가성호중구감소증 감별을 위한 평균과산화효소지수의 활용
Utilization of Mean Peroxidase Index for Discrimination of Pseudoneutropenia
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초록
배경: ADVIA2120 자동혈구계산기에서는 백혈구감별계산에 과산화효소 농도를 이용하므로, 과산화효소 농도가 낮은 검체는 호중구가 단구나 large unstained cell (LUC)로 잘못 계수되므로 가성호중구감소증을 보일 수 있다. 과산화효소의 결핍은 자동혈구계산기에서 제공하는 평균과산화효소지수(mean peroxidase index,MPXI)가 낮을 때 의심할 수 있다. 본 연구의 목적은 평균과산화효소지수의 참고범위를 설정하고, 가성호중구감소증을 감별하기 위해 말초혈액수기도말을 시행해야 하는 MPXI의 기준치를 정하는것이다. 방법: 2010년 4월부터 2012년 6월까지 건강검진을 받은 20세 이상성인 5,802예를 대상으로 CLSI C28-A3 가이드라인의 간접참고대상 추출법에 따라서 평균±2SD로 평균과산화효소지수의 참고범위를 설정하였다. MPXI 수치가 -10 이하인 검체는 말초혈액수기도말로 백혈구감별계산을 실시하였고, 말초혈액수기도말의 호중구가 자동혈구계산기의 결과보다 20%P 이상 많이 관찰되면 가성호중구감소증으로 판단하였다. 가성호중구감소증을 보인 검체와 보이지 않은 검체의 평균과산화효소지수 결과를 이용해 ROC 분석을 하여 가성호중구감소증을 감별하기 위한 기준치를 도출하였다. 결과: 평균과산화효소지수 참고범위를 전체대상은 -4.9에서 7.5, 남성은 -5.5에서 7.3, 여성은 -4.5에서 7.5로 설정하였다. 여성의 평균이유의하게 높았으며 연령에 따른 차이는 보이지 않았다. 가성호중구감소증을 보인 22예의 평균과산화효소지수 결과를 이용하여ROC 분석을 한 결과 평균과산화효소지수 -20.7을 이용하였을 때가성호중구감소증 감별에 민감도 94.9%, 특이도 77.3%를 보였다. 결론: ADVIA2120 자동혈구계산기를 사용하는 기관에서 평균과산화효소지수를 말초혈액수기도말 기준에 포함시키면 가성호중구감소증을 감별하여 환자에게 유용하게 사용할 수 있을 것으로생각된다.
Abstract
Background: Autoanalyzer ADVIA2120 uses intracellular peroxidase concentration to perform white blood cell (WBC) differential. Therefore, in specimens containing neutrophils with low peroxidase concentration, neutrophils can be miscounted as monocytes or large unstained cells resulting in pseudoneutropenia. Myeloperoxidase deficiency can be detected by the mean peroxidase index (MPXI). The aims of this study are to establish the reference interval of MPXI and define a cut off value for manual slide review to discriminate pseudoneutropenia. Methods: We calculated reference intervals as mean±2SD according to the indirect method of CLSI C28-A3 guideline from MPXI data of 5,802individuals who took routine health checkup from April 2010 to June 2012. We performed manual slide review on specimens with low MPXI and compared neutrophil differential count of manual method with that of autoanalyzer. When neutrophil differential in manual slide review was >20%P higher than autoanalyzer result, it was regarded as a pseudoneutropenia. We performed ROC analysis using the MPXI results of samples with and without pseudoneutropenia to define a cutoff to discriminate pseudoneutropenia. Results: The reference intervals of MPXI in total population, male, and female were -4.9 to 7.5, -5.5 to 7.3, and -4.5 to 7.5, respectively. The mean value of MPXI was significantly higher in female than in male and there was no difference by age. Twenty-two pseudoneutropenia samples from 7patients were identified. ROC analysis yielded cutoff value of -20.7 with 94.9% of sensitivity and 77.3% of specificity. Conclusions: MPXI may be used in the manual slide review guideline for detecting pseudoneutropenia.
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