Table of Content

20 May 2017, Volume 32 Issue 5

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Orginal Article

Combined determination of 15 biochemical indicators for the first treatment of malignant liver tumors

LIU Fenghua, WANG Lijie, ZHOU Yunheng, LI Jian, HU Qiong

2017, 32(5):  353-360.  DOI: 10.3969/j.issn.1673-8640.2017.05.002

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Objective To investigate the combined determination of 15 biochemical indicators for the first treatment of malignant liver tumors. Methodse A total of 54 patients with primary hepatic carcinoma（PHC）,54 patients with metastatic hepatic carcinoma（MHC） and 120 healthy subjects [normal control（NC）group] were enrolled. Serum cholyglycine（CG）,prealbumin（PA）,total bile acid（TBA）,mitochondrial aspartate aminotransferase（m-AST）,alanine aminotransferase（ALT）,aspartate aminotransferase（AST）,gamma-glutamyltransferase（GGT）,alkaline phosphatase（ALP）,lactate dehydrogenase（LDH）,cholinesterase（CHE）,total bilirubin（TB）,direct bilirubin（DBil）,total protein（TP）,albumin（Alb）and Alb/globulin（A/G） ratio were determined. Receiver operating characteristic（ROC）curve was used to evaluate diagnosis performance. Exploratory factor analysis（EFA） and Logistic regression model were used to investigate the significance from single determinations to combined determination. Results The 15 biochemical indicators were statistically significant between PHC and NC groups and MHC and NC groups （P<0.05,P<0.001）. There was statistical significance for TP,AST,m-AST,ALT,GGT,LDH,CG and TBA between PHC and MHC groups（P<0.05,P<0.001）,and there was no statistical significance for the other indicators （P>0.05）. Except for TP [area under ROC curve（AUC）=0.626],the other indicators' AUC in PHC group were ≥0.7. Except for ALT（AUC=0.600）and TB（AUC=0.566）,the other indicators' AUC in MHC group were ≥0.7. EFA showed that there were 6 potential factors in PHC and MHC groups. Each potential factor was screened by comprehensive evaluation method. P₉ model was made up of PA,CHE,Alb,CG,DBil,GGT,ALT,AST and LDH in PHC group. M₉ model was made up of PA,CHE,Alb,TBA,DBil,GGT,AST,LDH and TP in MHC group. The diagnosis performance of P₉ and M₉ was similar to the combined determination of 15 biochemical indicators （Z=0.590,P=0.555 4;Z=0.515,P=0.606 8）. The AUC of P₉ and M₉ were > 0.95,the sensitivities and specificities were > 95%,the positive likelihood ratios were >10,and the negative likelihood ratios were < 0.1. The optimal cut-off values of P₉ and M₉ were 1.66 and 0.58. Conclusions P₉ and M₉ models are effective for diagnosis performance and economical,which can replace the combined determination of 15 biochemical indicators,for the evaluation of treatment efficiency and follow-up monitoring of liver cancer.

Correlation of bone mineral density with bone turnover biochemical markers in postmenopausal women

