Table of Content

30 July 2016, Volume 31 Issue 7

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Orginal Article

Correlation of serum adiponectin with thyroid dysfunction in elderly people

SUN Jihong, ZHANG Yan, LU Hairong, SUN Tao, LA Mei, MU Junping, QIAN Jiao, SHEN Jianhua

2016, 31(7):  549-552.  DOI: 10.3969/j.issn.1673-8640.2016.07.001

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Objective To investigate the changes of metabolism indices,such as serum adiponectin （APN）, and the correlations with thyroid dysfunction in middle-aged and elderly people. Methods Electrochemiluminescence was used to determine 3,5,3'-triiodothyronine（T₃）,thyroxine（T₄）,free triiodothyronine（FT₃）,free thyroxine（FT₄）and thyroid stimulating hormone （TSH）in 159 patients with hyperthyroidism,120 patients with hypothyroidism and 140 healthy subjects（healthy control group）. Enzyme-linked immunosorbent assay（ELISA）was used for the determination of serum APN. The differences of serum APN,total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,apolipoprotein A1（apo A1）,apolipoprotein B（apo B）and apolipoprotein E（apo E）were analyzed among the groups. The correlations were analyzed as well. Results Serum APN,TC,TG,LDL-C and apo E had statistical significance in hyperthyroidism,hypothyroidism and healthy control groups（P<0.05）. Serum HDL-C,apo A1 and apo B was not statistically significant（P>0.05）. There were high correlations of FT₄ and TC in hyperthyroidism and hypothyroidism groups（r=-0.498 and -0.461,P=0.000）. Conclusions Serum APN and other indices in middle-aged and elderly people have obvious changes. TC is closely related with FT₄.

Correlations of serum free fatty acid and insulin resistance with metabolic syndrome

CHEN Xiaoqin, REN Jing

2016, 31(7):  553-558.  DOI: 10.3969/j.issn.1673-8640.2016.07.002

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Objective To study the change of serum free fatty acid（FFA）in metabolic syndrome（MS）patients,and to investigate the correlation of serum FFA with the risk factors of MS. Methods A total of 400 patients with MS and 100 healthy subjects （healthy control group） were enrolled. Their fasting serum FFA,fasting insulin（FINS）,fasting plasma glucose （FPG） and blood lipids [total cholesterol （TC）,triglyceride （TG）,low-density lipoprotein cholesterol（LDL-C）and high-density lipoprotein cholesterol（HDL-C）] were determined,and homeostasis model assessment for insulin resistance（HOMA-IR）was calculated. The height,weight,waist circumference,hip circumference,blood pressure,body mass index （BMI）and waist-to-hip ratio （WHR）were determined simultaneously. The 400 MS patients were classified into simple obesity group（120 cases）,diabetes mellitus group（110 cases）and hypertension group（170 cases）according to protopathies. Spearman analysis was used to analyze the correlations of serum FFA with blood lipids,blood pressure,FPG,BMI,WHR and insulin. Results Serum FFA,FPG,FINS,TC,TG,LDL-C,HOMA-IR,systolic blood pressure（SBP）,diastolic blood pressure（DBP）,BMI and WHR in MS group were higher than those in healthy control group （P<0.05）,but HDL-C was lower（P<0.05）. There was statistical significance for HOMA-IR and serum FFA in simple obesity,diabetes mellitus,hypertension and healthy control groups（P<0.05）. There were positive correlations of serum FFA with BMI,WHR,HOMA-IR,SBP,DBP,FPG,FINS,TG and LDL-C（r were 0.581,0.480,0.321,0.215,0.267,0.223,0.325,0.369 and 0.561,P<0.05）,and there was a negative correlation with HDL-C（r=-0.613,P<0.05）and no correlation with TC（r=0.674,P>0.05）. Conclusions Fasting serum FFA in MS patients is higher than that in healthy subjects with insulin sensitivity. Serum FFA is correlated in MS subgroups,and FPG,WHR,HDL-C and FINS have relationships with serum FFA and HOMA-IR.

