Table of Content

30 November 2020, Volume 35 Issue 11

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Current technical problem and specification of clinical body fluid analysis

HU Xiaobo

2020, 35(11):  1087-1089.  DOI: 10.3969/j.issn.1673-8640.2020.11.001

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The standard operating procedure of cerebrospinal fluid analysis,serous fluid analysis,synovial fluid analysis,fecal analysis,seminal fluid analysis and vaginal secretion fluid from physical,chemistry,immunology to cytology currently exists many problems. Because of the rapid development of analytical technologies,a part of body fluid qualitative analysis has been converted to quantitative analysis,and non-routine testing items have been converted into routine testing items. One of the key factors is the quality of specimen collection,transport and storage. This special topic mainly focuses on standardized operation and related technology application,hoping to help laboratories and physicians understand the requirements of body fluid analysis.

Clinical laboratories should pay attention to the standardized detection of semen

LU Jinchun

2020, 35(11):  1090-1093.  DOI: 10.3969/j.issn.1673-8640.2020.11.002

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The accuracy and reliability of semen analysis results affect the diagnosis and treatment of related diseases. Therefore,the clinical laboratories should pay attention to the standardized detection of semen. The standardization of semen analysis is reflected not only in the reasonable and scientific methodology,but also in the collection of semen samples,the name of detection items and specific operation details of each detection item. In the lack of specified institutions for the external quality assessment of semen analysis at present,it is necessary to establish the appropriate intra-laboratory quality control measures. With the continuous popularization of the automation of semen analysis and the optimization of instrument settings,the standardization of semen analysis will be easier to be implemented,and education,training and quality control will be important measures to ensure that all clinical laboratories carry out the standardized detection of semen samples and maintain the long-term stability of detection results.

Establishment of biological reference interval of semen parameters in Zhejiang sperm donors

WU Ying, SONG Yinli, SHEN Xiaofang

2020, 35(11):  1094-1098.  DOI: 10.3969/j.issn.1673-8640.2020.11.003

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Objective To investigate the reference interval of semen parameters from sperm donors in Zhejiang,and to provide a reference for fertility evaluation of clinical patients. Methods Semen samples from4 122 sperm donors at Zhejiang Human Sperm Bank were collected from Januray 2017 to August 2019. Routine semen analysis and semen morphology analysis were performed according to the World Health Organization（WHO） the 5th-edition guidelines,and the pH value,volume,sperm concentration,total sperm count,sperm progressive motility and the rate of sperm normal morphology were determined. The reference interval of semen parameters was obtained,which was compared with that of WHO the 5th-edition guidelines. Results The reference intervals of semen parameters were as follows,volume≥1.8 mL,total sperm count ≥51×10⁶/time,sperm concentration ≥16×10⁶/mL,PR≥20%,the rate of sperm normal morphology≥5% and the pH value≥8.0. Conclusions Compared with the reference interval of WHO the 5th-edition guidelines,Zhejiang sperm donors has low PR,and the reference intervals of the other semen parameters were different. The numerical distribution of semen parameters in Zhejiang is slightly different from that of WHO the 5th-edition guidelines,especially in the high percentile above P₅₀. With the increase of sperm donors,especially for males over 40 years old,sperm quality decreases significantly.

Evaluation on the cytological graphic report results of tuberculous effusion

WU Mao, WANG Zhenni, LIN Huijun, WU Nina

2020, 35(11):  1099-1102.  DOI: 10.3969/j.issn.1673-8640.2020.11.004

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Objective To analyze the relation of tuberculous effusion diagnosed by clinic and the results of graphic report,and to investigate the clinical role of graphic reports indicating tuberculous effusion. Methods With the changes of lymphocyte（LY）,macrophage（Ma）,neutrophil（NE） and mesothelial（Me） cell,224 cases of clinically confirmed tuberculous effusion and 82 cases with graphic reports which could not indicate tuberculous effusion were analyzed. Results The positive coincidence rate with clinical diagnosis increased from 39.4% in low value group（LY<60%） to 78.8% in high value group（LY≥80%）. There were the cases with graphic reports not indicating tuberculous effusion,accounting for 36.6%. The causes of missed diagnosis were mainly hemodilution or lack of LY,followed by the presence of nuclear heterogeneous cell interference and the increase of other types of cells. Conclusions The comparison of graphic report and clinical diagnosis can reveal the characteristics of cytological changes of tuberculous effusion,and provide a new idea for the clinical diagnosis of tuberculous effusion and the study of pathogenesis.

