Table of Content

30 March 2024, Volume 39 Issue 3

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Expression of lncRNA SOX21-AS1 and miR-875-5p in glioma tissues and relationship with prognosis of patients

FANG Dandong, CHENG Gang, HUANG Wei, LIU Xiaonan, MAO Jian, HOU Baosen, LIU Shimin

2024, 39(3):  209-214.  DOI: 10.3969/j.issn.1673-8640.2024.03.001

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Objective To investigate the expression levels of long non-coding RNA（lncRNA）SRY-box transcription factor 21 antisense RNA 1（SOX21-AS1）and miR-875-5p in glioma tissues and the relationship with the prognosis of patients. Methods Totally，77 patients with glioma in Sanmenxia Central Hospital from July 2014 to August 2018 were enrolled as glioma group，and 50 patients with brain injury were enrolled as control group. The glioma tissues and normal brain tissues that surgically removed in the 2 groups were taken，and the expression levels of lncRNA SOX21-AS1 and miR-875-5p were determined. Pearson correlation analysis was used to analyze the correlation between the expression levels of lncRNA SOX21-AS1 and miR-875-5p in glioma tissues. Kaplan-Meier curve was used to analyze the prognosis of patients with glioma. Cox regression analysis was used to analyze the factors for the prognosis of patients with glioma. Results The expression level of lncRNA SOX21-AS1 in glioma group was higher than that in control group（P<0.001），and the expression level of miR-875-5p was lower（P<0.001）. The expression levels of lncRNA SOX21-AS1 and miR-875-5p in glioma tissue had statistical significance with different World Health Organization（WHO）classifications（P<0.05）. The expression level of lncRNA SOX21-AS1 in glioma tissue was negatively correlated with miR-875-5p（r=-0.554，P<0.001）. The cumulative survival rate of patients with glioma in lncRNA SOX21-AS1 low expression group and miR-875-5p high expression group was higher than that in lncRNA SOX21-AS1 high expression group and miR-875-5p low expression group（P<0.05）. WHO classification and lncRNA SOX21-AS1 were independent risk factors that affected the poor prognosis of patients with glioma [hazard ratios（HR）were 2.266 and 2.390，95% confidence intervals（CI）were 1.452-3.536 and 1.496-3.818，P<0.001]. Conclusions The expressions of lncRNA SOX21-AS1 and miR-875-5p are related to the prognosis of patients with glioma，and both can be used as effective indicators to assess the prognosis of patients with glioma.

Predictive value of glucose variability parameters before delivery for macrosomia in patients with gestational diabetes mellitus