Serum 25-hydroxyvitamin D determination in patients with acute exacerbation of chronic obstructive pulmonary disease

GU Feng

2016, 31(7):  559-561.  DOI: 10.3969/j.issn.1673-8640.2016.07.003

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Objective To investigate serum 25-hydroxyvitamin D [25（OH）D] determination in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods The levels of serum 25（OH）D and C-reactive protein（CRP） were determined in 72 patients with chronic obstructive pulmonary disease（COPD）（44 cases of AECOPD and 28 cases of remission of COPD） and 36 healthy subjects（healthy control group）by electrochemiluminescence and turbidimetry immunoassay. Results The level of serum 25（OH）D in AECOPD group [（14.9±5.9）ng/mL] was lower than those in COPD remission group [（20.8±8.0）ng/mL] and healthy control group [（23.9±8.6）ng/mL]（P<0.05）. However,there was no statistical significance for serum 25（OH）D between COPD remission group and healthy control group（P>0.05）. The level of serum CRP in AECOPD group [（44.5±13.3）mg/L] was higher than those in COPD remission group [（8.72±2.76）mg/L] and healthy control group [（2.68±1.72）mg/L]（P<0.05）. The level of serum CRP in COPD remission group was higher than that in healthy control group（P<0.05）. Conclusions The deficiency of serum 25（OH）D may be one of risk factors for AECOPD patients. The supplementation of 25（OH）D may have a preventive effect on AECOPD.

sCD14-ST in the early diagnosis of sepsis

LIAO Juan, LIN Lixing, LI Yangyu, QIN Xuejun, ZHOU Zixin, CHEN Rongyan, SONG Yanfang, LIN Qing

2016, 31(7):  562-566.  DOI: 10.3969/j.issn.1673-8640.2016.07.004

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Objective To investigate the significance of soluble CD14-subtype（sCD14-ST）in the early diagnosis of sepsis. Methods Prospective study was used. A total of 30 healthy controls and 50 patients with suspected sepsis were enrolled from March 2012 to August 2014. According to the guidelines of American College of Chest Physicians/Society of Critical Care Medicine（ACCP/SCCM）,the 50 patients were classified into sepsis group,bacterial infection of systemic inflammatory response syndrome（SIRS）group and local bacterial infection group. Plasma and/or serum were/was collected at the first medical evaluation before any medical treatment and after the use of antibiotics for 24 h and 72 h. The levels of sCD14-ST,procalcitonin（PCT）and C-reactive protein（CRP）were determined. Receiver operating characteristic（ROC）curve was used to evaluate the role of sCD14-ST in the early diagnosis of sepsis. Results sCD14-ST,PCT and CRP levels were higher in 3 patient groups than in control group at the first medical evaluation before any medical treatment（P<0.05）. There was statistical significance for sCD14-ST level among the 3 patient groups（P<0.05）. There was no statistical significance for PCT and CRP levels between bacterial infection of SIRS and sepsis groups（P>0.05）. The dynamic changes of sCD14-ST,PCT and CRP levels in sepsis group before and after treatment were analyzed. sCD14-ST level had statistical significance at the first medical evaluation before any medical treatment and after the use of antibiotics for 24 h and 72 h （P<0.05）. The areas under ROC curves were 0.956 for sCD14-ST,0.939 for PCT and 0.848 for CRP, respectively. Conclusions sCD14-ST is better than PCT and CRP in the diagnosis of sepsis,which can provide a reference for the early diagnosis of sepsis.

The combined determination of GPI,anti-CCP antibody and RF for the diagnosis of rheumatoid arthritis