WANG Rong, CHEN Guangjie, SHEN Anda, HUANG Keliang, ZHOU Yingliang

2017, 32(5):  361-366.  DOI: 10.3969/j.issn.1673-8640.2017.05.003

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Objective To analyze the correlation of bone mineral density with bone turnover biochemical markers in premenopausal and postmenopausal women,and to investigate the levels of bone metabolism biochemical markers of women with decreasing bone mineral density in premenopause and postmenopause. Methodse Bone mineral densities of lumbar spine（L1-L4）and femoral neck were determined by dual energy X-ray. According to bone mineral densities,185 postmenopausal 45-65-year-old women were classified into bone mass normal group（50 cases）,bone mass loss group （35 cases）and osteoporosis group （100 cases）. A total of 45 postmenopausal 51-70-year-old women with decreasing bone mineral density were enrolled as postmenopausal decreasing bone mineral density group. A total of 25 premenopausal 42-50-year-old women with decreasing bone mineral density were enrolled as premenopausal decreasing bone mineral density group. Enzyme-linked immunosorbent assay（ELISA）was used to determine the levels of serum cathepsin K （Cathe K）,bone alkaline phosphatase（B-ALP）and tartrate-resistant acid phosphatase （TRAP）. The levels of osteocalcin,beta-collagen degradation product（β-crosslaps）and type Ⅰ procollagen N-terminal propeptide （PⅠNP）were determined by electrochemiluminescence. Results The levels of serum Cathe K,PⅠNP,β-crosslaps,osteocalcin and TRAP in osteoporosis group were higher than those in bone mass normal group （P<0.05）,which showed negative correlations with the bone mineral density of lumbar spine or femoral neck （P<0.05）,and B-ALP level was slightly lower than that in bone mass normal group without statistical significance （P>0.05）. Serum Cathe K and TRAP levels were lower in postmenopausal decreasing bone mineral density group than those in premenopausal decreasing bone mineral density group（P<0.01）,and serum PⅠNP and osteocalcin levels were higher（P<0.01）. The bone mineral densities of lumbar spine and femoral neck and the levels of β-crosslaps and B-ALP in the premenopausal and postmenopausal groups had no statistical significance（P>0.05）. Conclusions Postmenopausal women with osteoporosis is high turnover type. The levels of serum osteocalcin,β-crosslaps,PⅠNP,B-ALP,TRAP and Cathe K can reflect bone metabolism. Bone mineral density examination combined with bone turnover biochemical markers can be used for the prevention and treatment monitoring of osteoporosis.

Receiver operating characteristic curve for free fatty acid determination in patients with coronary heart disease

GU Keping, WANG Yaping, YU Wei, ZHANG Min, GONG Mengjiao, JIANG Yuhai

2017, 32(5):  367-369.  DOI: 10.3969/j.issn.1673-8640.2017.05.004

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Objective To investigate the correlation of free fatty acid （FFA）with coronary heart disease （CHD）. Methodse A total of 110 patients with CHD,71 disease controls and 50 healthy subjects（healthy control group） were enrolled. Serum FFA,homocysteine（Hcy）,triglyceride（TG）,total cholesterol（TC） and lipoprotein（a）[Lp（a）] levels were determined. Receiver operating characteristic（ROC）curve was used to evaluate the diagnosis performance of each index. Results FFA,Hcy,TG and Lp（a）levels in CHD group were higher than those in healthy control group（P<0.01） and disease control group（P<0.05,P<0.01）,those in disease control group were higher than those in healthy control group （P<0.01）. TC had no statistical significance among the 3 groups （P>0.05）. The optimal cut-off value of FFA for the diagnosis of CHD was 596.20 μmol/L,the area under ROC curve was 0.924,the sensitivity was 85.5%,and the specificity was 90.1%. The diagnosis performance of FFA was superior to those of Hcy,TG,Lp（a） and TC. Conclusions FFA plays a role in the diagnosis of CHD.

Correlation of blood lipid levels with ankylosing spondylitis

WU Zhiqiang, YANG Bin, FENG Weihua, CHEN Jie, HUANG Hengjian

2017, 32(5):  370-373.  DOI: 10.3969/j.issn.1673-8640.2017.05.005

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Objective To study the correlation of blood lipid levels with ankylosing spondylitis （AS）. Methodse A total of 314 AS patients and 138 healthy subjects （healthy control group） were enrolled. Total cholesterol（TC）,triglyceride（TG）,low-density lipoprotein cholesterol（LDL-C）,high-density lipoprotein cholesterol（HDL-C） and C-reactive protein（CRP） were determined. The correlation of blood lipid levels with AS was evaluated. Results Compared with healthy control group,AS group had increased level of TG and LDL-C/HDL-C ratio （P<0.01） and decreased levels of TC,HDL-C and LDL-C （P<0.01）. TC,TG,HDL-C and LDL-C in AS group were negatively correlated with CRP （r=-0.298,-0.198,-0.256 and -0.259,P=0.001,<0.001,<0.001 and <0.001）. According to CRP levels,AS group was sub-classified into low-level CRP group （CRP≤10 mg/L）,middle-level CRP group （CRP>10-<50 mg/L） and high-level CRP group （CRP≥50 mg/L）. Compared with high-level CRP group,TC,TG,HDL-C and LDL-C were lower than those in low-level CRP group （P<0.01）. There was no statistical significance for LDL-C/HDL-C ratio among the groups （P>0.05）. Conclusions AS patients have blood lipid metabolic disorder. Their blood lipid levels may be correlated with inflammation status.