Roles of CA125,NLR,PLR and hs-CRP combined determination for community-acquired pneumonia with pleural effusion based on datum mining model

ZENG Ruihuang, WANG Xiaolin, ZENG Ye, CHEN Zhixi, YUAN Ning, QIN Changhong

2020, 35(11):  1103-1107.  DOI: 10.3969/j.issn.1673-8640.2020.11.005

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Objective To investigate the roles of carbohydrate antigen 125（CA125）,neutrophil/lymphocyte ratio（NLR）,platelet/lymphocyte ratio（PLR）and high-sensitivity C-reactive protein（hs-CRP） combined determination for community-acquired pneumonia with pleural effusion. Methods A total of 284 patients with community-acquired pneumonia were enrolled. There were 180 patients with pneumonia without pleural effusion and 104 patients with pneumonia with pleural effusion. The levels of CA125,NLR,PLR and hs-CRP in the 2 groups were determined. The multilayer perceptron（MLP） neural network model,Chi-square automatic interaction detection（CHAID） decision tree model and Logistic regression model were established,and the diagnostic efficiency of CA125,NLR,PLR and hs-CRP combined determination was analyzed by receiver operating characteristic（ROC） curve. Results There was statistical significance in CA125,NLR,PLR and hs-CRP between pneumonia groups without and with pleural effusion（P<0.01）. In pneumonia group with pleural effusion,there was statistical significance in CA125,NLR,PLR and hs-CRP in small,medium and large amounts of pleural effusion（P<0.01）,and CA125,NLR,PLR and hs-CRP were positively correlated with the volume of pleural effusion（P<0.01）. The accuracy of the MLP neural network model was 78.1%,and the area under curve（AUC） was 0.803,that of the CHAID decision tree model was 75.0%（AUC=0.775）,and that of the Logistic regression model was 74.3%（AUC=0.785）. Conclusions MLP neural network model combined with CA125,NLR,PLR,hs-CRP determinations for community-acquired pneumonia with pleural effusion has certain auxiliary diagnostic value.

Application of creatine kinase isoenzyme MM in screening neonatal Duchenne muscular dystrophy

WANG Yanmin, TIAN Guoli, JI Wei, ZHANG Xiaofen

2020, 35(11):  1115-1119.  DOI: 10.3969/j.issn.1673-8640.2020.11.008

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Objective To evaluate the feasibility of creatine kinase isoenzyme MM（CK-MM） in neonatal Duchenne muscular dystrophy（DMD） screening. Methods Totally,7 035 dried blood spots of male newborns were collected. CK-MM was determined by time-resolved fluorescence method,and the positive results was determined by DMD gene determination further. The performance（accuracy,precision,linear range and so on） of CK-MM determined by time-resolved fluorescence method was verified. The efficiency of CK-MM in screening DMD was evaluated by receiver operating characteristic（ROC） curve. Results The within-run coefficient of variation（CV）,the between-run CV and average bias of CK-MM determined by time-resolved fluorescence method were <10%. The linear regression equation was Y= 1.045 8X+1.929 6（r=0.999 9,P<0.01）. The concentration of CK-MM in children with DMD was higher than that in healthy control group（P<0.000 1）,which was 67 times higher than that of healthy control group. Among the 7 035 male newborns,6（0.085%） cases were positive after screening,and 2 cases were confirmed. DMD gene determination results showed that all of them were hemizygous mutation,and their genotypes were c.1990C>T（p.Gln664*）and c.7657C>T（p.Arg2553*）. ROC curve analysis showed that the area under curve（AUC） of CK-MM for the diagnosis of DMD was 1.0,the optimal cut-off value was 762 ng/mL,the sensitivity was 100%,and the specificity was 99.94%. Conclusions Using dried blood spots to determine CK-MM can effectively screen the children with DMD,and this method is simple and worthy of clinical application.

Clinical roles of serum AFM and adropin in patients with DN

TIAN Xi, LI Baoxin, LI Na, GUO Shuqin, ZHANG Mali, LI Jie, WANG He, ZHANG Yunliang

2020, 35(11):  1120-1125.  DOI: 10.3969/j.issn.1673-8640.2020.11.009

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Objective To investigate the roles of serum afamin（AFM） and adropin（AD） in patients with diabetic nephropathy（DN）. Methods According to the urinary albumin to creatinine ratio（UACR）,180 patients with type 2 diabetes mellitus（T2DM） were classified into 3 groups,normal UACR group（UACR<30 mg/g）,low UACR group（UACR 30-<300 mg/g） and high UACR group（UACR≥300 mg/g）. Totally,52 healthy subjects were enrolled as healthy control group. General information was collected. The levels of AFM,AD,fasting blood glucose（FBG）,triglyceride（TG）,total cholesterol（TC）,serum creatinine（SCr）,aspartate aminotransferase（AST）,blood urea nitrogen（BUN）,total protein（TP）,albumin（Alb）,glycated hemoglobin A_1c（HbA_1c）,fasting insulin（FINS）and urinary microalbumin（mAlb）,24 h urine protein were determined. The homeostasis model assessment for insulin resistance（HOMA-IR）,estimated glomerular filtration rate（eGFR）,urinary albumin excretion（UAE） and UACR were calculated. Spearman correlation analysis and multiple linear regression analysis were used to assess the correlation between AFM and AD levels with various influencing factors. Receiver operating characteristic（ROC） curve was used to evaluate the diagnostic roles of AFM and AD for the diagnosis of DN. Results The AFM levels increased and the AD levels decreased in healthy control group,normal UACR group,low UACR group and high UACR group（P<0.05）. Spearman correlation analysis showed that AFM levels were positively correlated with systolic blood pressure,BUN,SCr,FBG,HbA_1c,FINS,HOMA-IR,mAlb,UAE,UACR and 24 h urine protein（P<0.05）,and were negatively correlated with TP,Alb and AD（P<0.05）. The AD levels were positively correlated with TP and Alb（P<0.05）,and were negatively correlated with systolic blood pressure,BUN,SCr,FBG,HbA_1c,FINS,HOMA-IR,mAlb,UAE,UACR,24 h urine protein and AFM（P<0.05）. Multiple linear regression analysis showed that the influencing factors of serum AFM levels were AD,HbA_1c,UACR and 24 h urine protein（β =-0.90,0.11,0.16 and 0.11,P<0.05）. The AFM,UACR and HbA_1c were influencing factors of serum AD levels（β =-0.53,-0.45 and -0.11,P<0.05）. ROC curve analysis showed that the area under curve（AUC） of AFM and AD for the diagnosis of DN were 0.80 and 0.96,and the optimal cut-off values were 87.57 mg/L and 171.86 pg/mL,with the sensitivities of 78.30% and 97.50% and the specificities of 71.50% and 92.00%,respectively. Conclusions Serum AFM and AD have certain clinical values for DN,which can be used for the auxiliary diagnosis of DN.

