网织红细胞通道光学法红细胞参数在冷凝集素干扰识别及纠正中的应用价值  

Rapid identification and correction of the interference of cold agglutinins by using RET channel red blood cell parameters

作　　者：唐文佳 杨烁 朱捷 李和晞 顾梅秀 王蓓丽 潘柏申 郭玮 Tang Wenjia;Yang Shuo;Zhu Jie;Li Hexi;Gu Meixiu;Wang Beili;Pan Baishen;Guo Wei(Department of Laboratory Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院检验科,上海200032

出　　处：《中华检验医学杂志》2023年第10期1020-1025,共6页Chinese Journal of Laboratory Medicine

基　　金：上海市临床重点专科建设项目(医学检验科)(shslczdzk03302);国家自然基金面上项目(81972000,82172348);厦门市医疗卫生重点项目(YDZX20193502000002);上海市医学重点专科项目(ZK2019B28);国家自然基金青年项目(81902139,82202608);复旦大学附属中山医院临床研究专项基金(2020ZSLC54);上海市启明星计划扬帆专项基金(22YF1406200)。

摘　　要：目的评估全自动血细胞分析仪网织红细胞(RET)通道中Delta-RBC参数对冷凝集素(CA)干扰的识别作用,并探讨RET通道光学法红细胞参数在纠正CA干扰中的应用价值。方法回顾性研究。收集复旦大学附属中山医院门诊2022年1月至2023年1月间,经镜检确认存在红细胞冷凝集的标本68份,无冷凝集对照组标本45份,室温下使用全血细胞计数(CBC)+RET通道检测冷凝集组及对照组所有标本,记录并计算阻抗法检测参数:红细胞(RBC-I)、血红蛋白(HGB)、血红蛋白红细胞比容(HCT-I)、红细胞平均血红蛋白含量(MCH-I)、红细胞平均体积(MCV-I)、红细胞平均血红蛋白浓度(MCHC-I)及光学法检测参数:RBC-O、HCT-O、MCH-O、R-MFV、MCHC-O、Delta-RBC。对冷凝集组标本进行37℃2 h温育,温育后使用CBC通道检测,记录阻抗法参数:RBC-I37℃2 h、HGB37℃2 h、HCT-I37℃2 h、MCH-I37℃2 h、MCV-I37℃2 h、MCHC-I37℃2 h。采用受试者工作特征(ROC)曲线分析Delta-RBC对CA干扰的识别效能,使用Bland-Altman法分析冷凝集组室温下光学法RBC参数检测结果与温育后阻抗法检测结果间一致性情况,使用Pearson及Spearman相关性分析对冷凝集组标本温育前后血细胞检测结果进行相关性分析。结果若使用Delta-RBC作为诊断指标对CA干扰进行识别,最佳截断值为1.065,曲线下面积为0.998。冷凝集组标本RBC-O、HCT-O、R-MFV、MCH-O、MCHC-O与RBC-I37℃2 h、HCT-I37℃2 h、MCV-I37℃2 h、MCH-I37℃2 h、MCHC-I37℃2 h结果间相关系数分别为0.985、0.981、0.729、0.870、0.649;结果差异百分比在一致性界限内的比例分比为95.6%、92.6%、95.6%、94.1%、95.6%。结论全自动血细胞分析仪RET通道光学法检出的RBC参数Delta-RBC可作为判断指标有效辅助临床判断是否存在CA干扰。使用RET通道的光学法RBC参数进行结果报告可以在无须标本预处理的情况下纠正CA干扰,得到更为正确的全血细胞计数结果。Objective To assess the role of Delta-RBC parameters in the automated hematocrit analyzer RET channel for the recognition of cold agglutinins(CA)and to explore the value of RET channel optical method parameters in correcting interference with CA.Methods This is a retrospective study.The Cas group included 68 samples with Cas interference and the control group included 45 samples without CA interference.All specimens were collected from Zhongshan Hospital Fudan University Outpatient Department from January 2022 to January 2023.Specimens in both the CA and Control group were examined using the CBC+RET channel at room temperature.Recorded and calculated the Impedance method test parameters RBC-I,HGB,HCT-I,MCH-I,MCV-I,MCHC-I and the Optical method test parameters RBC-O,HCT-O,MCH-O,R-MFV,MCHC-O,Delta-RBC.Examined the specimens in the CA group using the CBC channel after prewarmed at 37℃for 2 h,and Impedance method parameters RBC-I37℃2 h,HGB37℃2 h,HCT-I37℃2 h,MCH-I37℃2 h,MCV-I37℃2 h,MCHC-I37℃2 h were recorded.The ROC curves were used to analyze the discrimination efficacy of Delta-RBC in identifying CA interference,and the Bland-Altman method was used to analyze the consistency between the results of the optical method RBC parameters at room temperature and the results of the impedance method after prewarming.The correlation analysis was performed using Pearson and Spearman correlation analysis to analyze the results of the RBC parameters before and after prewarming in the CA group.Result If Delta-RBC was used as diagnostic indicators for the identification of CA interference,the best cut-off value was 1.065,with AUCs of 0.998.In the CA group,the correlation coefficients between RBC-O,HCT-O,R-MFV,MCH-O,MCHC-O,and RBC-I37℃2 h,HCT-I 37℃2 h,MCV-I 37℃2 h,MCH-I 37℃2 h,MCHC-I 37℃2 h were 0.985,0.981,0.729,0.870,and 0.649,respectively.The percentages within the limits of agreement of the percentage differences between the results of the two methods were 95.6%,92.6%,95.6%,94.1%,and 95.6%,respectively.Co

关 键 词：凝集素类 全血细胞计数 全自动血细胞分析仪 检测干扰 

分 类 号：R446.11[医药卫生—诊断学]