LIU Mengzhu, GU Jinyun, ZHU Xia, CHEN Xia

2024, 39(3):  215-221.  DOI: 10.3969/j.issn.1673-8640.2024.03.002

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Objective To investigate the correlation between blood glucose variability parameters before delivery and birth weight of newborns in gestational diabetes mellitus（GDM）patients. Methods A total of 100 GDM patients from Lianyungang Dongfang Hospital from March 2019 to February 2021 were enrolled，and 261 pregnant women with normal indicators were enrolled as controls. According to whether the newborns were macrosomia（weight≥4 000 g），they were classified into GDM macrosomia group，GDM healthy newborn group，macrosomia control group and healthy control group. The general data and laboratory determination results [blood lipid，blood glucose，glycated hemoglobin A_1c（HbA_1c）and so on] were collected，and blood glucose variability parameters [mean amplitude of glycemic excursions（MAGE），mean of daily differences（MODD），postprandial glucose excursion（PPGE）] were determined. Logistic regression analysis was used to evaluate the risk factors of macrosomia in GDM patients. The prediction model of nomogram was constructed and evaluated. Pearson correlation analysis was used to evaluate the correlation between neonatal weight and maternal blood glucose variability. The threshold effects of MAGE，MODD and PPGE were determined by curve fitting and threshold effect analysis. Results The blood glucose level at 30 min after birth in GDM macrosomia group was lower than that in macrosomia control group（P<0.05）. Fasting blood glucose（FBG），2 h postprandial blood glucose （2 h PG），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），HbA_1c，MAGE，PPGE，MODD and apolipoprotein B（apo B）in GDM macrosomia group were higher than those in the other 3 groups（P<0.05）. High-density lipoprotein cholesterol（HDL-C）and apolipoprotein A（apo A）were lower than those in the other 3 groups（P<0.05）. MAGE，PPGE，MODD and HbA_1c were all risk factors for macrosomia of GDM patients [odds ratios（OR）were 1.116，1.169，1.072 and 1.061，95% confidence intervals（CI）were 1.021-1.246，1.051 -1.301，1.012-1.134，1.004-1.121，respectively，P<0.05]. Neonatal weight was positively correlated with MAGE，PPGE，MODD and HbA_1c（r=0.77，0.68，0.72 and 0.75，P<0.05）. The results of curve fitting and threshold effect analysis show that when MAGE，PPGE and MODD were higher than 2.75，2.06 and 3.27 mmol·L^-1， respectively，the incidence of macrosomia in GDM patients showed an increasing trend with the increase of the 3 indicators. The area under receiver operating characteristic（ROC）curve （AUC）and consistency index（C-index）of the nomogram prediction model were 0.887 and 0.887，respectively，and the calibration curve fitted the ideal curve well. Conclusions Blood glucose variability parameters can be used as predictors of macrosomia in GDM patients，which have high clinical application value.

Roles on early diagnosis and prognosis of different infection indicators for bloodstream infection

SUN Kangde, YU Zhongmin, YAN Yuzhong

2024, 39(3):  222-226.  DOI: 10.3969/j.issn.1673-8640.2024.03.003

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Objective To investigate the roles on early diagnosis and prognosis of neutrophil-lymphocyte ratio（NLR），C-reactive protein（CRP），procalcitonin（PCT），serum amyloid A（SAA），interleukin-6（IL-6）and CD64 index for bloodstream infection. Methods Totally，380 patients with bacterial bloodstream infection were enrolled as bloodstream infection group from Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine from January 2019 to June 2023. A total of 100 inpatients with negative blood culture were enrolled as control group. The NLR，CRP，PCT，SAA，IL-6 and CD64 index were determined. According to the types of infecting bacteria，the subjects were classified into Gram-positive（G⁺）bacterium group（105 cases）and Gram-negative（G^-）bacterium group（275 cases）. Among the 380 patients，210 patients were complicated by sepsis，which were classified into death group（40 cases）and survival group（170 cases）based on their survival status. Results The patients in G⁺ bacteria induced bloodstream infection were mainly from emergency department，general surgery department and general surgery intensive care unit，and Staphylococcus aureus，Enterococcus faecium and Staphylococcus epidermis were the main ones. The patients in G^- bacteria induced bloodstream infection were mainly from general surgery intensive care unit，general surgery department and hematology department，which were mainly composed of Escherichia coli，Klebsiella pneumoniae and Acinetobacter baumannii. The NLR，CRP，PCT，SAA，IL-6 and CD64 index in G⁺ and G^- bacterium groups were higher than those in control group（P<0.05）. The PCT，IL-6 and CD64 index in G^- bacterium group were higher than those in G⁺ bacterium group（P<0.05），and there was no statistical significance in NLR，CRP and SAA between the 2 groups（P>0.05）. The NLR，PCT，CRP，SAA，IL-6 and CD64 index in death group were higher than those in survival group（P<0.05）. Conclusions NLR，CRP，PCT，SAA，IL-6 and CD64 index have efficacy in the diagnosis and prognosis of bloodstream infection. PCT，IL-6 and CD64 index may distinguish infecting bacterial types in bloodstream infection.

