Table of Content

30 April 2019, Volume 34 Issue 4

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Multiple drug resistant infection in patients with nosocomial bacterial pneumonia and risk factors for death within 30 d

LI Jing, LIU Xuechao, SUN Huimin, CUI Bingyi, LIU Xiuwei

2019, 34(4):  300-304.  DOI: 10.3969/j.issn.1673-8640.2019.04.002

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Objective To investigate the pathogenic spectrum and drug resistance status of nosocomial bacterial pneumonia and the risk factors for death within 30 d. Methods The clinical data of patients with bacterial pneumonia in Tangshan Hospital of Traditional Chinese Medicine from January 2017 to December 2017 were analyzed retrospectively. The pathogenic distribution and drug resistance status were analyzed. Logistic regression analysis and Cox regression analysis were performed on the related risk factors. Results Age,intensive care unit（ICU） stay day>7 d and invasive mechanical ventilation>7 d were independent risk factors for patients with bacterial pneumonia to develop multiple drug resistance（MDR） infection. Age,lung tumor and concurrent infection at other sites were independent risk factors for death within 30 d. Conclusions The risk factors for MDR infection and death within 30 d are identified,which provides a reference for the clinical prevention and treatment.

Influence factor analysis on 1 852 cases of blood culture

SHI Dake, NI Yuxing, HAN Lizhong, XIAO Chenlu

2019, 34(4):  305-308.  DOI: 10.3969/j.issn.1673-8640.2019.04.003

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Objective To evaluate the influence factors that might affect the results of blood culture in Shanghai Jiaotong University School of Medicine Ruijin Hospital. Methods Blood specimens were cultured by BD BACTECFX automatic blood culture instrument,and the microorganisms were identified by VITEK MS detection system. The effects of the variables on the results of blood culture were evaluated by Logistic regression analysis and receiver operating characteristic（ROC）curve. Results A total of 1 852 blood culture bottles were collected,155 bottles were positive,and the positive rate was 8.37%. Gram positive bacteria accounted for 38.06%（59 isolates）,Gram negative bacteria accounted for 58.06%（90 isolates）,and fungi accounted for 3.87%（6 isolates）. The average time of reporting positivity was 34.81 h. Logistic regression analysis showed that age [odds ratio（OR）=1.161,95% confidence interval（CI） 1.069-1.260,P=0.000],the temperature of the patients on the time of blood specimen collection（OR=2.680,95%CI 1.918-3.744,P=0.000）,the volume of blood collection（OR=1.475,95%CI 1.059-2.055,P=0.022）and white blood cell count（OR=3.758,95%CI 2.676-5.278,P=0.000）were influence factors for the positive rate of blood culture. Conclusions Age,the volume of blood collection,white blood cell count and the temperature of the patients on the time of blood specimen collection are correlated to the positive rate of blood culture. Collecting blood specimens correctly may increase the detection rate of blood stream infection（BSI）,which is helpful to clinical anti-infection treatment.

Influence of active human cytomegalovirus infection on uremia

XIA Jianping, HUANG Jianfeng, ZHANG Zihong, GONG Fang, QIAN Chunyan

2019, 34(4):  309-312.  DOI: 10.3969/j.issn.1673-8640.2019.04.004

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Objective To investigate the influence of active human cytomegalovirus（HCMV） infection on uremia. Methods The peripheral blood samples of 13 uremia patients with active HCMV infection,58 uremia patients with latent HCMV infection and 58 healthy subjects（healthy control group） were collected. The parameters,HCMV IgG antibody,HCMV IgM antibody,HCMV IE-1,HCMV pp65 antigen,serum creatinine（Cr）,blood urea nitrogen（BUN）,red blood cell（RBC） count,hematocrit（HCT）,hemoglobin（Hb） and lymphocyte percentage were determined. The influence of active HCMV infection on uremia was evaluated. Results Cr,BUN,RBC count,HCT and Hb in uremia groups had statistical significance compared with those in healthy control group（P<0.05）. In active HCMV infection group,Cr,BUN and lymphocyte percentage were increased compared with latent HCMV infection group（P<0.05,P<0.01）,and RBC count,HCT and Hb were decreased without statistical significance（P>0.05）. Conclusions Active HCMV infection might be involved in the pathogenesis of uremia.

