讨剩余稀释标本涂片细胞形态学复检在新生儿、婴幼儿末梢血预稀释模式三分群血常规检查中的可靠性。方法 对新生儿、婴幼儿末梢血血常规检查标本以Sysmex-kx-21三分群血细胞分析仪预稀释模式进行检测，并对筛查的结果进行手工复检；对剩余稀释标本的手工复检以离心沉淀或静置沉淀的方式进行浓缩与涂片瑞氏染色，镜检至少观察200个白细胞，同时每例检查补充末梢血直接涂片1~2张瑞氏染色镜检作为细胞形态学复检比对的金标准。结果 根据复检规则对仪器法检测结果进行统计学分析，得到真阳性率为4.6%，假阳性率为20.3%，真阴性率为74.0%，假阴性率为1.1%，复检率为24.9%，仪器法测定的敏感度为18.3%，特异度为98.6%，阳性预测值为81.3%，阴性预测值为78.5%，准确性为78.6%；两种涂片方式复检结果一致(P>0.05)。结论 基层单位末梢血预稀释模式三分群血常规检查简易形态复检能为新生儿、婴幼儿门诊保健和临床医疗提供安全保障。%Objective To investigate the reliability of smear review test in blood cells morphology with remaining di-luted specimen in neonatals and infants' blood routine tests by pre-diluted mode of three clustering instrument test. Method Neonatals and infants' peripheral blood routine examination specimens were detected by pre-dilution mode of Sysmex-kx-21 three classification blood cell analyzer,and the screening results were manually retested. On manual review of the remaining diluted samples,the centrifugal precipitation or static precipitation method was used to con-centrate and smear,wright's staining,microscopy to observe at least 200 white blood cells,and each peripheral blood smear examination supplemented 1~2 slide( s) with wright's staining and microscopy as the gold standard of cell morphological examination alignment at the same time. Result According to the review criteria of instrument method for statistical analysis,the true positive rate of instrument method was 4. 6%,false positive rate 20. 3%,true negative rate 74. 0%, false negative rate 1. 1%, the revive rate was 24. 9%. The sensitivity of instrument method was 18. 3%,the specificity was 98. 6%, the positive predictive value was 81. 3%, the negative predictive value was 78. 5%,the accuracy was 78. 6%. The recheck results of residual diluted samples' smear were consistent with their direct smears'(P>0. 05). Conclusion Simple morphological recheck of peripheral blood pre-diluted mode with three groups of blood routine test could be useful to provide security for neonatals and infants' patient care and clini-cal medicine in grass-roots units.