Application of CD14 reverse assisted gate method in detection of lymphocyte subsets

JING Lanting, ZHU Mengting, YANG Zhenkun, LUO Yuanyuan, ZOU Jian, YIN Ying

2024, 39(3):  227-236.  DOI: 10.3969/j.issn.1673-8640.2024.03.004

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Objective To establish CD14 reverse assisted gate method and investigate its application in the detection of lymphocyte subsets. Methods CD14-BV421 antibody was added to the conventional 6-color flow cytometry assay（conventional flow cytometry），and CD14 reverse assisted gate method was established. The lymphocyte subsets of quality control products，samples with different placement times（4，24，48 and 72 h）and patients with different diseases（systemic lupus erythematosus，viral pneumonia and kidney transplantation）were detected by conventional flow cytometry and CD14 reverse assisted gate method，and the difference and deviation of the detection results of the 2 methods were compared. Results The percentage of lymphocytes（LYMPH%）and the percentage of natural killer（NK）cells（NK%）detected by CD14 reverse assisted gate method were lower than those by conventional flow cytometry method（P<0.05），while there was no statistical significance in all the items between the 2 methods（P>0.05）. Compared with 4 h，the differentiation between CD14⁺ monocytes and lymphocytes was decreased with the extension of the sample placement time. Compared with whole blood samples at room temperature for 4 h，the relative deviations of CD14 reverse assisted gate method and conventional flow cytometry were <5% after 24 h（P>0.05）. After 48 h of sample placement，the relative deviations of CD14 reverse assisted gate method were all <5%，and the relative deviations of cytotoxic T lymphocyte（CTL）（CD3⁺CD8⁺）and B cells（CD3^-CD19⁺）percentages and their absolute values were all >5% by conventional flow cytometry. After 72 h of sample placement，the relative deviation of all the items by the both methods was >10%，which was clinically unacceptable. CD14 reverse assisted gate method can be used to detect lymphocyte subsets in peripheral blood of patients with systemic kidney erythematosus，viral pneumonia and kidney transplantation，which could better distinguish lymphocytes from monocytes and reduce the influence of atypical monocytes on NK% and the absolute value of NK cells. Conclusions CD14 reverse assisted gate method can reduce the wrong loop of lymphocyte gate in flow cytometry and improve the detection accuracy.

Role of serum MyD88 and TRAF-6 combined determination in diagnosis and prognosis of severe acute respiratory tract infection in children

YANG Jing, LIU Huapeng, LIU Ni

2024, 39(3):  237-242.  DOI: 10.3969/j.issn.1673-8640.2024.03.005

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Objective To investigate the roles of serum myeloid differentiation primary response protein 88（MyD88）and tumor necrosis factor receptor-associated factor 6（TRAF-6）combined determination in the diagnosis and prognosis of severe acute respiratory tract infection in children. Method Totally，80 children with acute respiratory tract infection（acute respiratory tract infection group）in Nanyang Central Hospital from January 2020 to June 2022 were enrolled. According to the results of etiological diagnosis，they were classified into non-bacterial infection group（42 cases）and bacterial infection group（38 cases）. According to the severity of patients' condition，they were classified into mild group（28 cases），moderate group（20 cases）and severe group（32 cases）. According to the prognosis of children，they were classified into good prognosis group（58 cases）and poor prognosis group（22 cases）. Totally，80 healthy children were enrolled as controls. Multivariate Logistic regression analysis was used to evaluate the prognostic factors of acute respiratory tract infection in children. Receiver operating characteristic（ROC）curve was used to analyze the diagnostic roles of serum MyD88 and TRAF-6 levels for severe acute respiratory tract infection in children. Results Serum levels of MyD88 and TRAF-6 in acute respiratory tract infection group were higher than those in control group（P<0.001）. Serum levels of MyD88 and TRAF-6 in bacterial infection group were higher than those in non-bacterial infection group（P<0.001）. Serum levels of MyD88 and TRAF-6 in mild，moderate and severe groups were increased in turn（P<0.001）. The areas under curves（AUC）of serum MyD88 and TRAF-6 single and combined determinations for the diagnosis of severe acute respiratory tract infection were 0.762，0.734 and 0.876，respectively. The proportion of bacterial infection，infection site in lower respiratory tract，the proportion of severe disease and the levels of white blood cell（WBC）count，C-reactive protein（CRP），MyD88 and TRAF-6 in poor prognosis group were higher than those in good prognosis group（P<0.05）. The severity of disease，elevated CRP，MyD88 and TRAF-6 were all risk factors for poor prognosis of children with acute respiratory tract infection [odds ratios（OR）were 1.693，1.864，3.218 and 2.869，95% confidence intervals（CI）were 1.142-2.510，1.228-2.830，1.561-6.633 and 1.511-5.446，P<0.05]. The AUC of serum MyD88，TRAF-6 and CRP for the prognosis of children with acute respiratory tract infection were 0.848，0.900，0.817 and 0.951，respectively. Conclusions Serum levels of MyD88 and TRAF-6 in children with acute respiratory tract infection are elevated，and the combined determination has good evaluation value in the diagnosis and prognosis of severe acute respiratory tract infection in children.