Correlation between glycolipid metabolism and lipopolysaccharide in patients with Alzheimer's disease

LI Dan, LIN Ping, JIN Weifeng, CHEN Shuzi, LI Ping, CHENG Xunjia

2020, 35(11):  1126-1129.  DOI: 10.3969/j.issn.1673-8640.2020.11.010

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Objective To analyze the correlation between glycolipid metabolism and lipopolysaccharide（LPS） in patients with Alzheimer's disease（AD）. Methods Blood lipids [total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C） and apolipoprotein E（apo E）],fasting blood glucose（FPG）,fasting insulin（FINS） and gut barrier function indicators（D-lactic acid and LPS） were determined in 38 patients with severe dementia（dementia group）,37 patients with mild cognitive impairment（MCI）（MCI group） and 40 geriatric healthy subjects（healthy control group）. Homeostasis model assessment fo insulin resistance（HOMA-IR） was calculated. Results The FPG,FINS,HOMA-IR and TC levels of dementia group and MCI group were higher than those of healthy control group（P<0.01）,and serum HDL-C level was lower（P<0.01）. Serum TG level in MCI group was higher than that in healthy control group（P<0.05）. The difference of FPG,FINS and HOMA-IR between dementia group and MCI group had statistical significance（P<0.01）. Serum levels of D-lactic acid and LPS in dementia group were higher than those in healthy control group（P<0.000 1）. Pearson correlation analysis showed a positive correlation between LPS and TC in dementia group（r=0.68,P<0.05）. Logistic regression analysis showed that increased TC and FPG were MCI and dementia's risk factors,and increased HDL-C was a protective factor（P<0.05）. Increased LPS was a risk factor for dementia（P<0.05）. Conclusions Abnormal glycolipid metabolism in AD patients may be associated with impaired gut barrier.

Analysis of routine biochemical indicators in 1 743 patients with corona virus disease 2019 in Wuhan

ZHENG Sihan, LIU Mingcong, LUAN Liang, LIU Jing, TIAN Xiao, LIU Yameng, WAN Nan

2020, 35(11):  1130-1135.  DOI: 10.3969/j.issn.1673-8640.2020.11.011

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Objective To investigate the roles of routine biochemical indicators for evaluating the severity of corona virus disease 2019（COVID-19）. Methods A total of 1 743 patients with COVID-19 were enrolled and classified into non-severe group（1 684 cases） and severe group（59 cases） according to the severity of COVID-19. Routine biochemical indicators,including high-sensitivity cardiac troponin T（hs-cTnT）,cardiac troponin I（cTnI）,creatine kinase（CK）,creatine kinase-MB isoenzyme（CK-MB）,myoglobin（MYO）,lactate dehydrogenase（LDH）,albumin（Alb）,albumin to globulin ratio（A/G）,aspartate aminotransferase（AST）,alanine aminotransferase（ALT）,direct bilirubin（DBil）,indirect bilirubin（IBil）,total bilirubin（TB）,creatinine（Cr）,urea（Urea）,uric acid（UA）,K⁺ and Na⁺,of all the patients were determined. Receiver operating characteristic（ROC） curve was used to evaluate the roles of routine biochemical indicators for evaluating the severity of COVID-19. Results The levels of hs-cTnT,cTnI,CK-MB,MYO,LDH,AST,DBil,IBil,TB and Urea in severe group were higher than those in non-severe group（P<0.05）. The levels of Alb,A/G,UA and Na⁺ in severe group were lower than those in non-severe group（P<0.05）. There was no statistical significance in CK,ALT,Cr and K⁺ levels between the 2 groups（P>0.05）. The positive rates of hs-cTnT,cTnI,CK,CK-MB,MYO,LDH,Alb,A/G,AST,DBil,IBil,TB,Cr,Urea,K⁺ and Na⁺ in severe group were higher than those in non-severe group（P<0.05）. There was no statistical significance in the positive rates of ALT and UA between the 2 groups（P>0.05）. ROC curve analysis showed that among the 18 biochemical indicators,the top 3 area under curve（AUC） indicators for the diagnosis of COVID-19 were hs-cTnT（0.881）,LDH（0.880） and Alb（0.867）,the sensitivities were 90.5%,76.3% and 84.7%,and the specificities were 71.9%,91.8% and 81.6%,respectively. Logistic regression analysis showed that the higher the hs-cTNT and the lower the Alb were,the higher the risk of severe disease was. Conclusions Biochemical indicators,hs-cTnT,LDH and Alb,have good diagnostic performance for evaluating severe and non-severe COVID-19,which can be used as potential biomarkers for evaluating the severity of COVID-19.