FENG Yuchen, FANG Qingqing, LIN Junping, XU Xiayu, ZHU Hui, SHEN Haili

2016, 31(7):  567-570.  DOI: 10.3969/j.issn.1673-8640.2016.07.005

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Objective To investigate the combined determination of glucose-6-phosphate isomerase（GPI）,anti-cyclic citrulinated peptide（CCP） antibody and rheumatoid factor（RF） for the diagnosis of rheumatoid arthritis（RA）. Methods A total of 60 RA patients were enrolled,and 60 non-RA patients were enrolled,including 28 patients with systemic lupus erythematosus （SLE）,22 patients with ankylosing spondylitis（AS） and 10 patients with osteoarthritis （OA）. A total of 30 healthy subjects were enrolled as healthy control group. GPI and anti-CCP antibody were determined by enzyme-linked immunosorbent assay,and RF was determined by turbidimetric immunoassay. Erythrocyte sedimentation rate（ESR） and C-reactive protein（CRP）were also determined. Disease activity score in 28 joints（DAS28）was used. Receiver operating characteristic （ROC）curve was used to define optimal threshold of GPI for the diagnosis of RA. Pearson correlation analysis was used to evaluate the correlations of GPI,anti-CCP antibody and RF with ESR,CRP and DAS28. Results There was statistical significance for RA and non-RA groups compared with healthy control group（P<0.05）. There was statistical difference for GPI,anti-CCP antibody and RF in RA group compared with non-RA group（P<0.05）. ROC curve showed that the optimal threshold of GPI was 0.28 mg/L for the diagnosis of RA,the sensitivity was 82.2%,the specificity was 89.5%,and the area under ROC curve was 0.87. The positivity of combined determination was defined as each index （GPI,anti-CCP antibody and RF） was positive,and the sensitivities and specificities of GPI and anti-CCP antibody single determinations were higher than those of RF single determination. The sensitivity of the combined determination was the lowest,but the specificity was the highest （99.9%）. There were 8 anti-CCP antibody-negative patients in RA group,its concentration of GPI was 0.757（0.001-3.001）μg/mL,and its positive rate was 87.5%. GPI was positively correlated with ESR, CRP and DAS28 in RA group （r=0.117,0.041 and 0.104,P<0.001）. Conclusions GPI can be used as an indicator for the diagnosis of RA and distinguishing RA activeness,especially for RA patients with negative anti-CCP antibody. The combined determination of GPI,anti-CCP antibody and RF can improve specificity in the diagnosis of RA.

The monitoring of Brucella and clinical analysis of human brucellosis in the southwest of Shandong Province

GAO Dongtian

2016, 31(7):  571-575.  DOI: 10.3969/j.issn.1673-8640.2016.07.006

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Objective To analyze the epidemic status of human brucellosis in the southwest of Shandong Province,and to provide a reference for prevention and control. Methods The isolates of Brucella were cultured by BacT ALERT 3D120 and identified by VITEK 2 Compact. The epidemiological analysis was performed with the case histories of patients. SPSS 17.0 software was used for statistical analysis. Results In 94 patients,there were 72 males（76.6%） and 22 females（23.4%）. The ratio of males to females was 3.27∶1. The ages were from 2 to 77 years,and 68.1% of them were 30-60 years old. There were 76 patients（80.9%） in Jining,mainly from Zoucheng City and Jiaxiang County. There were 18 patients（19.1%） in Heze,mainly from Juye County and Yuncheng County. There were 81 peasants（86.2%）in 94 patients,and 59 patients of them（62.8%）had contact with goats. The occurrence rate was 54.3% from April to June. The patients with respiratory tract infection accounted for 56.5%. There were some high indices,including alanine aminotransferase（ALT）（61 cases）,aspartate aminotransferase（AST）（59 cases）,C-reactive protein（CRP）（72 cases）and procalcitonin（PCT）（64 cases）. The positive alarm always happened in oxygen bottles on the 2nd-5th days. The identification rate of Brucella melitensis was 91%-99%. The rates for therapies with rifampin,doxycycline,levofloxacin and minocycline were 100.0%,68.1%,44.7% and 31.9%,respectively. Conclusions In the southwest of Shandong Province,human brucellosis is scattered,and there is an increasing trend. The detection of Brucella and clinical analysis of human brucellosis are important for the prevention and treatment of diseases and epidemiological analysis.

Pathogen distribution and drug resistance of hospital-acquired urinary tract infection in elderly patients with different ages