Role of human papillomavirus DNA assay combined with liquid-based cytology for screening cervical lesion

HUANG Yan, ZHU Xiaoyun, LI Tianying

2019, 34(4):  313-317.  DOI: 10.3969/j.issn.1673-8640.2019.04.005

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Objective To investigate the role of human papillomavirus（HPV） DNA assay combined with thin prep liquid-based cytology test（TCT） in cervical lesion screening. Methods From July 2015 to April 2018,8 498 women undergoing routine cervical lesion screening were enrolled from Peking University International Hospital. HPV DNA assay and TCT were performed. The positive rate of high-risk HPV infection and the detection rate of TCT were calculated. The sensitivities and specificities of HPV DNA assay and TCT for the diagnosis of high-grade cervical lesions were evaluated. Results The positive rate of high-risk HPV infection was 12.2%. The sensitivity of TCT for the diagnosis of cervical lesions was 56.0%,and the specificity was 77.8%. The sensitivity of HPV DNA assay was 98.4%,and the specificity was 48.9%. The sensitivities of TCT and HPV DNA assay were 55.8% and 99.0% in patients with cervical intraepithelial neoplasia（CIN）≥2,respectively. Combined TCT with HPV DNA assay,the sensitivity was 90.1%,and the negative predictive value was 91.2%. Conclusions Using HPV DNA assay as primary screening method,TCT is performed or not according to the results of HPV DNA assay. This combined screening scheme is advantageous in the diagnosis of cervical lesions.

Diagnostic cut-off value of HbA₂ for screening thalassemia and the combined determination of HbA₂,MCV and MCH

CHEN Yabin, JIANG Yancheng, CHEN Zixuan, YANG Wei, ZHANG Zhishan

2019, 34(4):  318-321.  DOI: 10.3969/j.issn.1673-8640.2019.04.006

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Objective To study the role of hemoglobin（Hb） A₂,mean corpuscular volume（MCV） and mean corpuscular hemoglobin（MCH） combined determination scheme for screening thalassemia. Methods The HbA₂ levels of α-thalassemia group,light β-thalassemia group and healthy subjects（healthy control group） were determined,and the results were analyzed comparatively. The efficiency of HbA₂ for screening thalassemia was evaluated by receiver operating characteristic（ROC） curve. The performance of the scheme was evaluated through screening 322 clinical suspected cases of thalassemia. Results The HbA₂levels in α-thalassemia group,light β-thalassemia group and healthy control group had statistical significance（P<0.05）,but there was no statistical significance among stationary type,standard type and intermediate type α-thalassemia groups and healthy control group（P>0.05）. The diagnostic cut-off values for screening α-thalassemia and light β-thalassemia were HbA₂<3.05% and HbA₂>3.90%,respectively. The sensitivity,specificity,positive predictive value,negative predictive value and consistency rate were 76.33%,58.82%,67.19%,69.23% and 68.10%,respectively. Conclusions The scheme,MCV<82.1 fL and（or） MCH<27.3 pg with HbA₂<3.05% or HbA₂>3.90%,has a good performance for screening thalassemia. It should carry on relevant auxiliary determination or detect thalassemia gene directly for suspected α-thalassemia patients.

Evaluation of optimal cut-off value and performance of serum IgG4 and IgG4/IgG ratio in the diagnosis of typeⅠ autoimmune pancreatitis