Roles of SARS-CoV-2 N protein and S protein antibody determinations in the diagnosis of COVID-19

TIAN Yaling, LU Junyan

2020, 35(11):  1136-1139.  DOI: 10.3969/j.issn.1673-8640.2020.11.012

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Objective To compare the roles of serum severe acute respiratory syndrome coronavirus 2（SARS-CoV-2） nucleocapsid（N） protein antibody and spike（S） protein antibody determinations in the diagnosis of corona virus disease 2019（COVID-19）. Methods Enzyme-linked immunosorbent assay（ELISA） was used to determine SARS-CoV-2 N protein immunoglobulin（Ig） M and IgG antibodies and SARS-CoV-2 receptor binding domain（RBD） IgM and IgG antibodies in sera of 39 COVID-19 patients（COVID-19 group）,40 suspected COVID-19 patients（disease control group） and 225 healthy subjects（healthy control group）. Receiver operating characteristic（ROC） curve was used to evaluate the roles of various indicators in diagnosing COVID-19. Results The S/CO values of SARS-CoV-2 N protein IgM antibody and IgG antibody and SARS-CoV-2 RBD IgM antibody and IgG antibody in COVID-19 group were higher than those in disease control group（P<0.05） and healthy control group（P<0.05）. ROC curve analysis results showed that the areas under curves（AUC） of SARS-CoV-2 N protein IgM antibody,IgG antibody,IgM+IgG antibodies and SARS-CoV-2 RBD IgM antibody,IgG antibody,IgM+IgG antibodies for the diagnosis of COVID-19 were 0.949,0.991,0.992,0.994,0.999 and 0.999,respectively. Conclusions SARS-CoV-2 RBD antibodies have better diagnostic performance for the diagnosis of COVID-19 than that of SARS-CoV-2 N protein antibodies.

Role of SARS-CoV-2 viral load in predicting the severity of COVID-19

HAO Yexia, YAN Xinsheng, YANG Huihui, HU Yuanping, LIAO Xin, LIU Zejin

2020, 35(11):  1140-1142.  DOI: 10.3969/j.issn.1673-8640.2020.11.013

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Objective To investigate the role of severe acute respiratory syndrome coronavirus 2（SARS-CoV-2） viral load in predicting the severity of corona virus disease 2019（COVID-19）. Methods Nasopharyngeal swabs of 264 COVID-19 patients admitted to Wuhan Asia General Hospital from January 29,2020 to February 22,2020 were collected to detect SARS-CoV-2 nucleic acid by real-time fluorescent quantitative polymerase chain reaction（PCR）. There were 243 cases of mild group and 21 cases of severe group. The Ct value change trend and the time of nucleic acid negative transition were recorded in the mild and severe groups. Their general data were anlyzed. Results Among the 264 COVID-19 patients,142 cases were males,and 122 cases were females. The age was 55.7±16.11. The viral load of severe patients（Ct value 25.80±4.46） was higher than that of mild patients（Ct value 30.25±4.26）（P<0.001）,and the severe patients [（26.7±5.6）d] had longer nucleic acid negative transition time than that of mild patients [（16.3±4.7）d]（P<0.001）. Conclusions The viral load of SARS-CoV-2 and the time of nucleic acid existence are correlated with the severity of COVID-19,which can predict the severity of COVID-19.

Expression of TLR-4 and HMGB1 in peripheral blood of children with SLE and its clinical significance

