Table of Content

30 July 2025, Volume 40 Issue 7

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Expert consensus on non-invasive laboratory diagnosis for hepatic fibrosis

Yueyang Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai University of Traditional Chinese Medicine Shanghai Center for Clinical Laboratory, Clinical Laboratory Society of Chinese Association for Rehabilitation Medicine Clinical Laboratory Society of Chinese Association of Integrative Medicine, Tumor Immunology Branch of Shanghai Society for Immunology Molecular Diagnostics Society of Shanghai Medical Association

2025, 40(7):  625-641.  DOI: 10.3969/j.issn.1673-8640.2025.07.001

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Hepatic fibrosis is a pathological repair response of the liver to various chronic injuries. Early diagnosis and intervention can stop or even reverse hepatic fibrosis. Currently，there remains the lack of specific biomarkers for hepatic fibrosis in clinical practice. Existing direct（serum）biomarkers and indirect biomarkers（the models established based on hematological parameters）hold significant value in exclusion diagnosis，offering advantages such as convenience，safety and repeatability. Based on relevant international and Chinese guidelines or expert consensus statements，multicenter research findings and regional quality surveys in Shanghai，Yueyang Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai University of Traditional Chinese Medicine in collaboration with other institutions jointly developed the Expert Consensus on Non-invasive Laboratory Diagnosis for Hepatic Fibrosis. This expert consensus address the key issues of non-invasive laboratory diagnosis for hepatic fibrosis，including the clinical implications，applicable subjects，result interpretation，determination methods，quality control and cutting-edge advancements. This expert consensus aims to assist the better understanding and scientific application of non-invasive biomarkers in the diagnosis，monitoring and therapeutic evaluation of hepatic fibrosis.

Positive rate analysis of urinary AD7c-NTP of patients with different brain diseases

WU Jun, TAO Yue, CHEN Dezhu, SHA Jiaojiao, DU Liangjia, CHEN Yiqiang, LIU Siyuan, SONG Hongyan, ZHENG Qian, BAI Bing

2025, 40(7):  642-647.  DOI: 10.3969/j.issn.1673-8640.2025.07.002

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Objective To investigate the distribution of the positive rate of urinary Alzheimer's disease-associated neurofilament protein（AD7c-NTP）of patients with different brain diseases，and to analyze its diagnostic value for Alzheimer's disease（AD）. Methods The urinary AD7c-NTP enzyme-linked immunosorbent assay（ELISA）results of 10 208 patients in the Brain Hospital Affiliated to Nanjing Medical University from July 2018 to November 2023 were collected. All the patients were classified into 37 groups based on clinical diagnosis，and the positive rates of urinary AD7c-NTP in each group were compared. Results The overall positive rate of urinary AD7c-NTP was 2.54%（259/10 208）. The positive rates of urinary AD7c-NTP in AD group，dementia group and cognitive impairment group were 3.79%（19/501），2.78%（5/180）and 2.01%（6/298），respectively. The positive rates in the dizziness/headache/syncope/vertigo group（0.81%，3/372） and depressive disorder group（1.91%，27/1 414） were lower than those in AD group（χ²=6.58 and 4.82，respectively，P<0.05）. The hemifacial spasm group exhibited a higher positive rate（20.00%，2/10） compared to dementia and cognitive impairment groups（P<0.05）. No statistical significance in positive rates were observed between the remaining non-dementia disease groups and AD，dementia and cognitive impairment groups （P>0.05）. Conclusions The positive rate of urinary AD7c-NTP of patients with AD，dementia and cognitive impairment is relatively low，and there is no significant difference from the urinary AD7c-NTP positive rate of other non-dementia diseases. The clinical value of urinary AD7c-NTP determination remains to be further clarified.