Plasma heat shock protein 90 alpha in the diagnosis and treatment of breast cancer

ZHANG Wenlong, LU Renquan, JIANG Minglei, WANG Yanchun, GAO Xiang, GUO Lin

2017, 32(5):  374-377.  DOI: 10.3969/j.issn.1673-8640.2017.05.006

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Objective To investigate the role of plasma heat shock protein 90 alpha （Hsp90α） in the diagnosis and treatment of breast cancer. Methodse Plasma samples were collected from 289 patients with breast cancer,172 patients with benign breast disease and 90 healthy subjects （healthy control group）. Enzyme-linked immunosorbent assay（ELISA） was used for determining Hsp90α levels,and the difference of Hsp90α levels among age,tumor size,clinical stage and lymphatic metastasis was analyzed. Results The level of Hsp90α in breast cancer group was higher than those in benign breast disease and healthy control groups（P<0.001）. There was no statistical significance for Hsp90α levels with different ages （P>0.05）. Hsp90α levels in patients with a tumor≥3 cm,inⅡ-Ⅳclinical stages and with lymphatic metastasis were higher than those with a tumor <3 cm （P=0.003）,inⅠclinical stage （P<0.001） and without lymphatic metastasis （P=0.031）,respectively. Conclusions Plasma Hsp90α might be a potential tumor marker for breast cancer,which plays a role in the diagnosis and prognosis of breast cancer.

Blood lipid levels and risk factors in pregnant women with preeclampsia during the second trimester pregnancy

YANG Wenwei, YUE Chaoyan

2017, 32(5):  378-381.  DOI: 10.3969/j.issn.1673-8640.2017.05.007

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Objective To investigate blood lipid levels and risk factors in pregnant women with preeclampsia during the second trimester pregnancy. Methodse Serum triglyceride（TG）,total cholesterol（TC）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C）,apolipoprotein（apo） A1,apo B100,free fatty acid（FFA）,lipoprotein（a）[Lp（a）] were determined in 456 healthy pregnant women （healthy control group）and 62 pregnant women with preeclampsia at 24-28 gestational weeks. Body mass index （BMI） was calculated at 14-18 gestational weeks. Risk factors were analyzed by multivariate Logistic regression analysis. Results Compared with healthy control group,BMI,systolic blood pressure,diastolic blood pressure,TG,FFA,Lp（a）,HDL-C,LDL-C and apo B100 levels were increased in preeclampsia group（P<0.05）,and the difference for other indices between the 2 groups had no statistical significance（P>0.05）. Multivariate Logistic regression analysis showed that after adjusting for age and gestational weeks,BMI at 14-18 gestational weeks [odds ratio（OR）=1.46,95% confidence interval（CI） 1.20-1.78],Lp（a）（OR=1.01,95%CI 1.00-1.02）,apo B100（OR=3.27,95% CI 1.07-10.67）,systolic blood pressure（OR=4.71,95% CI 2.05-9.32）,diastolic blood pressure（OR=3.42,95% CI 1.34-8.64） were risk factors for preeclampsia. Conclusions The abnormal levels of blood pressure and blood lipid metabolism in pregnancy are related to preeclampsia.