WENG Lizhen, ZHU Liyue, CHEN Menglin, HU Leiguang

2016, 31(7):  576-580.  DOI: 10.3969/j.issn.1673-8640.2016.07.007

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Objective To analyze the pathogen distribution and drug resistance of hospital-acquired urinary tract infection in elderly patients with different ages,in order to provide a reference for clinical prevention,control and treatment of hospital-acquired urinary tract infection in elderly patients. Methods A total of 2 145 isolates were collected from urine samples of patients with hospital-acquired urinary tract infection. These isolates were identified by ATB identification analyzer. Kirby-Bauer method was used for analyzing drug resistance,according to the Clinical and Laboratory Standards Institute （CLSI） M100-S24. Results A total of 374 isolates（17.4%）were collected from urine samples of patients with ≤60 years old,263 isolates（12.3%）were collected from urine samples of patients with 61-70 years old,443 isolates（20.7%）were collected from urine samples of patients with 71-80 years old,and 1 065 isolates（49.6%）were collected from urine samples of patients with >80 years old. The detection rates of Enterococcus faecium and Enterococcus faecalis increased with ages. The drug resistance rates of Escherichia coli increased with ages against piperacillin,ampicillin-sulbactam,piperacillin-tazobactam,cefazolin,cefaclor,cefuroxime,cefotaxime,ceftazidime,cefepime,ertapenem,ciprofloxacin and compound sulfamethoxazole. The drug resistance rates of Klebsiella pneumoniae increased with ages against cefepime and amikacin. The drug resistance rates of Enterococcus faecalis increased with ages against ampicillin, ciprofloxacin and levofloxacin. The drug resistance rates of Enterococcus faecium increased with ages against ciprofloxacin and levofloxacin. Conclusions The drug resistance of pathogens in elderly patients with hospital-acquired urinary tract infection is serious.

Wells' score combined with D-dimer determination for screening deep vein thrombosis

DUAN Xiuqun, YIN Liangqiong, GONG Guofu

2016, 31(7):  581-583.  DOI: 10.3969/j.issn.1673-8640.2016.07.008

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Objective To investigate the significance of clinical probability model Wells' score combined with D-dimer（DD）determination for screening deep vein thrombosis（DVT）. Methods A total of 127 patients with suspected DVT were enrolled for Wells' score,and the prediction probability score was obtained. DD level before treatment was determined. According to the color Doppler flow imaging and multislice CT venography,the further diagnosis was performed. Results The positive rate of Wells' score for screening DVT was 30.7%,and the positive rate of DD determination was 36.2%. The positive rate of combined determination for screening DVT was 47.2%,which was higher than those of Wells' score and DD determination（P<0.05）. The performance of DD determination was better than that of Wells' score（P<0.05）. Conclusions Wells' score combined with DD determination can help for the early screening of DVT,reduce miss diagnosis rate,and effectively eliminate DVT.

Correlations of ALDH2 gene polymorphism and living habits with gastric cancer susceptibility

YUAN Qing, XUE Yadong, ZHENG Yaping, WANG Qunying

2016, 31(7):  584-587.  DOI: 10.3969/j.issn.1673-8640.2016.07.009

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Objective To investigate the correlations of aldehyde dehydrogenase 2（ALDH2） gene polymorphism and bad living habits with gastric cancer susceptibility. Methods By gene chip technology,161 patients with gastric cancer and 150 healthy subjects（healthy control group） were determined for ALDH2 gene polymorphism. The information on living habits（smoking,drinking,eating too fast,overeating and liking hot food,pickled food and spicy food） was collected. Logistic regression analysis was used for evaluating the factors of gastric cancer susceptibility. Results The proportion of bad living habits in gastric cancer group was higher than that in healthy control group（P<0.05）. The frequency of GG genotype of ALDH2 gene polymorphism was higher than those of GA and AA genotypes（P<0.05）,G allele frequency was higher than A allele frequency（P<0.05）,but there was no statistical significance between males and females （P>0.05）. Logistic regression analysis showed that genotypes [odds ratio（OR）=3.767,95% confidence interval（CI）1.92-8.77）,alleles（OR=3.200,95% CI 1.68-7.85）,bad living habits（OR=2.779,95% CI 0.85 - 5.82） and gastric cancer symptoms（OR= 3.180,95% CI 0.99-6.72） were risk factors for gastric cancer susceptibility（P<0.05）. Conclusions Bad living habits and ALDH2 gene polymorphism are correlated with gastric cancer susceptibility.

Comparison of T cell subset absolute counts between single-platform and double-platform flow cytometry