LÜ Yingxia, YANG Junmei, ZHENG Lijuan, HUANG Qinghua

2020, 35(11):  1143-1146.  DOI: 10.3969/j.issn.1673-8640.2020.11.014

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Objective To investigate the roles of Toll-like receptor 4（TLR-4） and high mobility group protein B1（HMGB1） in peripheral blood of children with systemic lupus erythematosus（SLE）. Methods Totally,40 children with SLE（SLE group） and 15 healthy children（control group） were enrolled. SLE group was classified into active group（20 cases） with systemic lupus erythematosus disease activity index（SLEDAI） score ≥10 and stable group（20 cases） with SLEDAI score <10,and according to presence or absence of nephritis,they were classified into nephritis group（24 cases） and non-nephritis group（16 cases）. Serum interleukin（IL）-17,IL-23,HMGB1 and TLR-4 were determined. Pearson correlation analysis was used to analyze the correlations. Results Serum levels of IL-17,IL-23,HMGB1 and TLR-4 in SLE group were higher than those in control group（P<0.05）. Serum levels of IL-17,IL-23,HMGB1 and TLR-4 in active group were higher than those in stable group（P<0.05）. Serum levels of IL-17,IL-23,HMGB1 and TLR-4 in nephritis group were higher than those in non-nephritis group（P<0.05）. HMGB1 was positively correlated with TLR-4,IL-17 and IL-23（r=0.424,0.563,0.498 and 0.745,P<0.05）. IL-17 was positively correlated with SLEDAI score（r =0.726,P<0.05）. IL-23 was positively correlated with SLEDAI score,IgM,IgG and C-reactive protein（CRP）（r=0.615,0.321,0.465 and 0.587,P<0.05）. There was a negative correlation between C3 and C4（r =-0.461 and -0.399,P<0.05）. HMGB1 was positively correlated with anti-double-stranded DNA（dsDNA） antibody,anti-Sm antibody,IgM and IgG（r=0.727,0.659,0.487 and 0.550,P<0.05）. There was a negative correlation with C3（r=-0.367,P<0.05）. TLR-4 was positively correlated with SLEDAI score,anti-dsDNA antibody,CRP and IgM（r=0.762,0.721,0.614 and 0.636,P<0.05）. There was a negative correlation between C3 and C4（r=-0.520 and -0.434,P<0.05）. Conclusions TLR-4 and HMGB1 are related to the occurrence and development of SLE in children,and they also play roles in renal injury in children with SLE.

Role of sialylated haptoglobin for the auxiliary diagnosis of hepatitis B-related hepatocellular carcinoma

BIE Lihan, FANG Meng, FENG Huijuan, LU Zhicheng, GAO Chunfang

2020, 35(11):  1147-1152.  DOI: 10.3969/j.issn.1673-8640.2020.11.015

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Objective To investigate the role of sialylated haptoglobin（Sia-Hp） in the auxiliary diagnosis of hepatitis B-related hepatocellular carcinoma（HCC）. Methods A total of 236 patients with hepatitis B-related cirrhosis were enrolled,and there were 121 patients with liver cirrhosis and HCC（HCC group） and 115 patients with liver cirrhosis without HCC（liver cirrhosis group）. Totally,107 healthy subjects were enrolled as healthy control group. Lectin enzyme-linked immunosorbent assay（Lectin-ELISA） for determining serum Sia-Hp levels was established. Spearman rank correlation analysis was used to evaluate the correlation between various indicators. Receiver operating characteristic（ROC） curve was used to evaluate the efficiency of Sia-Hp and alpha-fetoprotein（AFP） in diagnosing liver cirrhosis with HCC. Results Serum Sia-Hp levels in HCC,healthy control and liver cirrhosis groups were 1.76（1.32-2.22）,1.60（1.17-1.70） and 0.85（0.11-1.56） AU/mL,respectively,which decreased successively among the 3 groups（P<0.001）. Spearman rank correlation analysis showed that there was no correlation between Sia-Hp and AFP in HCC and liver cirrhosis groups（r=0.09,P>0.05）. In HCC group,serum Sia-Hp levels were related to TNM staging（P<0.05）,but were not related to the presence or absence of MVI and tumor size（P>0.05）. There was no statistical significance in serum Sia-Hp levels between patients with different Child-pugh grades in liver cirrhosis group（P>0.05）. ROC curve analysis results showed that the areas under curves（AUC）of Sia-Hp,AFP and the combined determination model DIAHCC for diagnosing liver cirrhosis with HCC were 0.83,0.78 and 0.92,respectively,and the AUC of patients with liver cirrhosis and HCC by Sia-Hp and the combined determination model DIAHCC for diagnosing AFP negative（AFP<20 μg/L） were 0.84 and 0.88,respectively. Conclusions Serum Sia-Hp may be used as one of the auxiliary diagnostic indicators of liver cirrhosis with HCC.