Correlation between serum Cat S，β2-MG，suPAR and severity of diabetic nephropathy

XU Na, SONG Yonghua, ZHANG Jienan, NIE Chanjuan

2025, 40(7):  648-653.  DOI: 10.3969/j.issn.1673-8640.2025.07.003

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Objective To investigate the correlation between serum cathepsin S（Cat S），beta 2-microglobulin（β2-MG），soluble urokinase-type plasminogen activator receptor（suPAR） and the severity of diabetic nephropathy（DN）. Methods A total of 140 patients with DN（DN group），162 patients with simple type 2 diabetes mellitus（T2DM）（T2DM group）and 140 healthy subjects（healthy control group）in Shijiazhuang Maternal and Child Health Hospital from November 2020 to November 2023 were enrolled. The clinical data and laboratory determination results were collected. According to the scores of interstitial fibrosis and tubular atrophy（IFTA），DN patients were classified into mild group（43 cases，with an IFTA score of 0），moderate group（35 cases，with an IFTA score of 1），slightly severe group（31 cases，with an IFTA score of 2）and severe group（31 cases，with an IFTA score of 3）. Logistic regression analysis was used to evaluate the influencing factors of severe DN incidence，and Spearman correlation analysis was applied to analyze the correlation between each index and the severity of DN. The efficacy of each index in diagnosing DN was evaluated by receiver operating characteristic（ROC）curve. Results The serum levels of Cat S，β2-MG and suPAR in DN group，T2DM group and healthy control group were decreased sequentially（P<0.001）. There was no statistical significance in various clinical data among the 3 groups（P>0.05）. Course of T2DM disease and the serum levels of glycated hemoglobin A1c（HbA1c），Cat S，β2-MG and suPAR in mild group，moderate group，slightly severe group and severe group were all increased sequentially（P<0.001）. The number of hypertension patients in severe group was higher than those in mild group，moderate group and slightly severe group（P<0.05）. There was no statistical significance in the other indicators among the 3 groups（P>0.05）. The levels of serum Cat S，β2-MG，suPAR，HbA1c，disease course and hypertension were all positively correlated with the severity of DN（r=0.656，0.782，0.849，0.751，0.705 and 0.817，P<0.001）. Course of T2DM disease，hypertension and elevated HbA1c，serum Cat S，β2-MG and suPAR levels were risk factors for severe DN（P<0.05）. The areas under curves（AUC）of serum Cat S，β2-MG and suPAR single and combined determinations for the diagnosis of severe DN were 0.815，0.851，0.878 and 0.979，respectively. Conclusions The serum levels of Cat S，β2-MG and suPAR in DN patients are positively correlated with DN severity，which can be used as indicators for judging the condition of DN.

Clinical role of fibrinogen/albumin ratio in disease activity and diagnosis of lupus nephritis patients with systemic lupus erythematosus

LI Fei, YI Changlin, JIN Peipei, WANG Fang, DING Ning

2025, 40(7):  654-659.  DOI: 10.3969/j.issn.1673-8640.2025.07.004

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Objective To investigate the role of fibrinogen/albumin ratio（FAR）in disease activity and diagnosis of systemic lupus erythematosus（SLE）and lupus nephritis（LN）. Methods A total of 99 SLE patients（SLE group）and 50 healthy subjects（healthy control group） from Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January to December 2023 were enrolled. SLE patients were classified into LN group（40 cases）and non-LN group（59 cases）. The erythrocyte sedimentation rate（ESR），creatinine（Cr），blood urea nitrogen（BUN），fibrinogen（Fib）and albumin（Alb）were determined，and the FAR was calculated. The disease activity of SLE patients was evaluated using the systemic lupus erythematosus disease activity index 2000（SLEDAI-2000）. Pearson correlation analysis or Spearman correlation analysis was used to evaluate the correlation between FAR and other indicators. Logistic regression analysis was used to evaluate the influencing factors of LN occurrence. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of FAR in diagnosing SLE，SLE moderate-severe activity and LN. Results The FAR in SLE group was higher than that in healthy control group （P<0.001）. The FAR in LN group was higher than those in non-LN group and healthy control group （P<0.001），while there was no statistical significance in the other indicators among LN group，non-LN group and healthy control group （P>0.05）. FAR was positively correlated with ESR，Cr，BUN，Fib and SLEDAI-2000 score （r values were 0.459，0.249，0.223，0.806 and 0.450，respectively，P<0.05），and it was negatively correlated with Alb （r=-0.604，P<0.05）. FAR was a risk factor for LN occurrence in SLE patients [odds ratio （OR）=1.013，95% confidence interval （CI） 1.002-1.024]. After adjusting for confounding factors （age，gender，ESR，Cr，BUN，CRP，Fib，Alb），the risk of LN in the Q3 group （83.33 mg·g-1< FAR≤110.71 mg·g-1） was 2.633 times than that of the Q1 group （FAR≤64.10 mg·g-1） （OR=2.633，95% CI 1.180-5.878）. The area under curve（AUC）of FAR for diagnosing SLE was 0.723 8，that for diagnosing moderate-severe SLE activity was 0.748 3，and that for diagnosing LN was 0.633 9. Conclusions FAR has certain value in the assessment of SLE disease activity and the diagnosis of LN.