Determinations of serum amyloid A and C-reactive protein for the diagnosis of infectious diseases in children

TIAN Yueru, LI Wei, YE Zhicheng, YANG Dan, XU Jin

2017, 32(5):  382-385.  DOI: 10.3969/j.issn.1673-8640.2017.05.008

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Objective To investigate the combined determination of serum amyloid A （SAA） and C-reactive protein （CRP） for the diagnosis of infectious diseases in children. Methodse SAA and CRP levels were determined in 65 patients with viral infection,72 patients with bacterial infection and 60 healthy children （healthy control group）,and white blood cell （WBC） count and differentiation were determined,and the neutrophil/lymphocyte ratio （NLR） was calculated. Receiver operating characteristic （ROC）curve was used to analyze the efficacy of SAA,CRP,SAA/CRP ratio,WBC count and NLR in the diagnosis of bacterial and viral infections. Results The levels of SAA,CRP,WBC count and NLR in bacterial infection group were higher than those in healthy control group （P<0.05）,and SAA/CRP ratio was lower（P<0.05）. The levels of SAA and SAA/CRP ratio were higher in viral infection group than those in healthy control group （P<0.05）,and there was no statistical significance for CRP,WBC count and NLR compared with healthy control group（P>0.05）. ROC curve showed that CRP had the best performance for the diagnosis of bacterial infection,and the area under ROC curve （AUC）,sensitivity and specificity were 0.977,99.0% and 83.2%,respectively. SAA/CRP ratio had the best performance for the diagnosis of viral infection,and AUC,sensitivity and specificity were 0.916,87.7% and 89.4%. Conclusions SAA and CRP can be used as diagnostic parameters for bacterial infection. In viral infection,SAA increases more obviously than CRP,and SAA/CRP ratio is sensitive. The combined determination of SAA and CRP can determine the types of infections quickly and accurately,and can provide a reference for the early diagnosis and follow-up treatment.

Prenatal screening for 63 109 pregnant women in Shanghai

SUN Bin, WANG Shan, QIAN Jun, TANG Zhenhua

2017, 32(5):  386-389.  DOI: 10.3969/j.issn.1673-8640.2017.05.009

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Objective To evaluate the results of prenatal screening for pregnant women in Shanghai,including the indices of alanine aminotransferase （ALT）, aspartate aminotransferase （AST）, hepatitis B surface antigen （HBsAg）, anti-hepatitis C virus （HCV） antibody, anti-human immunodeficiency virus （HIV） antibody and anti-treponema pallidum （TP） antibody. Methodse The levels of ALT, AST, HBsAg,anti-HCV antibody,anti-HIV antibody and anti-TP antibody were determined in 63 109 pregnant women from 2013 to 2016. Results The positive rates of HBsAg,anti-TP antibody,ALT and AST were higher in >35-year-old group than those in ≤35-year-old group （P<0.01）. There was no statistical significance for the positive rate of anti-HCV antibody between the 2 groups （P>0.05）. The positive rate of HBsAg had a decreasing trend from 2013 to 2016 （P<0.05）. The positive rate of anti-TP antibody had an increasing trend （P<0.05）,and there was no statistical significance for the other indices from 2013 to 2016 （P>0.05）. The women with abnormal pregnancy history had a higher positive rate of anti-TP antibody compared with healthy pregnant women （P<0.01）,and other indices had no statistical significance between the 2 groups（P>0.05）. Conclusions Prenatal screening may contribute to understand the prevalence of diseases in pregnant women,which is beneficial for good prenatal and postnatal care.

Influence of three dimensional conformal radiation therapy combined with chemotherapy on Treg in peripheral blood of esophagus carcinoma patients