Rapid bacterial identification and drug susceptibility test of blood culture-positive samples

LI Anqi, ZHANG Shuya, HE Shanna, CHEN Qiaoqiao, LÜ Qi, LÜ Wanfei, LI Chunxian, WANG Weihua, ZHENG Lin

2024, 39(3):  243-248.  DOI: 10.3969/j.issn.1673-8640.2024.03.006

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Objective To analyze the clinical roles of rapid bacterial identification and drug susceptibility test of blood culture-positive samples by centrifuge enrichment method and 5 h culture method combined with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry（MALDI-TOF-MS）. Methods Totally，211 blood culture-positive samples at the First Affiliated Hospital of Ningbo University from October 2021 to October 2022 were collected. The pretreatment was performed by centrifuge enrichment method and 5 h culture method（rapid method）and 12 h culture method（standard method），respectively. MALDI-TOF-MS was used for rapid isolate identification of blood culture-positive samples treated by the 3 methods. The drug susceptibility test of 156 blood culture-positive samples from aerobic bottle was carried out by automatic microbiological identification drug susceptibility instrument. According to the identification results of conventional culture（18-24 h）+MS，the identification accuracy of 2 rapid methods of 5 h culture method+MS and centrifuge enrichment method+MS were compared. According to the identification results of 24 h，the consistency of the results of drug susceptibility test between standard method after 5 h culture method，centrifuge enrichment was evaluated. Results The identification accuracy of Enterococcus faecalis was the highest，and the identification accuracies were 100.00% and 87.50%，respectively. The identification accuracy of Streptococcus was low（33.33%）after 5 h culture method+MS. The drug susceptibility test results of the 2 methods for Enterobacteriaceae and non-fermentative bacteria were more than 73.00% and 85.00%，respectively，compared with the results of standard method. The results of drug susceptibility test for Staphylococcus and Enterococcus were consistent（100.00%）. The consistency of vancomycin sensitivity analysis was the lowest（70.73%）. Conclusions The 5 h culture method+MS and centrifuge enrichment method+MS can rapidly identify the isolate and drug resistance of pathogenic bacteria in blood culture-positive samples with high accuracy，which is suitable for clinical microbiology laboratories.

Virulence genes and molecular characteristics of Klebsiella pneumoniae isolated from bloodstream infection patients