Roles of MCV,RDW and SAA in the progression of chronic hepatitis B

GUO Ping, ZHUANG Lihua, CHEN Liting, WANG Jianbiao, WU Jianfeng

2020, 35(11):  1153-1157.  DOI: 10.3969/j.issn.1673-8640.2020.11.016

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Objective To investigate the roles of mean corpuscular volume（MCV）,red blood cell distribution width（RDW）and serum amyloid A（SAA） in the progression of chronic hepatitis B. Methods Totally,198 patients with different liver diseases and 39 healthy subjects were enrolled. The patients included 50 cases of chronic hepatitis B,56 cases of liver cirrhosis and 92 cases of hepatocellular carcinoma. Receiver operating characteristic（ROC） curve were used to evaluate the diagnostic values of MCV,RDW and SAA in liver cirrhosis and hepatocellular carcinoma. The correlations between SAA and clinicopathological characteristics were analyzed. Results MCV,RDW and SAA in different liver disease groups were higher than those in healthy control group（P<0.05）,MCV and RDW in liver cirrhosis group were higher than those in chronic hepatitis B group（P<0.05）,SAA in hepatocellular carcinoma group was higher than that in chronic hepatitis B（P<0.05）,MCV and RDW in liver cirrhosis group were higher than those in hepatocellular carcinoma group（P<0.05）,and SAA was lower（P<0.05）. The sensitivities of MCV,RDW,SAA and the combined determination for the diagnosis of liver cirrhosis were 60.71%,87.50%,78.57% and 92.86%,respectively,and the specificities were 80.68%,69.32%,71.59% and 72.73%,respectively. The sensitivities and specificities of MCV,RDW and SAA in the diagnosis of hepatocellular carcinoma were 40.22%,67.36%;58.70%,58.33%;53.26%,92.36%,respectively. There was no correlation between SAA and patients' sex,tumor number and vascular invasion in hepatocellular carcinoma group（P>0.05）,while there were correlations between SAA and tumor size and extrahepatic metastasis（P<0.05）. Conclusions MCV,RDW and SAA are sensitive indicators of hepatitis B-related liver cirrhosis. SAA is highly specific for the diagnosis of hepatocellular carcinoma and is closely related to tumor size and extrahepatic metastasis. The determinations of MCV,RDW and SAA are fast and convenient,which have practical application value in the follow-up and monitoring progress of patients with chronic hepatitis B.

Role of berberine on anti-platelet aggregation in children with Kawasaki disease in vitro

LIU Yunfeng, ZHENG Hao, CHE Di, PI Lei, FU Lanyan, GU Xiaoqiong

2020, 35(11):  1158-1160.  DOI: 10.3969/j.issn.1673-8640.2020.11.017

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Objective To investigate the feasibility of berberine（BB） in the treatment of Kawasaki disease（KD） in children,and to provide a reference for KD treatment. Methods A total of 71 ethylene diamine tetraacetic acid anticoagulant blood samples were collected from healthy children and children with KD,respectively. Platelet（PLT） rich plasma（PRP） was separated,which was washed with 0.9% NaCl and added with 5 mg/mL BB. Adenosine diphosphate was used to induce aggregation in vitro. The aggregation rate was determined. Results After BB was added,the PLT aggregation rate decreased with statistical significance（P<0.05）. Conclusions BB has a good ability of anti-PLT aggregation in vitro. It can be considered to further investigate the application of BB in anti-thrombosis treatment of KD patients.

Distribution and drug resistance of food-borne Salmonella in Hanzhong

TANG Jin, MA Guozhu, HUANG Xiaoxia, CHEN Yali, KONG Huajuan, BAI Ying, LI Jingyuan, ZHENG Chunmei

2020, 35(11):  1161-1164.  DOI: 10.3969/j.issn.1673-8640.2020.11.018

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Objective To study the distribution,drug resistance and homology of food-borne Salmonella in Hanzhong. Methods From January 2018 to December 2018,the isolates of Salmonella were isolated from feces of patients with diarrhea caused by food-borne diseases diagnosed in 3 sentinel hospitals of Hanzhong. The sex,age,serotype and drug resistance of Salmonella were analyzed. Pulsed field gel electrophoresis（PFGE） was used for homology analysis. Results Babies,infants and children accounted for 77.3% of the total population,elders >65years old accounted for 18.9% of the total population,and adults <65 years old accounted for 3.8%. A total of53 isolates were isolated,including 7 serotypes. Salmonella typhimurium（26 isolates）,Salmonella enteritidis（13 isolates） and Salmonella stanley（6 isolates） were the top 3 Salmonella serotypes. The drug resistance rates of Salmonella to carbapenems and fluoroquinolones were <10%. The drug resistance rates of Salmonella to aminoglycosides and cephalosporins were 10%-30%. The drug resistance rates of Salmonella to piperacillin,tetracycline and ampicillin were 97.74%,65.81% and 55.03%,respectively. However,the drug resistance rate of Salmonella enteritidis to tetracycline was only 7.70%. PFGE was used to classify and cluster Salmonella enteritidis and Salmonella typhimurium. There were 3 groups of Salmonella typhimurium with 100% similarity in PFGE fingerprint pattern,and 2 isolates in each group. There were 3 groups of Salmonella enteritidis,of which the most had 7 isolates,and the rest had 2 isolates. Conclusions Food-borne Salmonella infection is common in infants and children in Hanzhong,especially for Salmonella typhimurium. Food-borne Salmonella has a high drug resistance rate to piperacillin,tetracycline and ampicillin. Salmonella enteritidis infection has certain homology.