HU Xiaolei, ZHOU Lingling, ZHAO Zhigang

2016, 31(7):  593-598.  DOI: 10.3969/j.issn.1673-8640.2016.07.012

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Objective To find out a stable and economical method based on CYTOMICS FC500 for T cell subset absolute counts in peripheral blood. Methods T cell subset absolute counts in 280 patients' peripheral blood were determined by single-platform and double-platform CYTOMICS FC500 flow cytometry（FCM）,and the consistency and correlation of the 2 methods were analyzed. The within-run and between-run precisions of the 2 methods in high-level and low-level samples were evaluated. Results The double-platform FCM correlated well with single-platform FCM for T cell subset absolute counts（r≥0.984）,but T cell subset absolute counts differed between the 2 methods（P<0.01）. The mean absolute count of double-platform FCM for CD4⁺CD8-（CD4+）T cell was lower than that of single-platform FCM by 36.5 （-71.8,114.7）cells/μL,and the mean bias percentage was 8.7%（-13.8%,31.2%）. The mean absolute count of double-platform FCM for CD4-CD8⁺（CD8+）T cell was lower than that of single-platform FCM by 41.4 （-84.4,167.2）cells/μL,and the mean bias percentage was 8.7%（-13.9%,31.3%）. The absolute counts of CD4-CD8- T cell（DNT） and CD4+CD8+ T cell（DPT） obtained by double-platform FCM were lower than those by single-platform FCM. The within-run coefficients of variation（CV） of double-platform FCM for CD4+ T cell,CD8+ T cell,DNT cell and DPT cell in high-level and low-level samples were 3.5% and 4.2%,3.8% and 3.4%,6.1% and 7.6%,and 9.5% and 18.7%. The between-run CV were 5.1% and 5.9%,5.5% and 5.1%,7.7% and 9.6%,and 12.2% and 24.6%,which were lower than those of single-platform FCM. The within-run CV of single-platform were 4.0% and 4.8%,4.2% and 4.0%,6.7% and 8.6%,and 11.1% and 21.4%,and the between-run CV were 6.3% and 7.5%,7.0% and 6.8%,8.5% and 10.3%,and 13.6% and 26.4%. Conclusions The differences of T cell subset absolute counts between double-platform and single-platform FCM based on CYTOMICS FC500 are too big to use the 2 methods alternately. Furthermore,double-platform FCM is precise and economical,which is a good choice.

GeneXpert MTB/RIF system in the diagnosis of pulmonary tuberculosis

ZHANG Qing, XU Bingru, LI Kecheng

2016, 31(7):  599-602.  DOI: 10.3969/j.issn.1673-8640.2016.07.013

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Objective To evaluate the significance of GeneXpert MTB/RIF system in the diagnosis of pulmonary tuberculosis. Methods A total of 99 sputum samples from suspected pulmonary tuberculosis patients were collected,and the samples were determined by acid fast staining,Mycobacterium tuberculosis（MTB） culture and GeneXpert MTB/RIF system. Results The positive rates of GeneXpert MTB/RIF system,MTB culture and acid fast staining were 29.6%,25.7% and 20.2% in all suspected pulmonary tuberculosis patients. The positive rates of GeneXpert MTB/RIF system,MTB culture and acid fast staining were 100.0%,100.0% and 80.0% in confirmed cases. Conclusions GeneXpert MTB/RIF system is of significance in the diagnosis and treatment efficiency evaluation of pulmonary tuberculosis.

The determination of mannan for the diagnosis of invasive candidiasis

JIANG Yueting, XIAO Yiwen, SU Danhong, YI Jianyun

2016, 31(7):  603-606.  DOI: 10.3969/j.issn.1673-8640.2016.07.014

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Objective To investigate the determination of mannan for the diagnosis of invasive candidiasis. Methods Mannan concentrations were determined in 53 patients with invasive candidiasis,30 patients with bacterial infection,28 patients with skin Candida infection and 20 healthy subjects （healthy control group） by enzyme-linked immunosorbent assay （ELISA）. Receiver operating characteristic （ROC） curve was used to evaluate diagnostic efficacy,and freeze-and-thawing experiment was used to determine stability. Results According to the positive threshold of the kits （≥1.0 μg/L）,the positive rate of mannan in invasive candidiasis group was higher than those in bacterial infection,skin Candida infection and healthy control groups （P<0.01）. ROC curve showed that the diagnostic sensitivity and specificity were 66.1% and 96.2% at positive threshold of ≥1.0 μg/L. The diagnostic sensitivity and specificity were 73.6% and 87.1% at positive threshold of ≥0.6 μg/L,and its area under the curve was 0.829 （95% confidence interval was 0.749-0.908）. After freeze-and-thawing for 1-4 times,mannan concentrations decreased by times with statistical significance （P<0.05）. Conclusions Mannan concentration may be a marker for the early diagnosis of invasive candidiasis.