YU Feng, HU Longhua, XIAO Yanping, YANG Junping

2024, 39(3):  249-255.  DOI: 10.3969/j.issn.1673-8640.2024.03.007

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Objective To investigate the virulence gene distribution and clinical molecular characteristics of Klebsiella pneumoniae. Methods Totally，158 non-duplicate clinical isolates of Klebsiella pneumoniae were collected from the Second Affiliated Hospital of Nanchang University from January 2016 to March 2017. Automatic drug susceptibility analyzer was used to identify the isolates and determine drug susceptibility in vitro. The high virulence Klebsiella pneumoniae（hvKP）was screened by string test. The virulence genes and drug resistance genes of Klebsiella pneumoniae and 5 common capsule serotypes were determined by polymerase chain reaction（PCR）. Multi-locus sequence typing（MLST）and homology analysis were performed. The clinical data of infected patients were collected，and the clinical characteristics of patients infected with carbapenem-resistant Klebsiella pneumoniae（CRKP）and common antibiotics sensitive Klebsiella pneumoniae（SKP）were compared. Results Among the 158 isolates of Klebsiella pneumoniae，22 isolates（13.9%）were CRKP，and 29 isolates（18.4%）were SKP. All CRKP isolates were multi-drug resistant，all of them expressed carbapenem resistance gene bla_KPC-2，and one isolate also carried metalloenzyme carbapenem resistance gene bla_IMP-4. The results of string test showed that among 51 isolates of Klebsiella pneumoniae with bloodstream infection，13 were hvKP，2 were CRKP，and 11 were SKP. The determination rates of uge，iutA，mrkD，alls and aerobactin genes in SKP were higher than those of CRKP，and the determination rate of ybtA gene was higher（P<0.05）. Capsule serotyping results showed that K1 and K2 had 4 isolates each，and K57 had 1 isolate，all of which were SKP. No common capsule serotypes were determined in CRKP. MLST results showed that the 51 CRKP and SKP isolates were dominated by ST11 type（24/51），22 CRKP isolates were all ST11 type，and the SKP capsule serotypes were ST23（4 isolates），ST11（2 isolates）and ST65（2 isolates）. Homology analysis showed that 21 of 51 isolates of CRKP and SKP had homology>70%，among which type A（5 isolates），type B（9 isolates）and type C（3 isolates）were ST11 CRKP，and 4 isolates of ST23 SKP were type D. Invasive procedures，use of carbapenems and prognosis of patients with CRKP and SKP infection were statistically significant（P<0.05），but there was no statistical significance in age，sex，underlying diseases and department distribution（P>0.05）. Conclusions The Klebsiella pneumoniae virulence genes（ybtA，uge，mrkD，alls，iutA and aerobactin）could be used as virulence markers of hvKP. The drug resistance genes of CRKP isolates are complex and diverse，and the prognosis of patients infected with CRKP is poor，so it is recommended to conduct CRKP medical screening as soon as possible.

Microbial distribution and drug resistance in chronic dacryocystitis

CHEN Yu, ZHAO Ya, WANG Lin

2024, 39(3):  256-259.  DOI: 10.3969/j.issn.1673-8640.2024.03.008

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Objective To investigate the microbial distribution and drug resistance in chronic dacryocystitis，and to provide a reference for empirical clinical use. Methods A total of 104 patients with chronic dacryocystitis were enrolled from Xi'an First Hospital from June 2022 to June 2023，and the specimens of dacryocystic secretions were collected for identification by automated identification drug sensitivity instrument. In vitro drug susceptibility test was carried out by instrument method and disk diffusion method，and the consistency of the 2 methods was analyzed. Results The bacterial positive determination rate in patients with chronic dacryocystitis was 74.04%（77/104），with a total of 109 strains isolated，among them，75 cases of Gram-positive（68.81%），23 cases of Gram-negative（21.10%），10 cases of anaerobic bacteria（9.17%）and 1 case of fungus（0.92%）. The most sensitive antimicrobial drugs against Staphylococcus were moxifloxacin，rifampicin and vancomycin，with sensitivity rates of 80.00%，97.50% and 100.00%，respectively. The drug resistance rate of methicillin-resistant Staphylococcus（MRS）was higher than that of methicillin-sensitive Staphylococcus（MSS），and there was statistical significance for levofloxacin and clindamycin（P<0.05）. The consistency of drug susceptibility test between instrument method and disk diffusion method was good（Kappa value was 0.832，P<0.05）. Conclusions Staphylococcus is the main pathogen of chronic dacryocystitis，and moxifloxacin，rifampicin and vancomycin can be the drugs of choice for the treatment of chronic dacryocystitis.