An improved POCT of urinary albumin/creatinine ratio for CKD screening

SUN Xiangyang, DING Hui, CHEN Minghui, YAO Jiameng, SUN Hanxiao, LIN Jinpiao, SHENG Huiming

2025, 40(7):  660-665.  DOI: 10.3969/j.issn.1673-8640.2025.07.005

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Objective To evaluate the clinical application value of an improved point-of-care testing （POCT）-based modified time-resolved fluoroimmunoassay（TRFIA） for rapid quantitative determination of urinary albumin/creatinine ratio（ACR）. Methods Totally，200 kidney disease patients and 20 healthy subjects from Shanghai Jiao Tong University School of Medicine Affiliated Tongren Hospital were enrolled from January to April 2024，and the random urine specimens were collected. Estimated glomerular filtration rate （eGFR） was used for kidney injury staging （G1，G2，G3 and above）. Urinary albumin （Alb） and creatinine （Cr） were determined by both Hitachi 3500 and LTRIC-600，and urinary ACR was calculated. Methodological evaluation of LTRIC-600 was performed，and urinary Cr in 40 selected patients was verified by mass spectrometry. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of LTRIC-600 in determining ACR for differentiating kidney injury between G1 and G2 stages. Results LTRIC-600 showed good performance in determining urinary Alb and Cr. Urinary ACR consistency between LTRIC-600 and Hitachi 3500 was good （kappa=0.89）. Good correlations were found between the 2 methods for urinary Alb （r=0.89），Cr （r=0.78） and ACR （r=0.86）（P<0.05）. Mass spectrometry also showed good correlations with both the 2 methods （r=0.89 and 0.83）. No significant ACR differences were seen between LTRIC-600 and Hitachi 3500 across kidney injury stages （P>0.05）. LTRIC-600 had an area under curve （AUC） of 0.872 for distinguishing G1 from G2. Conclusions LTRIC-600 demonstrates high accuracy and consistency in ACR determination，making it suitable for chronic kidney disease screening and monitoring，with potential in primary and home-care settings.

A risk prediction model for depressive disorders in children based on serum amino acids and cytokines

JIN Weifeng, LI Dan, WANG Mengxia, PAN Nuoxuan, ZHANG Hong, LIN Ping

2025, 40(7):  666-672. 

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Objective To establish a nomogram model for predicting the risk of depressive disorders in children based on serum amino acids and cytokines，and to evaluate its clinical efficacy. Methods A total of 103 children with depressive disorders （depressive disorder group） from Shanghai Mental Health Center from January to October 2024 and 54 healthy children undergoing physical examinations （healthy control group） were enrolled. Ten cytokines and 23 amino acids in serum of all the subjects were determined by flow cytometry and liquid chromatography-tandem mass spectrometry，respectively. Variates were screened by LASSO regression analysis and multivariate Logistic regression analysis. A nomogram model based on the screened variates was established. The clinical efficacy was evaluated by receiver operating characteristic （ROC） curve，Hosmer-Lemeshow goodness-of-fit test and clinical decision curve. Results Serum levels of tryptophan，phenylalanine，threonine，arginine，methionine，alanine，asparagine，glutamic acid，leucine，lysine，proline，tyrosine，valine，ornithine，5-hydroxytryptamine（5-HT），kynurenine，5-hydroxyindoleacetic acid（5-HIAA），interferon-alpha（IFN-α），interleukin-5（IL-5），interleukin-1beta（IL^-1β），interferon-gamma（IFN-γ），tumor necrosis factor-alpha（TNF-α），interleukin-10（IL^-10），interleukin-6（IL-6）and interleukin-2（IL-2） showed statistical significance between depressive disorder group and healthy control group（P<0.1）. Five variates（arginine，asparagine，glutamic acid，5-HT and IL-2）were selected using LASSO regression analysis. Decreased levels of arginine，asparagine and 5-HT，along with elevated levels of glutamic acid and IL-2，were all independent risk factors for the development of depressive disorders in children（P<0.05）. The nomogram prediction model constructed based on the 5 selected variates had an area under curve（AUC） of 0.961 for diagnosing depressive disorder，with an internal validation AUC of 0.939. The predicted probability of the nomogram model showed good agreement with the actual probability（Hosmer-Lemeshow test P=0.510 6）. The model demonstrated high net benefit rates within the threshold probability range of 0.02% to 98.00%，with a maximum net benefit rate of 0.6. Conclusions The nomogram prediction model based on arginine，asparagine，glutamic acid，5-HT and IL-2 demonstrates high efficacy in the diagnosis of childhood depressive disorders and may serve as an auxiliary tool for diagnosing depression in children.