Clinical application of rapid pathogen detection technologies for detecting influenza A virus

FU Xiaorui, KANG Beipei, XU Xiuli, ZHAO Feng, ZHANG Pengliang, ZHOU Lei

2020, 35(11):  1165-1168.  DOI: 10.3969/j.issn.1673-8640.2020.11.019

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Objective To investigate the clinical application roles of influenza A virus（FluA） antigen,FluA nucleic acid and Filmarray rapid pathogen detection technologies for detecting FluA. Methods The patients with suspected FluA infection in Xijing Hospital from October 2016 to January 2019 were enrolled for the detections of FluA nucleic acid and antigen. The results were analyzed comparatively. Filmarray rapid pathogen detection was used as well. Results The positive rate of FluA antigen detection was 9.56%,and the positive rate of FluA nucleic acid detection was 27.29%. The period from December to February was the outbreak season,and the positive rate of FluA antigen detection in this period was 10.95%,and the positive rate of FluA nucleic acid detection in this period was 27.71%. Infants <5 years old,adolescents around 20 years old and elders >90 years old were susceptible subjects. There was no statistical significance in FluA nucleic acid detection between males and females（P<0.05）. Using Filmarray rapid pathogen detection technology,170 positive specimens were detected,and 207 positive results were obtained,some of which included multiple infection resulted from different respiratory pathogens. Conclusions FluA antigen and nucleic acid detections could clarify the infection. Filmarray rapid pathogen detection technology could serve the diagnosis of infectious diseases and is of significance for the diagnosis and treatment of clinical respiratory tract infection.

Clinical role of SAT in the diagnosis of tubercular meningitis

OU Weizheng, QIN Wan, WANG Qiong, WANG Mingdong, ZHANG Juan, XU Yong, ZHANG Tingmei

2020, 35(11):  1169-1172.  DOI: 10.3969/j.issn.1673-8640.2020.11.020

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Objective To investigate the clinical role of simultaneous amplification and testing（SAT） in the diagnosis of tubercular meningitis（TBM）. Methods A total of 496 suspected patients diagnosed central nervous system infection were enrolled. Among them,328 patients who were clinically diagnosed as TBM were enrolled as TBM group,while the remaining 168 patients who were clinically excluded were enrolled as control group. The cerebrospinal fluid specimens were collected and analyzed by L-J culture method,nucleic acid polymerase chain reaction（PCR） and SAT. The efficiencies of the 3 methods in detecting Mycobacterium tuberculosis（MTB） were compared. Results Taking the clinical diagnosis of TBM as gold standards,the sensitivity and specificity of SAT in detecting MTB were 15.24% and 99.40%,respectively,the sensitivity of SAT was higher than those of L-J culture method（11.28%）（χ²=2.24,P>0.05） and PCR（6.71%）（χ²=12.23,P<0.05）. The specificity of SAT was lower than those of L-J culture method and PCR（100%）（χ²=1.00,P>0.05）. Taking L-J culture method as gold standards,in TBM group,the sensitivity,specificity and consistency rate of SAT were 37.84%,87.63% and 82.01%,respectively. The sensitivity of SAT was higher than that of PCR（21.62%）,while the specificity and consistency rate were lower than those of PCR（95.19% and 86.89%）. The MTB positive detection rate of L-J culture method had no statistical significance with that of SAT（χ²=2.24,P>0.05）,but had statistical significance with that of PCR（χ²=4.19,P<0.05）. Conclusions SAT can rapidly detect MTB in cerebrospinal fluid,its sensitivity is higher than those of L-J culture method and PCR and it can provide a reference for the early diagnosis of TBM. The combined detection of the 3 methods can improve the positive detection rate of MTB in cerebrospinal fluid specimens.

Homemade Sephadex-G50 microcolumn gel card for Brucella serum agglutination test

LI Yan, GENG Huijuan, QIU Siyuan, WANG Xianghua, WANG Hao

2020, 35(11):  1173-1176.  DOI: 10.3969/j.issn.1673-8640.2020.11.021

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Objective To investigate homemade microcolumn gel card for Brucella serum agglutination test. Methods For 160 suspected patients with Brucella infection,3 different specifications of Sephadex-G50 microcolumn gel particles were used as fillers to make homemade microcolumn gel cards for Brucella serum agglutination test. Serum tube agglutination test was used as the gold standard for application role comparison. Results The microcolumn gel card prepared with G50-Fine gel dry powder was compared with serum tube agglutination test. The authenticity,reliability and correlation of serum agglutination titer were satisfactory. Conclusions The microcolumn gel card prepared by G50-Fine gel dry powder is suitable for Brucella serum agglutination test. The method is easy to measure,accurate and reliable,and has a short detection time. It has good clinical application value.

Establishment of Lectin-ELISA for the detection of multi-antennary AAG and its preliminary application

GUAN Wenqian, GAO Zhiyuan, FENG Huijuan, HONG Song, HE Yutong, HE Lu, GAO Chunfang