Serotypes and drug resistance of invasive Streptococcus agalactiae in children

CHEN Huan, DONG Fang, LÜ Zhiyong, ZHEN Jinghui, CHEN Mei, SU Jianrong

2024, 39(3):  260-264.  DOI: 10.3969/j.issn.1673-8640.2024.03.009

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Objective To investigate the serotypes and drug resistance causing invasive Streptococcus agalactiae（Group B Streptococcus，GBS）infection in children，and to provide a reference for clinical reduction of GBS infection and rational drug treatment. Methods GBS was isolated from sterile site specimens in Beijing Friendship Hospital of Capital Medical University from January 2012 to December 2018，and serotyping and in vitro drug susceptibility test were performed. Results Totally，139 cases were neonates（61.2%），followed by infants（38.8%）. A total of 185 isolates of invasive GBS were isolated，of which 46.0%（64/139）were isolated from blood specimens，20.9%（29/139）were isolated from cerebrospinal fluid specimens，and 33.1%（46/139）were isolated from both blood and cerebrospinal fluid specimens. A total of 5 serotypes were isolated，of which type Ⅲ had the highest determination rate（54.6%，76/139），followed by type Ⅰb（28.1%，39/139），type Ⅰa（12.9%，18/139），type Ⅱ and type Ⅴ（2.2%，3/139，respectively）. The drug resistance rate of 139 isolates of GBS to erythromycin was the highest（89.9%），followed by clindamycin（74.1%）and levofloxacin（31.7%）. No isolates insensitive to penicillin，ceftriaxone，cefepime，linezolid and vancomycin were determined. There were some differences in drug resistance among different serotypes of GBS. Conclusions Invasive GBS infection in children can cause bloodstream infection and meningitis，and serotyping and drug susceptibility test are important for the prevention and treatment of pediatric clinical infections.

Clinical characteristics，drug resistance and poor prognosis factors in children with invasive pneumococcal disease with necrotizing pneumonia

MA Chen, ZHANG Yi, LI Fang, WANG Jing, CHEN Wei

2024, 39(3):  265-271.  DOI: 10.3969/j.issn.1673-8640.2024.03.010

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Objective To investigate the clinical characteristics，drug resistance and poor prognosis factors for invasive pneumococcal disease（IPD）with necrotizing pneumonia（NP）. Methods A total of 158 children with IPD with NP from the First Affiliated Hospital of Xi'an Jiao Tong University from June 2018 to June 2022 were enrolled as observation group，and 92 mycoplasma pneumoniae patients with NP were enrolled as control group. The clinical manifestations and laboratory indexes were compared. In vitro drug susceptibility test was performed. The observation group was classified into poor prognosis group（26 cases）and good prognosis group（132 cases）according to whether there was poor prognosis. Multivariate Logistic regression analysis was used to screen the influencing factors of poor prognosis in children with IPD and NP，and the prediction model of nomographic chart was constructed and evaluated. Receiver operating characteristic（ROC）curve was used to evaluate the prediction efficiency of the nomographic chart prediction model. Results In the observation group，fever time，breathless incidence rate，C-reactive protein（CRP），white blood cell（WBC）count，the absolute value of neutrophils （NEUT#），tumor necrosis factor-alpha（TNF-α），procalcitonin（PCT）levels and pleural effusion lactate dehydrogenase（LDH），WBC count and glucose level were higher than those in control group（P<0.05）. Streptococcus pneumoniae was more sensitive to vancomycin，levofloxacin and linezolid，but less sensitive to erythromycin and clindamycin. CRP>161.75 mg·L^-1，WBC count>20.24×10⁹/L，NEUT#>0.86×10⁹/L，PCT>2.98 μg·L^-1，blood sodium <2.24 mmol·L^-1 and blood calcium<136.35 mmol·L^-1 were associated with poor prognosis in children with IPD and NP（P<0.05）. Conclusions The children with IPD and NP have a long fever time and are prone to breathless. The infected isolates are sensitive to vancomycin，levofloxacin and linezolid. High levels of CRP，WBC count，NEUT#，PCT and low levels of blood sodium and blood calcium are associated with poor prognosis in children with IPD and NP.