Drug resistance genes，virulence genes and molecular typing characteristics of 101 isolates of Campylobacter based on whole genome sequencing

YANG Shu, YANG Lihua, SHENG Fengsong, JIANG Yonggen, QIAO Xuefei, ZHU Tianyue, YU Zifan, TANG Yiming

2025, 40(7):  673-679.  DOI: 10.3969/j.issn.1673-8640.2025.07.007

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Objective To analyze the distribution of drug resistance genes and virulence genes in Campylobacter，as well as the molecular prevalence and homology characteristics of Campylobacter from different sources，and to provide a reference for infection prevention and control. Methods For 913 anal swab samples of patients with diarrhea，701 samples of poultry meat and 1 sample of chicken manure in Songjiang Shanghai from 2017 to 2021，Campylobacter jejuni and Campylobacter coli were identified，and the genomes of the determined Campylobacter were determined by whole genome sequencing（WGS）. The carriage of related drug resistance genes and virulence genes，as well as the multilocus sequence typing（MLST）characteristics，were analyzed. Results Among the 913 anal swab samples，115 isolates（12.60%） of Campylobacter were determined（96 isolates of Campylobacter jejuni and 19 isolates of Campylobacter coli）. Totally，78 isolates（11.13%） of Campylobacter were found in 701 poultry meat food samples（31 isolates of Campylobacter jejuni and 47 isolates of Campylobacter coli）. There was no statistical significance in the determination rate of Campylobacter between the 2 types of samples（χ² =0.813，P=0.367）. In the 193 Campylobacter isolates，101 isolates met the sequencing requirements，and the sequencing data were available（56 isolates were isolated from anal swab samples of diarrhea patients and 45 isolates were isolated from poultry meat food samples）. The mutation rate of gyrA gene was the highest among 9 drug resistance genes，and that of tet（M）gene was the lowest. Isolates carrying more than 3 types of drug resistance genes accounted for 90.10%. Among the 6 drug resistance genes [gyrA mutation，erm（B），tet（O），tet（M），blaOXA，cat]，the carrying rates in anal swab and food samples were not statistically significant（P>0.05）. The carrying rates of 9 virulence genes were 100% for iamA，ciaB and cheY. The carrying rates of cadF，cdtB and cdtA were all >95%. The carrying rates of flaA and virB11 were <6%. All isolates carried 3 or more virulence genes，and the carrying rates of 7 virulence genes [cadF，flaA，virB11，cdtB，iamA，ciaB，cheY] in anal swab and food samples were not statistically significant（P>0.05）. MLST classified 102 isolates of Campylobacter（including 1 isolate from chicken manure sample）into 68 different ST types（10 new ST types）and 16 clonal groups [C828 was the most important clonal group（56 isolates，54.9%）]. Among the 3 main clonal groups，CC828 and CC21 isolates were mainly isolated from anal swab samples of diarrhea patients and poultry meat food samples，while CC354 isolates were mainly isolated from anal swab samples of diarrhea patients. Conclusions There is no significant difference in the determination rate of Campylobacter in anal swab samples of patients with diarrhea and poultry meat food samples. The types of drug resistance genes and virulence genes are numerous，and the carrying rates are high. There are 3 main clonal groups and 68 ST types（including 10 new ST types）in MLST. The Campylobacter has high drug resistance and pathogenicity，and the MLST types are diverse. Relevant departments can formulate measures for preventing and controlling the spread of Campylobacter infection based on this.

Application of a machine learning model based on routine inflammatory markers to distinguish the severity of community-acquired pneumonia

GUAN Chao, HUANG Ying, SONG Yunxiao, ZHOU Ying

2025, 40(7):  680-686. 