2020, 35(11):  1177-1185.  DOI: 10.3969/j.issn.1673-8640.2020.11.022

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Objective To establish a lectin enzyme-linked immunosorbent assay（Lectin-ELISA） for the detection of multi-antennary alpha 1-acid glycoprotein（AAG）,and to investigate the clinical application role of multi-antennary AAG in hepatocellular carcinoma（HCC）. Methods A Lectin-ELISA for detecting datura stramonium agglutinin（DSA）-AAG was established based on the principle that DSA can specifically identify the AAG of multi-antennary structure. This method was used to detect serum DSA-AAG levels of 220 HCC patients（HCC group）,237 disease controls [disease control group,74 cases of intrahepatic cholangiocarcinoma（ICC）（ICC group）,120 cases of liver cirrhosis（LC）（LC group）,43 cases of chronic hepatitis B（CHB）（CHB group）] and 80 healthy subjects（healthy control group）. Meanwhile,the pathological data and laboratory determination results of HCC patients were collected. Pearson correlation analysis was performed. Logistic regression method was used to establish the multi-index joint determination model. Receiver operating characteristic（ROC） curves were used to evaluate the efficiency of single and combined determinations in the diagnosis of HCC. Results The linear regression coefficient（r²） of serum DSA-AAG determined by Lectin-ELISA was 0.976,and the maximum between-run coefficient of variation（CV） was 10.51%. Free bilirubin,binding bilirubin,hemolysis and chylous had no effect on serum DSA-AAG determined by Lectin-ELISA. Serum DSA-AAG level of HCC group was higher than those of disease control group and healthy control group（P<0.001）,and serum AAG levels of HCC group and disease control group were higher than that of healthy control group（P<0.001）. Serum levels of DSA-AAG and AAG in cancer group（HCC+ICC） were higher than those in non-cancer group（LC+CHB+healthy control）（P<0.001）. Serum DSA-AAG level of HCC group was higher than that of ICC group（P<0.001）,while serum AAG level was lower than that of ICC group（P<0.001）. There was a negative correlation between DSA-AAG and alpha-fetoprotein （AFP） in HCC group（r=-0.029,P<0.05）. There was no statistical significance in serum DSA-AAG level among HCC patients with different tumor sizes and stages（P>0.05）. The areas under curves（AUC） of DSA-AAG,AAG and AFP single and combined determination models Logit_AAG1 for differentiating HCC from non-HCC were 0.651,0.632,0.803 and 0.836,respectively. The AUC of DSA-AAG and AAG single and combined determination model Logit_AAG2 for the differential diagnosis of AFP negative HCC and non-HCC were 0.669,0.607 and 0.929,respectively. Conclusions DSA-AAG and combined determination model may play roles in the differential diagnosis of HCC and AFP negative HCC.

Performance evaluation of portable glucometers in a hospital of Beijing

SONG Jingchen, ZENG Jie, CHEN Tong, ZHANG Chuanbao, PAN Qi, LI Chuanbao, WU Quanying, TANG Dandan, WANG Qin

2020, 35(11):  1186-1189.  DOI: 10.3969/j.issn.1673-8640.2020.11.023

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Objective To investigate the performance evaluation methods of portable glucometers,and to provide a reference for the quantitative quality control of portable glucometers in medical institutions. Methods Under the guidance of the hospital point-of-care testing（POCT）management committee,the performance of portable glucometers was evaluated according to the system and guidance documents. Results All the portable glucometers were qualified except 1 portable glucometer. Conclusions The performance evaluation of portable glucometers is practical and feasible,which lays a foundation for further improvement of its quantitative and accurate management.

Preliminary study on the application of glucose reference method to determine the target value for EQA samples

JIN Zhonggan, JU Yi, ZHANG Sujie, LI Qing, OU Yuanzhu, YU Xiaoxuan, SUN Hewei, FAN Xiaoyu, YU Keying

2020, 35(11):  1190-1193.  DOI: 10.3969/j.issn.1673-8640.2020.11.024

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Objective To investigate the feasibility of using glucose（Glu） reference method to determine the target value for external quality assessment（EQA） samples. Methods The value of Glu was assigned to the samples of EQA in Shanghai using isotope dilution gas chromatography tandem mass spectrometry（ID-GC/MS） which was recommended by the Joint Committee for Traceability in Laboratory Medicine（JCTLM）. The data was used as the target value for statistical analysis of the feedback results of participating laboratories in the 2nd EQA of 2018. Results The data of the 2nd EQA was from 509 laboratories in 2018. When the target value was average from all laboratories,setting 7% as allowable total error,the failure rates of EQA samples were 2.16%,2.95%,3.34%,3.14% and 1.77%,respectively. However,the failure rates were 2.75%,3.14%,2.75%,7.86% and 2.16%,respectively,using the value assigned by reference method as target value. Conclusions The quality assessment institutions should pay attention to the quality of EQA samples,and clinical laboratories should pay attention to the reliability of Glu measurement at low concentration.

Research progress on the spread and diffusion of SARS-CoV-2 aerosol

ZHAN Yongyou, LIN Yang, YANG Kangtu, LI Chunhong

2020, 35(11):  1194-1196.  DOI: 10.3969/j.issn.1673-8640.2020.11.025

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At the beginning of the outbreak of severe acute respiratory syndrome coronavirus 2（SARS-CoV-2） infection,the lack of understanding of susceptible population,mode of transmission and intensity of transmission is the main factor leading to the infection of many medical staff. In addition to direct contact and droplet transmission,there is also a risk of aerosol transmission,that is,in a limited space,the virus flows through the air,enters lungs from the respiratory tract,and then infects each other. This review focuses on the research progress on the basic characteristics and spread mechanism of virus aerosol,and expounds the importance of the spread and prevention of SARS-CoV-2 aerosol in confined space,such as clinical laboratories and inpatients areas.