自动化尿液及体液常规分析的复检规则制定及探讨

发布时间：2018-01-14 04:05

本文关键词：自动化尿液及体液常规分析的复检规则制定及探讨　出处：《北京协和医学院》2015年硕士论文　论文类型：学位论文

【摘要】：目的：针对不同的自动化尿常规分析系统,制定各自的形态学复检规则；对自动化体液常规分析的复检规则进行初探。方法：1058例新鲜尿液标本通过Siemens Atlas型全自动干化学分析仪和4台全自动有形成份分析仪IRIS IQ200、AVE-766、US 2026、Sysmex UF-1000i检测尿液常规指标,以相差显微镜人工镜检法作为参考方法,通过假阴性率和复检率制定适合每个系列尿常规分析仪的最佳复检规则。150份体液标本,通过XE-5000全自动血液分析仪体液模式进行细胞计数和分类,结合人工镜检法、瑞氏-吉姆萨及苏木素-伊红染色法评估仪器法的可靠性,探讨复检规则。结果：单独使用干化学分析仪时,(PR02+)+(RBC2+)+(WBC2+)+肾内科来源的标本进行复检的方案最佳,假阴性率小于临床可接受水平(5%),为4.65%,镜检率为40.41%。联合干化学与有形成份时,对于干化学联合IRIS IQ200、AVE-766、US 2026的最佳复检方案为；干化学BLD≥2+(女性2+)或RBC超出参考范围2倍或WBC阴阳不符或数量级不符或干化学PRO≥2+或沉渣CAST超出参考范围；此时假阴性率分别为1.94%、2.03%、1.74%,镜检率分别为41.09%、40.12%、44.86%。对于干化学联合Sysmex UF-1000i的最佳复检方案为：干化学BLD≥2+(女性2+)或RBC超出参考范围2倍或WBC阴阳不符或数量级不符或干化学PRO≥2+或沉渣CAST超出参考范围,当干化学BLD与有形RBC阴阳不符时,先非离心计数RBC/μ1,根据镜检结果适当修正干化学或有形RBC后再进入规则；其假阴性率为1.65%、总镜检率为50.39%。浆膜腔积液和CSF的细胞计数优于BALF,浆膜腔积液的细胞分类计数优于CSF和BALF。 HF-BF用于预测大细胞的ROC曲线下面积为0.806,优于对瘤细胞的预测；此时,cut-off值为3.60,诊断敏感度为0.82,特异度为0.76。细胞数低于490×106/L时,精密度和准确性均较差。结论：个性化的复检规则,能控制自动化尿常规的漏诊率达到临床可接受水平,并具有临床可操作性；XE-5000体液模式用于浆膜腔积液的细胞计数与分类优于CSF和BALF,HF用于大细胞的预测优于肿瘤细胞。
[Abstract]:Objective: to automate routine urine analysis for different systems, making their morphological criteria; for routine analysis of the criteria of automated fluid were studied. Methods: 1058 cases of fresh urine samples by Siemens Atlas automatic chemical analyzer and 4 automatic analyzer IRIS IQ200 components AVE-766, US, 2026, Sysmex UF-1000i urine routine index, reference method using phase contrast microscope as artificial microscopy, the false negative rate and rate of re examination rules and make the best.150 parts of body fluid specimens for each series of urine analyzer, cell counting and classification by XE-5000 automatic blood analyzer fluid model, combined with artificial microscopy, Wright Giemsa and hematoxylin eosin staining method to investigate the reliability evaluation instrument, review criteria. Results: single use dry chemical analyzer, (PR02+) + (RBC 2+) + (WBC2+) + nephrology sources were re examination of the best solution, the false negative rate is less than the clinically acceptable level (5%), 4.65%, 40.41%. combined with dry chemical and physical composition rate during bronchoscopy, for dry chemical combined with IRIS IQ200, AVE-766, US 2026 is the best solution for re examination; dry BLD = 2+ (chemical female 2+) or RBC beyond the reference range of 2 times or WBC and inconsistent or magnitude or not more than 2+ or PRO dry chemical sediment CAST beyond the reference range; the false negative rate were 1.94%, 2.03%, 1.74%, examination rate is respectively 41.09%, 40.12%, 44.86%. for the best review program dry chemical combined with Sysmex UF-1000i for BLD = 2+: dry chemical (female 2+) or RBC beyond the reference range of 2 times or WBC and inconsistent or magnitude or not more than 2+ or PRO dry chemical sediment CAST beyond the reference range, when the dry chemistry BLD and physical RBC of yin and Yang is inconsistent, the first non centrifugal counting RBC/ 1, According to the microscopic examination of the modified dry chemical or physical RBC before entering the rule; the false negative rate was 1.65%, the total rate of microscopic cell counting is better than BALF 50.39%. and CSF in serous cavity effusion, serous effusion cell count and BALF. is better than CSF HF-BF for predicting ROC curve area of large cells was 0.806 better than the prediction of tumor cells; at the same time, the cut-off value was 3.60, the diagnostic sensitivity was 0.82, specificity of 0.76. cell count below 490 * 106/L, precision and accuracy were poor. Conclusion: the personalized examination rules, can control the automatic urinary routine clinical misdiagnosis rate reached an acceptable level, and has the clinical operation mode for XE-5000 fluid; serous effusion cell count and classification is better than that of CSF and BALF, HF for the prediction of tumor cells is better than that of large cells.

【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R446.12

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