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Objective To develop and validate a machine learning model for assessing the severity of community-acquired pneumonia（CAP） based on 11 routinely used clinical inflammatory markers. Methods A total of 3 674 patients with newly diagnosed CAP at Xuhui District Central Hospital between January 2016 and November 2024 were retrospectively enrolled. The patients were classified into a training cohort（January 2016-December 2021，1 363 mild cases and 1 320 severe cases） and a validation cohort（January 2022-November 2024，563 mild cases and 428 severe cases） according to the time of diagnosis. The clinical data and the determination results of 11 inflammatory markers were collected for each patient. Six machine learning algorithms-including decision tree（DT），K-nearest neighbors（KNN），Logistic regression（LR），random forest（RF），support vector machine（SVM） and extreme gradient boosting（XGBoost） were used to the training cohort to construct models for distinguishing mild from severe CAP. Using receiver operating characteristic（ROC） curve，the optimal model was selected based on the area under curve（AUC），and it was further validated in the validation cohort. Results Significant differences were observed between mild and severe CAP groups in both the training and validation cohorts with respect to white blood cell（WBC）count，platelet（PLT）count，the absolute value of neutrophils（NEUT#），the absolute value of lymphocytes（LYMPH#），the absolute value of monocytes（MO#），neutrophil-to-lymphocyte ratio（NLR），platelet-to-lymphocyte ratio（PLR），lymphocyte-to-monocyte ratio（LMR），systemic immune-inflammation index（SII），C-reactive protein（CRP） and procalcitonin（PCT）（P<0.001）. No statistically significant differences were found for the other indicators（P>0.05）. Among the 6 models，XGBoost demonstrated the optimal performance in the training cohort with an AUC of 0.95 and an accuracy of 89%. In the validation cohort，XGBoost achieved an AUC of 0.91 for distinguishing mild and severe CAP，an accuracy of 86%，a sensitivity of 81% and a specificity of 90%. Subgroup analysis showed that XGBoost achieved an AUC of 0.92 for distinguishing severity in bacterial CAP and 0.90 in viral CAP. Conclusions The XGBoost model based on routine inflammatory markers can effectively differentiate between mild and severe CAP，offering a practical tool for clinical severity assessment.

Combined determination of inflammatory markers in differential diagnosis of pathogens in acute respiratory tract infections

ZHOU Rui, YANG Aiping, ZHANG Guohua, YANG Danping, WANG Hong

2025, 40(7):  687-692.  DOI: 10.3969/j.issn.1673-8640.2025.07.009

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Objective To investigate the application of combined determination of inflammatory markers in acute respiratory tract infections，and to provide a reference for clinical prevention and rational diagnosis and treatment. Methods A total of 122 560 patients with acute respiratory tract infections in Shanghai Songjiang Jiuting Hospital from February 2023 to January 2024 were enrolled. They were classified into ≤3，4-6，7-11，12-14 and >14 years old groups. IgM antibodies against Mycoplasma pneumoniae（MP），Chlamydia pneumoniae（CP），respiratory syncytial virus（RSV），adenovirus（ADV），group B coxsackie virus（COXB），influenza A virus （IFVA） and influenza B virus （IFVB） were determined. Totally，300 patients with acute respiratory tract infections in the same period in Shanghai Songjiang Jiuting Hospital were enrolled. The positive status of pathogens was determined by polymerase chain reaction-fluorescence probe method，and the patients were classified into MP infection group（100 cases，MP positive），viral infection group（100 cases，IFVA or IFVB positive）and bacterial infection group（100 cases）. Another 80 healthy subjects from Shanghai Songjiang Jiuting Hospital during the same period were enrolled as healthy control group. Blood routine test，interleukin-6（IL-6），procalcitonin（PCT），C-reactive protein（CRP）and neutrophil-to-lymphocyte ratio（NLR）were performed，determined and calculated. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of each indicator in differentiating different pathogen infections. Results The total positive rates of pathogens in the≤3，4-6，7-11，12-14 and >14 years old groups were 17.75%，24.48%，22.70%，19.20% and 15.91%，respectively. There was statistical significance in the positive rates of MP IgM antibodies among different age groups （P<0.05），and they were gradually decreased with the increase of ages. The positive rate of MP IgM antibody in≤3 years old group was higher than that of other pathogens（P<0.05），and the positive rates of MP and IFVA in 7-11 years old group were higher than those in other age groups（P<0.05）. The bacterial infection group，viral infection group and MP infection group，except for NLR（P>0.05），had higher indicators[white blood cell（WBC）count，CRP，PCT，IL-6]than healthy control group （P<0.05）. The areas under curves（AUC）of the combined determination of PCT，CRP，WBC count and IL-6 for differentiating between bacterial infection and viral infection，bacterial infection and MP infection，and viral infection and MP infection were 0.887，0.856 and 0.658，respectively. Conclusions The combined determination of inflammatory indicators has certain clinical value in the differential diagnosis of bacterial infections and viral infections，as well as Mycoplasma infections. Combined with pathogen determination，it can enhance the efficiency of early differential diagnosis of acute respiratory tract infections in children.