XIA Changsheng, FAN Chunhong, WANG Hui

2019, 34(4):  322-326.  DOI: 10.3969/j.issn.1673-8640.2019.04.007

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Objective To investigate the optimal cut-off value and performance of serum immunoglobulin（Ig）G4 and IgG4/IgG ratio in the diagnosis of typeⅠ autoimmune pancreatitis（AIP）. Methods Serum IgG subclass（IgG1,IgG2,IgG3 and IgG4） levels in 47 patients with type Ⅰ AIP,109 patients with pancreatic cancer or cholangiocarcinoma（disease control group） and 99 healthy subjects（healthy control group） were determined by immunonephelometry. Receiver operating characteristic（ROC） curve was used to identify the optimal cut-off values and the area under curve（AUC） of serum IgG4 and IgG4/IgG ratio for the diagnosis of typeⅠ AIP. Results The levels of serum IgG2,IgG4,IgG and IgG4/IgG ratio in typeⅠ AIP group were higher than those in healthy control group（P<0.001）. The levels of serum IgG1,IgG3,IgG4 and IgG4/IgG ratio in disease control group were lower than those in healthy control group（P<0.05）. The proportion of elevated IgG4 level in type Ⅰ AIP group（95.7%） was higher than those in disease control group（3.7%） and healthy control group（2.0%）（P<0.001）,and there was no statistical significance between disease and healthy control groups（P>0.05）. The AUC of serum IgG4 for the diagnosis of typeⅠ AIP was 0.992,and the optimal cut-off value was 1 740 mg/L. The sensitivity,specificity and accuracy were 97.9%,96.2% and 96.5%. The AUC of IgG4/IgG ratio for the diagnosis of typeⅠ AIP was 0.988,the optimal cut-off value was 0.103,and the sensitivity,specificity and accuracy were 97.9%,93.8% and 94.5%. There was no statistical significance for the AUC of serum IgG4 and IgG4/IgG ratio in the diagnosis of type Ⅰ AIP（P>0.05）. Conclusions Serum IgG4 level and IgG4/IgG ratio play roles in the diagnosis of typeⅠ AIP.

Role of peripheral blood CD4⁺CD25^high Treg percentage in the prognosis of ALL

ZHAO Lian, HE Jinlong, WU Cuiyun, ZHOU Haiyan, ZHOU Weilun, WU Cuiping

2019, 34(4):  327-330.  DOI: 10.3969/j.issn.1673-8640.2019.04.008

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Objective To investigate the percentage changes of peripheral blood CD4⁺CD25^high regulatory T cells（Treg） in patients with acute lymphoblastic leukemia（ALL） before and after treatment. Methods Flow cytometry was used to determine CD4⁺CD25^high Treg percentage in peripheral blood of 22 ALL patients before and after treatment [vincristine,daunorubicin,cyclophosphamide and prednisone（VDCP）]. After 5-year follow-up,13 cases achieved complete remission（CR）（CR group）,and 9 cases of non-remission（NR）（NR group） were enrolled. Totally,20 healthy subjects were enrolled as healthy control group. Results Compared with healthy control group,the percentage of CD4⁺CD25^high Treg in peripheral blood increased before and after treatment in ALL group（P<0.05）. The percentage of CD4⁺CD25^high Treg in CR group was increased（P<0.001）,while NR group had no statistical significance before treatment（P>0.05）. The percentage of CD4⁺CD25^high Treg after treatment was slightly lower in ALL group than that before treatment without statistical significance（P>0.05）. The percentage of CD4⁺CD25^high Treg after treatment was lower in CR group than that before treatment（P<0.01）,and it was close to that in healthy control group（P>0.05）. The percentage of CD4⁺CD25^high Treg after treatment in NR group was higher than that before treatment（P<0.01）,and it was higher than that in healthy control group（P<0.001）. Conclusions CD4⁺CD25^high Treg in peripheral blood may be used as an indicator for the treatment efficiency of ALL.

Roles of 4 serum tumor markers for the auxiliary diagnosis and efficacy evaluation of lung cancer