IFCC reference methods on the determination of glycated hemoglobin A1c and laboratory network inter-comparison

LI Qing, JU Yi, JIN Zhonggan, YU Xiaoxuan, OU Yuanzhu, TANG Liping, WANG Meijuan, LIU Wenbin

2016, 31(7):  607-609.  DOI: 10.3969/j.issn.1673-8640.2016.07.015

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The International Federation of Clinical Chemistry and Laboratory Medicine（IFCC） introduces the reference methods on the determination of glycated hemoglobin A_1c（HbA_1c） and the laboratory network inter-comparison and value assignment. This article briefly introduces the principle and operation of reference methods and also includes the last international reference laboratory network inter-comparison as an example. A total of 6 calibrators,5 inter-comparison samples,2 controls and 3 CalCheck samples are used with glutamic acid endoproteinase to release glycated six peptides （Glu-Val-His-Leu-Thr-Pro-Glu） and non-glycated six peptides （Val-His-Leu-Thr-Pro-Glu）. High performance liquid chromatography（HPLC） is used to collect fraction of six peptides' mixture. The HbA1c and hemoglobin A₀（HbA0） mixture is separated by capillary electrophoresis. The peak areas of HbA_1c and HbA₀ are integrated,and the ratio is calculated. The calibration curve is made by measuring 5 calibrators. The linearity between test values and given values is good with the equation Y_{given values}= 0.998 36 Xtest values-0.000 08 （R2=0.999 82）. The test results show low proportional bias（-0.001） and systematic bias （0.23）when they are assessed with other network laboratories. IFCC reference method can accurately measure HbA_1c. In this inter-comparison,the results are qualified and thus can assign values accurately and reliably to IFCC calibrators. The values provide supports for global HbA_1c traceability to IFCC international units.

Quality control procedures for patient data

FEI Yang, WANG Wei, WANG Zhiguo

2016, 31(7):  610-612.  DOI: 10.3969/j.issn.1673-8640.2016.07.016

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：With the development of quality control procedures based on risk management,clinical laboratories can combine different types of quality control to monitor different failure modes or different sources of errors. Quality control procedures based on patient results can improve the capability of error detection and reduce the usage of expensive quality control materials. The article is mainly about quality control procedures for patient data,and quality control procedures can be a reference for clinic. The use of quality control procedures for patient data can obtain accurate and reliable results,so that laboratories can provide a good service for clinic.

Development and application of strain management system in clinical microbiology laboratories

LIN Xuefeng, YING Huayong, CHEN Xiaojun, JIANG Danying, WANG Bingyong, CHEN Jing

2016, 31(7):  613-617.  DOI: 10.3969/j.issn.1673-8640.2016.07.017

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A successfully-applied strain management system in clinical microbiology laboratories was described. The system includes system login module,user management module,strain information management module,basic datum table management module,information input module,strain search and recovery use module and recovery strains' record query module. The system can effectively improve the standardization and working efficiency of strain management,and provide support for public health security by tracking the usage of clinical strains.

Research progress and treatment strategies of carbapenemases-producing Enterobacteriaceae

LIU Ping, MU Hong

2016, 31(7):  618-622.  DOI: 10.3969/j.issn.1673-8640.2016.07.018

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Enterobacteriaceae being resistant to carbapenemases has occurred in many countries in recent years. The main mechanism is carbapenemases-producing. Particularly,Enterobacteriaceae,which produces Class A enzymes of Klebsiella pneumoniae carbapenemases（KPC） or Class B metallo-beta-lactamases（MβL）,has outbroken in many areas of the world. Carbapenemases-producing Enterobacteriaceae（CPE） could result in serious bacterial infections and lead to patient death. However,the current treatment options are limited,so the early detection and monitoring of CPE colonization or infection are crucial for controlling the occurrence and spread of drug resistance.

Status of clinical application of ionized calcium determination and corrected calcium concentration equation

WU Jiong, PAN Baishen

2016, 31(7):  623-626.  DOI: 10.3969/j.issn.1673-8640.2016.07.019

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Total calcium is consisted of ionized calcium and physiologically inactive calcium（mainly associated with albumin,as well as bicarbonate,citrate and lactate）. Monitoring patients' calcium status is not straightforward, because both ionized and total calcium determinations are commonly available for clinical interpretation,and each has advantages and disadvantages. Total calcium is more convenient to be measured than ionized calcium,and is more frequently used by clinical laboratories. However,total calcium can not represent patients' calcium status correctly in some specific clinical situations. This review focuses on the research status of corrected calcium concentration equation,ionized calcium and total calcium.