Clinical characteristics and prognostic factors of patients with carbapenem-resistant hypervirulent Klebsiella pneumoniae infection

WANG Yali, CHEN Zongyao, ZHENG Mao, XU Dan, GUO Jiniuniu

2025, 40(7):  693-697.  DOI: 10.3969/j.issn.1673-8640.2025.07.010

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Objective To investigate the clinical characteristics of patients infected with carbapenem-resistant hypervirulent Klebsiella pneumoniae（CR-hvKP）and the risk factors for 30 d mortality in these patients，and to provide a reference for the formulation of targeted measures in clinical practice. Methods A total of 150 patients with positive CR-hvKP etiology and clinically diagnosed as CR-hvKP infection in the People's Hospital of Deyang from July 2020 to July 2023 were enrolled. All the patients' clinical data were collected，and they were classified into death group（35 cases）and survival group（115 cases）based on the 30 d mortality. Laboratory determination results of the patients were collected，and Cox proportional hazard regression analysis was used to evaluate the risk factors for the 30 d mortality of patients. Results The patients with CR-hvKP infection were mainly distributed in the neurology department（27.3%），and the main disease type was respiratory system infection（65.3%）. Mechanical ventilation，tracheal intubation and admission to intensive care unit（ICU）were independent risk factors for 30 d mortality in patients with CR-hvKP infection，while the use of tigecycline was a protective factor for the 30 d mortality of patients（P<0.05）. The 30 d survival rates of patients with mechanical ventilation（Log-rank χ²=5.985，P=0.014），tracheal intubation（Log-rank χ²=8.890，P=0.003），no history of tigecycline use（Log-rank χ²=4.378，P=0.036）and admission to ICU（Log-rank χ²=4.848，P=0.028） were lower. Conclusions Mechanical ventilation，tracheal intubation，the use of tigecycline and admission to ICU are independent risk factors for 30 d mortality in patients with CR-hvKP infection. Clinically，targeted prevention and treatment measures should be formulated based on these risk factors to reduce the mortality of infected patients.

Distribution characteristics of common pathogenic microorganism and risk factors of acute diarrhea in children

SHEN Gang, WU Liuyun

2025, 40(7):  698-702.  DOI: 10.3969/j.issn.1673-8640.2025.07.011

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Objective To analyze the distribution characteristics of common pathogenic microorganism and risk factors of acute diarrhea in children. Methods A total of 112 children with acute diarrhea and 112 healthy children in Lanxi Ruikang Hospital were retrospectively enrolled as diarrhea group and control group from April 2021 to April 2023，respectively. The distribution characteristics of common pathogenic microorganism in children with acute diarrhea were analyzed. The differences in relevant information such as general data and hygiene habits were compared between the 2 groups. The risk factors of acute diarrhea were analyzed by Logistic regression analysis. Results There were 83 positive samples in the 112 clinical samples，with positive determination rate of 74.11%（83/112）. In infectious diarrhea，the determination rate of viral infection was the highest，and there were 67 isolates of enterovirus，with positive determination rate of 59.82%（67/112）. Rotavirus was the main virus. There were 16 isolates of bacteria，with positive determination rate of 14.29%（16/112），and Salmonella was the main bacterium. There was statistical significance in patients' ages and hygiene habits between the 2 groups（P<0.05），but there was no statistical significance in gender and parental education level（P>0.05）. Age ≤2 years，delayed disposal of leftovers，tableware non-disinfection，non-frequent nail trimming，flies or cockroaches in rooms，children's hand non-washing before meals and after using toilets，antibiotic usage，finger-sucking habit and omophagia were independent risk factors of acute diarrhea in children（P<0.05）. Conclusions Children with acute diarrhea are mainly infected with enteroviruses，and rotavirus infection is common. For children aged ≤2 years，special attention should be paid to food hygiene and hand hygiene to prevent the occurrence of acute diarrhea.

