CLIN CHEM LAB MED:下一代儿童血液学参考区间

2019-11-17 MedSci MedSci原创

解释儿童的血液学分析具有一定的难度,因为随着生理发育,造血系统也发生了广泛的变化,并导致明显的性别和年龄特异性的动态变化。从出生到成年的连续百分位图允许精确地考虑这些动态。然而,儿科参考区间特有的伦理和实践挑战限制了百分位数图的创建,当前实验室检测结果显示方法的局限性也限制了它们在指导临床决策时的使用。

解释儿童血液学分析具有一定的难度,因为随着生理发育,造血系统也发生了广泛的变化,并导致明显的性别和年龄特异性的动态变化。从出生到成年的连续百分位图允许精确地考虑这些动态。然而,儿科参考区间特有的伦理和实践挑战限制了百分位数图的创建,当前实验室检测结果显示方法的局限性也限制了它们在指导临床决策时的使用。

研究人员采用一种改进的数据驱动方法,从10个德国中心在病人护理期间收集的实验室数据中创建百分位图(来自358292个病人的9,576,910个样本,每个分析物有412,905-1,278,987个样本)。使用百分比图和z分数(www.pedref.org/hematology)来显示血液学检测结果的可视化,并评估百分比和z分数对不同血液学疾病诊断的支持潜力。

研究人员制作了血红蛋白、红细胞压积、红细胞指数、红细胞计数、红细胞分布宽度、白细胞计数和血小板计数的百分比图,并记录了从出生到18岁的女孩和男孩。儿科医生使用百分位图评估复杂的临床情况与常规/表格表示的比较表明,百分位图可以在选定的病例中改进医生对其的评估。年龄特异性百分位数和z分数与绝对检验结果相比,提高了对血球计数异常儿童的鉴别能力和对不同血液病的鉴别能力。

本研究所提供的参考区间能够精确评估儿科血液学检测结果。使用百分位数和z分数来表示测试结果有助于对其进行解释,并展示了数字方法改善临床决策的潜力。

原始出处:

Jakob ZierkJohannes HirschmannNext-generation reference intervals for pediatric hematology

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