Role of plasma leptin determination in nutritional status and bone mineral density in preschool children

DONG Mingying, TAO Bingtong, LI Enyao

2024, 39(3):  272-276.  DOI: 10.3969/j.issn.1673-8640.2024.03.011

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Objective To investigate the role of plasma leptin determination in nutritional status and bone mineral density in preschool children. Methods Totally，140 preschool children who underwent physical examination in Nanyang Second People's Hospital from February 2020 to February 2021 were enrolled. The height and weight were measured，and body mass index（BMI） was calculated. Serum triglyceride（TG），total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），albumin（Alb），hemoglobin（Hb） and plasma leptin levels were determined，and bone mineral density was determined as well. According to BMI，all the 140 children were classified into lean group（29 cases），normal group（61 cases） and overweight group（50 cases）. According to bone mineral density，all the children were classified into normal bone mineral density group（95 cases） and low bone mineral density group（45 cases）. Pearson correlation analysis was used to evaluate the correlation among the indicators. The efficacy of leptin in differentiating nutritional status and bone mineral density in preschool children was evaluated by receiver operating characteristic（ROC） curve. Results Compared with lean group，leptin levels in normal and overweight groups were increased（P<0.05），and overweight group's leptin levels were higher than those of normal group（P<0.05）. Leptin was positively correlated with BMI，TG，TC，LDL-C，Hb and Alb（r values were 0.672，0.486，0.603，0.422，0.244 and 0.388，respectively，P<0.01）. There was a negative correlation with HDL-C（r=-0.260，P=0.002）. The area under curve（AUC） of leptin for differentiating lean，normal children and normal，overweight children were 0.842 and 0.865，respectively. Compared with normal bone mineral density group，TG，TC，LDL-C，Alb，Hb and leptin in low bone mineral density group were decreased（P<0.05），and HDL-C was increased（P<0.05）. Leptin was positively correlated with speed of sound（SOS） of preschool children（r=0.217，P=0.010）. The AUC of leptin for differentiating normal and low bone mineral densities was 0.634. Conclusions The level of leptin in preschool children has a certain relationship with nutritional status and bone mineral density，which can be used to evaluate the nutritional status and bone mineral density of children.

Efficiency of serum homocysteine，BNP and fibrinogen for deep venous thrombosis of lower extremity after cesarean section

LUO Lili, LIU Xiaohui, HAO Jianjun, WANG Lili, LUO Jiao, CHEN Qimei

2024, 39(3):  277-281.  DOI: 10.3969/j.issn.1673-8640.2024.03.012

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Objective To investigate the predictive roles of serum homocysteine（Hcy），B-type natriuretic peptide（BNP）and fibrinogen（Fib）in patients with deep venous thrombosis（DVT）of lower extremity after cesarean section. Methods A total of 74 females who underwent cesarean section in the Fifth Hospital of Zhangjiakou City from March 2017 to April 2019 were enrolled，which included 37 female patients with postoperative DVT（DVT group）and 37 females without lower extremity DVT（healthy control group）. Totally，30 birth-giving female patients with lower extremity DVT during the same period were enrolled as disease control group. Wells score was used to evaluate the clinical characteristics of patients in DVT group. The differences of Hcy，BNP and Fib among the groups were evaluated. Receiver operating characteristic（ROC）curve and area under curve（AUC）were used to evaluate the efficiency of each indicator in predicting lower extremity DVT after cesarean section. Pearson correlation analysis was used to evaluate the correlation among all the indicators. Results The levels of Hcy，BNP and Fib in DVT group and disease control group were higher than those in healthy control group（P<0.05），and there was no statistical significance in Hcy，BNP and Fib between DVT group and disease control group（P>0.05）. There was statistical significance in the levels of Hcy，BNP and Fib among lower extremity DVT patients with mild，moderate and severe degrees（P<0.05），and the levels of Hcy，BNP and Fib were increased with the increase of Wells scores. ROC curve analysis showed that the AUC of Hcy，BNP and Fib single and combined determinations to predict lower extremity DVT after cesarean section were 0.912，0.861，0.877 and 0.946，respectively. Conclusions Serum Hcy，BNP and Fib have good clinical predictive values for lower extremity DVT after cesarean section.