Consistency of mitochondrial aspartate aminotransferase reagent test results from different brands

LIN Feiran, OU Yuanzhu, YU Xiaoxuan, GE Danhong, GONG Jingkai, ZHAO Pinqi, WANG Wenqin

2025, 40(7):  703-707.  DOI: 10.3969/j.issn.1673-8640.2025.07.012

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Objective By comparing the determination results of mitochondrial aspartate aminotransferase （m-AST） reagents of 7 brands，the influencing factors of the harmonization of serum samples determined by different brands of m-AST reagents have been discussed in order to provide a reference for the harmonization of m-AST determination results in Shanghai. Methods Seven m-AST determination systems and 7 aspartate aminotransferase（AST）determination systems were composed of m-AST and AST determination reagents of 7 brands and Hitachi 3500 automatic analyzer. Seven m-AST and AST determination systems were used to determine 30 serum samples. The 7 m-AST systems were paired in pairs to form 21 comparison combinations，and the correlation coefficients of 21 groups were calculated. Passing-Bablok regression analysis was used to analyze the slope and intercept of the 21 groups，and Bland-Altman analysis was used to analyze the relative average deviation of the 21 groups. The coefficient of variation（CV）and mean CV of m-AST and AST results of the same serum samples determined by 7 m-AST and AST determination systems were calculated，respectively，as well as the ratio of the determination results of 7 m-AST determination systems to the corresponding AST determination systems. Results Among the 21 m-AST system comparison combinations，except for one group，the harmonization of the results in the remaining 20 groups was poor. The average CV of the same clinical sample determined by 7 m-AST determination systems was 39.53%，and the average CV of the same clinical sample determined by 7 AST determination systems was 6.17%. The ratio of m-AST to AST was different from that of each determination system，except for one determination system and the corresponding AST determination system，and the ratio of the determination results of the other systems at each concentration level fluctuated significantly，but the fluctuation trend was consistent. Conclusions There are significant differences in the results of m-AST，which lacks comparability. The reason for the lack of comparability of m-AST results is mainly the difference in the inhibition rate of cytoplasmic aspartate aminotransferase （c-AST） among various reagents.

Changes of platelet and coagulation function indicators in elderly patients with diabetic foot ulcers

JIANG Fengying, JIANG Yun, MI Rui, QIAN Ximing, WANG Qiubo

2025, 40(7):  708-712.  DOI: 10.3969/j.issn.1673-8640.2025.07.013

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Objective To analyze the changes and clinical roles of platelet （PLT） and coagulation function indicators in elderly patients with diabetic foot ulcers （DFU）. Methods A total of 79 patients aged ≥60 years with type 2 diabetes mellitus （T2DM） combined with DFU （DFU group） and 86 patients with T2DM without DFU （T2DM group） at Wuxi Ninth People's Hospital Affiliated to Soochow University from January 2022 to December 2023 were enrolled. Fasting blood glucose（FBG），glycated hemoglobin A_1c（HbA_1c），erythrocyte sedimentation rate（ESR），C-peptide，ferritin，total protein（TP），albumin（Alb），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），triglyceride（TG），total cholesterol（TC），creatinine（Cr），urea nitrogen，platelet （PLT） count and activated partial thromboplastin time（APTT），prothrombin time （PT），thrombin time（TT），fibrinogen（Fib），antithrombin-Ⅲ（AT-Ⅲ），fibrin（fibrinogen） degradation product （FDP） and D-dimer（DD）were determined. The clinical data of patients were collected. The differences in clinical indicators between DFU group and T2DM group were compared. Logistic regression analysis was used to evaluate the influencing factors of DFU. Results Cr，urea nitrogen，PLT count，PT，Fib，FDP and DD in DFU group were higher than those in T2DM group （P<0.05），and Alb，HDL-C and TC were lower than those in T2DM group （P<0.05）. PLT count，PT and HDL-C were positively correlated （P<0.05），AT-Ⅲ was positively correlated with Alb，Cr and urea nitrogen （P<0.05），Fib was negatively correlated with Alb，HDL-C and TC （P<0.05），and DD was negatively correlated with Alb and HDL-C （P<0.05）. Fib and FDP were independent risk factors for DFU （P<0.05），and AT-III was a protective factor for DFU （P<0.05）. Conclusions Elderly patients with T2DM combined with DFU have a hypercoagulable state. The occurrence of DFU is related to PLT count and coagulation function. Monitoring PLT count and coagulation function is helpful for the early determination of complications of T2DM.