XU Xinxin, WANG Yungang, CAI Hua, SHEN Pei, CHU Fuying

2017, 32(5):  390-393.  DOI: 10.3969/j.issn.1673-8640.2017.05.010

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Objective To investigate the influence of three dimensional conformal radiation therapy （3D-CRT） combined with chemotherapy on CD4⁺ Foxp⁺ regulatory T cell （Treg） proportion and transforming growth factor-beta 1 （TGF-β1） level in peripheral blood of esophagus carcinoma patients,and to investigate the internal influence mechanism of 3D-CRT combined with chemotherapy for the treatment of esophagus carcinoma. Methodse Flow cytometry was used to determine Treg proportion in 87 esophagus carcinoma patients and 30 healthy subjects. Serum TGF-β1 level was determined by enzyme-linked immunosorbent assay （ELISA）. The difference of Treg proportion and TGF-β1 level was analyzed among patients undergoing 3D-CRT combined with chemotherapy,patients with single 3D-CRT and healthy subjects. Results Compared to single 3D-CRT group,the Treg proportion and TGF-β1 level in peripheral blood decreased in 3D-CRT combined with chemotherapy group after patients undergoing radiochemotherapy （P<0.05）. Conclusions The 3D-CRT combined with chemotherapy could reduce Treg proportion and TGF-β1 level in peripheral blood of esophagus carcinoma patients,and plays a role for the treatment of esophagus carcinoma.

Elevation of interleukin-37b-producing lymphocyte proportion in patients with active pulmonary tuberculosis

LIU Ganbin, ZHANG Junai, DAI Youchao, ZHUANG Zegang, CHEN Chen, YI Lailong, XU Junfa

2017, 32(5):  394-398.  DOI: 10.3969/j.issn.1673-8640.2017.05.011

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Objective To investigate the proportion of interleukin （IL）-37b-producing lymphocytes in patients with active pulmonary tuberculosis （ATB）. Methodse IL-37b-producing lymphocytes in peripheral blood from 42 patients with ATB were determined by flow cytometry,and the 8 patients were followed up. A total of 10 healthy subjects were enrolled as healthy control group. Results The proportion of IL-37b-producing lymphocytes in patients with ATB was higher than that in healthy control group,and it was decreased after treatment in the 8 followed-up patients. The proportion of IL-37b-producing lymphocytes in patients with positive tuberculosis antibody and positive sputum smear were higher than those in patients with negative tuberculosis antibody and negative sputum smear,respectively. The proportion of IL-37b-producing lymphocytes in patients received treatment again was higher than that in patients received initial treatment. The proportion of IL-37b-producing lymphocytes in peripheral blood mononuclear cell （PBMC）increased after the stimulation by bacillus Calmette-Guerin vaccination,especially for ATB patients. Conclusions The proportion of IL-37b-producing lymphocytes in patients with ATB is correlated with the severity and prognosis of ATB. The proportion of IL-37b-producing lymphocytes might be a parameter for evaluating the curative effect in ATB.

Reference intervals of serum HE4 and ROMA index determined by electrochemiluminescence

HE Hua, HU Rong, LI Feng, ZHU Yafei, REN Ling, JIANG Lixia

2017, 32(5):  399-402.  DOI: 10.3969/j.issn.1673-8640.2017.05.012

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Objective To investigate the reference intervals of serum human epididymis protein 4 （HE4） and the risk of ovarian malignancy algorithm （ROMA） index in females. Methodse Serum HE4 and carbohydrate antigen 125 （CA125） were determined by Roche Cobas E601 automatic electrochemiluminescence in 700 healthy subjects （414 cases of non-menopause and 286 cases of menopause） and 160 ovarian tumor patients （80 cases of ovarian malignant tumor and 80 cases of ovarian benign tumor）,and ROMA index was calculated according to ROMA model. The reference intervals of serum HE4 and ROMA index in females were established,and the clinical diagnostic performance of serum HE4 and ROMA index with different reference intervals was verified. Results The reference intervals of serum HE4 were <72.25 pmol/L in premenopausal females and <82.72 pmol/L in postmenopausal females. The reference intervals of ROMA index were <15.09% in premenopausal females and <21.32% in postmenopausal females. Conclusions The combined determination of CA125 and serum HE4 and ROMA index improves the diagnosis of ovarian epithelial cancer, and the establishment of serum HE4 and ROMA index reference intervals is helpful for the early diagnosis of ovarian cancer. The established reference intervals are more suitable for our laboratories than that of manufacturers.