ZHANG Liying, FU Guanhua, WU Junqi

2019, 34(4):  331-334.  DOI: 10.3969/j.issn.1673-8640.2019.04.009

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Objective To investigate the roles of carcinoembryonic antigen（CEA）,carbohydrate antigen （CA） 125,neuron specific enolase（NSE） and cytokeratin-19-fragment（CYFRA21-1） in the auxiliary diagnosis and chemotherapy efficacy evaluation of lung cancer. Methods A total of 86 patients with lung cancer（lung cancer group） were enrolled,which were classified into 36 cases of squamous carcinoma,29 cases of adenocarcinoma and 21 cases of small cell carcinoma,and 30 healthy subjects were enrolled as healthy control group. The levels of CEA,CA125,NSE and CYFRA21-1 were determined. The auxiliary diagnosis efficacy of the 4 serum tumor markers for lung cancer was evaluated,and the consistency with computed tomography（CT） efficacy evaluation was analyzed. Results Serum CEA,CA125,NSE and CYFRA21-1 in lung cancer group were higher than those in healthy control group（P<0.05）. The levels of CEA and CA125 in adenocarcinoma group were higher than those in squamous carcinoma and small cell carcinoma groups（P<0.05）,the levels of CYFRA21-1 in squamous carcinoma group was higher than those in adenocarcinoma and small cell carcinoma groups（P<0.05）,and the level of NSE in small cell carcinoma was higher than those in adenocarcinoma and squamous carcinoma groups（P<0.05）. The sensitivity,specificity and area under receiver operating characteristic（ROC） curve（AUC） of the combined determination of the 4 serum tumor markers were higher than those of their single determinations. CEA and CA125 had good consistencies with CT（Kappa values were 0.508 and 0.470,P<0.001）. Conclusions CEA,CA125,NSE and CYFRA21-1 have auxiliary diagnostic values for lung cancer. The chemotherapy efficacy of CEA and CA125 have good consistencies with CT.

Establishment on electrochemical DNA sensor for MRAB OXA-23 gene determination

GUO Hongbo, DAI Piaopiao, HUANG Hualiang, GUO Yanwei

2019, 34(4):  346-350.  DOI: 10.3969/j.issn.1673-8640.2019.04.013

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Objective To establish a new electrochemical DNA sensor for determining multidrug-resistant Acinetobacter baumannii（MRAB） OXA-23 gene. Methods Polyallylamine-functionalized Pt nanostructures with long-spined sea-urchin-like morphology（Pt-LSSUs@PAA） was used to modify electrochemical DNA sensor interface. RuHex was used as a signal indicator. Using the established electrochemical DNA sensor,the differential pulse voltammetry was used to determine the presence of negatively charged phosphorus-bound RuHex electrochemical signal differences generated by OXA-23 mutant gene to be determined quantitatively. Results The sensor had good stability and reproducibility. The modification of Pt-LSSUs@PAA can increase the effective area of electrode,speed up the electron conduction rate on the surface of electrode and achieve signal amplification. The linear range of OXA-23 was 10 fmol/L-10 nmol/L. The determination limit was 3.3 fmol/L（signal-to-noise ratio was 3）,and the sensor had good specificity. Conclusions The established sensor can achieve sensitive and specific quantitative determination of OXA-23 mutant gene.

Application of multiple methods for Eperythrozoon determination

LU Lingyi, WANG Jianbiao, YAO Yufeng

2019, 34(4):  351-354.  DOI: 10.3969/j.issn.1673-8640.2019.04.014

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Objective To improve the determination specificity of human Eperythrozoon through multiple methods. Methods A total of 223 patients with blood diseases were enrolled. Eperythrozoon was determined by Wright-Giemsa staining and acridine staining. The determination rates were compared between the 2 methods. The cases with both positive results were determined by polymerase chain reaction（PCR）. The positive results of PCR were analyzed by sequencing and GenBank comparison. Results The positive rates were 46.19% and 28.25% by Wright-Giemsa staining and acridine staining,respectively. In 40 cases with both positive results,10 cases were positive by PCR,and 1 case with dark stripe was sequenced. The homology of 16S rRNA sequences between this case and Mycoplasma suis was 95.84%,that for Mycoplasma bovis was 86.84%,and that for Mycoplasma capricolum was 87.33%. Conclusions The multiple methods for Eperythrozooncould improve determination specificity.

Performance evaluation of 3 kinds of serum cholinesterase determination kits by manual DGKC method

OU Yuanzhu, TANG Liping, YU Xiaoxuan, LIU Wenbin

2019, 34(4):  355-359.  DOI: 10.3969/j.issn.1673-8640.2019.04.015

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Objective To evaluate the performance of 3 kinds of commercial serum cholinesterase（CHE） determination kits by manual method recommended by German Clinical Chemical Association（Deutsche Gesellschaft für Klimische Chemie,DGKC）. Methods Through manual DGKC method,the performance of the 3 kinds of serum CHE determination kits,including the correlation with manual DGKC method,comparability,imprecision and linear range,was evaluated. Results There was a good correlation of the 3 determination kits with manual DGKC method（r²=0.999）,and the relative deviation between the upper and lower limits of CHE reference intervals of the 3 determination kits and manual DGKC method was <1/2 allowable total error （TEa）（7.5%）. The repeatabilities were all <1%,and within-laboratory precisions were all ≤1.5%. Using relative bias <7.5% as standard,the linear ranges of manual DGKC method and the 3 determination kits were 417-26 363,1 605-17 609,788-30 853 and 839-25 767 U/L,respectively. The lower limit of the 3 determination kits were higher than that of manual DGKC method. The upper limit of linear range had exceeded the upper limit of linear range declared by the manufacturer. Conclusions The 3 kinds of serum CHE determination kits have good determination performance without matrix effect,which may meet the needs of clinical determination.

