XN-9000血细胞分析仪筛查外周血中Sezary细胞的临床价值研究

摘要

目的 评估采用XN-900形态报警和结构参数用于筛检外周血中Sezary细胞的可行性和有效性.方法 分别采用光学显微镜,XN-9000血细胞分析仪和流式细胞术(FCM)对21例Sezary综合征患者(sezary syndrome,SS)和三个对照组(皮肤T细胞淋巴瘤对照组48例、慢性淋巴组织增生性B细胞疾病(CLPD)对照组55例、正常人对照组45例)进行检测,采用对照分析法对Sysmex xn-9000分析生成的淋巴细胞结构参数(ly-x,ly-y,ly-z)及“Blast/Abn Lympho(原始/异常淋巴)”报警进行对比分析,采用受试者工作曲线(ROC)来确定ly-x和ly-z的最佳触发筛查Sezary细胞的临界值,对“Blast/Abn Lympho(原始/异常淋巴)”报警提示和结构参数(ly-x和ly-z)的各种组合筛检规则的诊断效能指标进行评估.结果 Sezary综合征组淋巴细胞结构参数ly-x和ly-z分别为89.80(87.55～91.52)和73.60(69.10～74.32),明显高于皮肤T细胞淋巴瘤对照组、CLPD组和正常人对照组(U=37,40,44,55,38,41,均P＜0.05);ly-x与Sezary细胞数量正相关,ly-z与大Sezary细胞存在正相关(r=0.248,0.198,P＜0.05);采用ROC曲线确定ly-x和ly-z筛查Sezary细胞的临界值分别为≥86和≥68,将上述三个指标组合起来(即“报警Blast/Abn Lympho≥100,ly-x≥86且ly-z≥68)的灵敏度和特异度分别为100％和92.1％,可获得最好的筛检Sezary细胞诊断效能.结论 采用血细胞分析仪所产生的“Blast/Abn Lym-pho(原始/异常淋巴)”报警提示和结构参数(ly-x,ly-z)组合规则可在外周血中Sezary细胞筛检中获得较高的特异度和敏感度,可用于疑似SS样本的复片筛检.%Objective To evaluate the performance alarms and parameters generated by hematology analyzer during detection of circulating sezary cells of peripheral blood smears.Methods Blood samples from patients with Sezary syndrome (n=21) were studied with Sysmex XN-9000 analyzer,and compared to patients with benign or tumoral skin lesions (n=48) and patients with chronic lymphoproliferative B-cell diseases (n=55) and normal person (n=45) used as control.Results In present series,the value of structural lymphoid parameters (ly-x and ly-z) and the alarm Blast/Abn Lympho were statistically higher in Sezary cases than in control cases (U=37,40,44,55,38,41,all P＜0.05).Screening Sezary cells critical values of ly-x and ly-z determined by ROC curve were greater than or equal to 86 and was more than or equal to 68.The combination of above three indexes up (i.e."alarm Blast/Abn Lympho＞ 100,ly-x=86 and ly-z＞68) sensitivity and specificity respectively for 100 ％ and 92.1 ％,in order to get the best screening Sezary cells diagnostic efficiency.In addition,the value of ly-x was associated to the count of circulating Sezary cells and value of ly-z to the presence of large Sezary cells,both parameters described as prognostic factors.Conclusion The combination of alarm Blast/Abn Lympho and structural parameters (ly-x/ ly-z/ly-y) may allow to define rule of blood slide review to screen circulating Sezary cells.