Long-term biological variation of serum sex hormones during female follicular phase in Shanghai

WANG Zhengquan, WU Zhengmu, LI Wen

2024, 39(3):  282-288.  DOI: 10.3969/j.issn.1673-8640.2024.03.013

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Objective To investigate the long-term biological variation of 7 serum sex hormones during female follicular phase in Shanghai，and to derive the performance specification based on biological variation. Methods A total of 64 volunteers（non-pregnant females aged 20-40 years old）were enrolled from the International Peace Maternal and Child Health Hospital affiliated to Shanghai Jiao Tong University School of Medicine. Peripheral blood samples were collected on the 2nd or 3rd day of menstruation of each volunteer every month for 6 months. The 7 serum sex hormones [anti-Müllerian hormone（AMH），estradiol（E2），follicle-stimulating hormone（FSH），luteinizing hormone（LH），prolactin（PRL），progesterone（Prog）and testosterone（Testo）] were determined. The allowable imprecision，allowable deviation and allowable total error of the 3 levels of "best"，"appropriate" and "lowest" were derived according to the relevant formulas. Results Compared with European Federation of Clinical Chemistry and Laboratory Medicine（EFLM）database，Prog，Testo intra-individual coefficient of variation（CV_I）and inter-individual coefficient of variation（CV_G），FSH CV_I were compared with existing data，and there was no statistical significance（P>0.05）. CV_I and CV_G of E2 were higher than the existing data（P<0.01），CV_I and CV_G of PRL and LH，CV_G of FSH and CV_I of AMH were lower than the existing data（P<0.01），and no CV_G of AMH had ever been reported. Conclusions Long-term biological variation data of 7 serum sex hormones of females in Shanghai has been determined. It can provide a performance specification based on the biological variation of the population in Shanghai.

Research progress on the factors of CYP2D6 genotyping

SHEN Jinjin, XUE Han, LI Jinfu, GAO Lifei, ZHENG Yehuan

2024, 39(3):  291-297.  DOI: 10.3969/j.issn.1673-8640.2024.03.015

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Cytochrome P450 family 2 subfamily D member 6（CYP2D6）is one of most important drug metabolism enzymes in the cytochrome P450 family. It mainly metabolizes many drugs，including antidepressants，antipsychotics and opioids. The complexity of CYP2D6 gene locus and allelic variation can be translated into the polymorphism of CYP2D6. To date，over 170 allelic variations have been published. CYP2D6 activity is highly variably ranging from no activity to ultrarapid metabolism. The phenotypes are categorized into ultrarapid metabolizer，normal metabolizer，intermediate metabolizer and poor metabolizer. With the development of individualized medicine，the CYP2D6 genotyping can utilize the pharmacogenetics and genotyping as part of the clinical decision-making process. The complexity of CYP2D6 allelic variations includes single nucleotide polymorphism，insertion，deletion，gene copy number variation and gene rearrangement. The CYP2D6 gene not only had individualized differences，but also the frequency of alleles between different races was different. Furthermore，CYP2D6 had a non-functional gene CYP2D7 with high homology，so its phenotype prediction by CYP2D6 genotyping was a challenging task. This review summarizes the polymorphism of CYP2D6 gene and the complexity of CYP2D6 genotyping，and also summarizes the impact of different allelic variations on CYP2D6 genotyping. It is valuable for clinical laboratories to perform CYP2D6 genotyping for phenotype prediction in the future.