Performance evaluation of galectin-3 detection by chemiluminescence and its preliminary application in heart failure

ZHENG Xiaorong, WAN Jun, ZHANG Liangying, LI Yongshu, HAN Xuejing, SHI Ping, JIA Kegang

2019, 34(4):  360-366.  DOI: 10.3969/j.issn.1673-8640.2019.04.016

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Objective To evaluate the performance of galectin-3（Gal-3） detection by chemiluminescence and its preliminary application in heart failure（HF）. Methods According to related documents,the performance of Gal-3 detection by chemiluminescence [limit of blank（LoB）,limit of detection（LoD）,limit of quantitation（LoQ）,precision,linear range and interference] was evaluated,and the manufacturer's reference interval was verified. The effects of age,sex and specimen type on Gal-3 detection were compared. A total of 55 patients with HF（HF group） and 80 healthy subjects（healthy control group） were enrolled,and their plasma samples were collected for Gal-3 detection. Receiver operating characteristic（ROC） curve was used to analyze the role of Gal-3 in HF diagnosis. Results The Gal-3 kit（chemiluminescence） got a satisfying result in verification on LoB,LoD and LoQ,with the values of 0.80,1.0 and 1.0 ng/mL by the manufacturer,respectively. The repeat precision expressed by coefficient of variation（CV） was 1.9%-4.8%,and the within-laboratory precision expressed by CV was 2.6%-6.1%,and the manufacturer's precision got verification. In the range of 4.07-113.11 ng/mL,there was a good linearity of Gal-3 detection by chemiluminescence. Serum Gal-3 level determined by chemiluminescence would not be affected in samples with hemoglobin level <20 g/L,total bilirubin（TB）<403.2 μmol/L,direct bilirubin（DBil） < 214.08 μmol/L or the turbidity of chyle <7 450 FTU. The plasma Gal-3 level was higher than that in serum （P<0.05）. There was no statistical significance in Gal-3 levels between males and females（P>0.05）. The research subjects were classified by sample types（serum and plasma） and ages. In serum group,Gal-3 level had statistical significance in 3 age subgroups（20~<45-year-old group,45~<60-year-old group and ≥60-year-old group）（P<0.05）,and there was statistical significance for plasma Gal-3 levels in 20~<60-year-old group and ≥60-year-old group（P<0.05）. Gal-3 levels increased with ages. The level of Gal-3 was higher in patients with HF than that in healthy control group（P<0.001）. The area under ROC curve （AUC） of Gal-3 for HF diagnosis was 0.969,and the optimal cut-off value was 20.04 ng/mL,with a sensitivity of 85.5% and a specificity of 100.0%. Conclusions The analytical performance of Gal-3 detection by chemiluminescence is good. Age has a certain effect on Gal-3 levels. Gal-3 plays a role in the auxiliary diagnosis of heart failure.

Research progress of ubiquitin-like modification of Neddylation and MLN4924 for the treatment of tumors

LIU Yue, WANG Shiwen, ZHANG Yanmei, ZHAO Hu

2019, 34(4):  370-374.  DOI: 10.3969/j.issn.1673-8640.2019.04.018

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Neddylation modification is a new type of protein posttranslational modification discovered in recent years. A wide range of biological processes,including cell cycle,signal transduction and immune recognition,can be regulated. Neddylation modification is highly activated in many cancer cells and promotes cancer development. Blocking this modification has anti-tumor effect. MLN4924,small molecule inhibitor of Neddylation modification,can lead to the induction of cell cycle arrest,apoptosis,senescence and the inhibition of tumor angiogenesis. The review focuses on the mechanism and inhibitor of Neddylation modification and MLN4924.