Establishment on the reference ranges of serum complement C1q among apparently healthy adults in Taizhou

CHEN Wenju, XU Jiajia, ZHONG Qianyi, LI Zhaoyun

2017, 32(5):  403-405.  DOI: 10.3969/j.issn.1673-8640.2017.05.013

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Objective To establish the reference ranges of serum complement C1q among apparently healthy adults in Taizhou,and to investigate the relationship between complement C1q and other parameters. Methodse A total of 463 apparently healthy adults were enrolled in Taizhou Central Hospital from February 2016 to March 2016,including 240 males and 223 females. Serum complement C1q was determined by turbidimetric inhibition immunoassay. The reference ranges were expressed by bilateral 95% confidence interval of normal distribution. Results The levels of complement C1q were expressed as normal distribution. The level of complement C1q in females [（210.3±25.6） mg/L] was higher than that in males [（197.8±26.1） mg/L]（P<0.01）. Complement C1q had positive correlations with globulin,white blood cell （WBC）,total cholesterol （TC） （r>0,P<0.05）,and had negative correlations with creatinine （Cr） and hemoglobin （Hb）（r<0,P<0.05）. There was no correlation with ages （P>0.05）. Conclusions The level of complement C1q in healthy adults has difference between males and females. The reference ranges of complement C1q should be established for males and females in Taizhou respectively.

Diagnostic and prognostic significance of AFP,CA199 and CEA levels in patients with hepatocellular carcinoma

LIU Yongwei, WU Xiangmin

2017, 32(5):  406-409.  DOI: 10.3969/j.issn.1673-8640.2017.05.014

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Objective To investigate the levels of alpha-fetoprotein （AFP）,carcinoembryonic antigen （CEA） and carbohydrate antigen 199（CA199） in the carcinogenesis course of liver diseases and their prognostic significance. Methodse A total of 30 healthy subjects （healthy control group）,38 patients with chronic hepatitis B,12 patients with hepatic cirrhosis,42 patients with primary hepatocellular carcinoma （PHC）and 12 patients with metastatic hepatocellular carcinoma were enrolled. The levels of AFP,CEA and CA199 were determined. The changes of AFP,CEA and CA199 were determined before operation for 1 d and after operation for 4 weeks and 8 weeks. Results The AFP levels of healthy control,chronic hepatitis B,hepatic cirrhosis,PHC and metastatic hepatocellular carcinoma groups were （11.2±59.87） μg/L,（27.9±17.83） μg/L,（68.91±19.87）μg/L,（668.18±260.74）μg/L and （414.64±170.33） μg/L. The levels of CEA were （2.72±1.21） μg/mL,（2.36±1.43）μg/mL,（4.09±1.67）μg/mL,（16.36±10.68） μg/mL and （31.91±17.44）μg/mL. The CA199 levels were （27.36±7.6）U/L,（18.19±6.6）U/L,（26.54±5.76） U/L,（59.09±18.67）U/L and （51.63±12.89） U/L. The positive rates for the combined determination of AFP,CEA and CA199 were 3.33%,15.79%,58.33%,88.09% and 84.62% in healthy control,chronic hepatitis B,hepatic cirrhosis,PHC and metastatic hepatocellular carcinoma groups. The AFP and CEA levels in recurrence group were （397.17±201.29）μg/Land （29.12±16.78） μg/mL（P<0.05）,which were higher than those in non-recurrence group [（113.3±68.48） μg/L and （4.82±1.25） μg/mL]. Conclusions The combined determination of AFP,CEA and CA199 can improve the diagnosis rate of hepatocellular carcinoma,and it can be used for the diagnosis of PHC and metastatic hepatocellular carcinoma. AFP and CEA are of prognostic significance.

GenoType MTBDRplus VER2.0 for determining Mycobacterium tuberculosis and drug resistance in sputum specimens

WANG Hongxiu, YANG Jinghui, WANG Nuan, LI Yikun, CHEN Jin

2017, 32(5):  410-414.  DOI: 10.3969/j.issn.1673-8640.2017.05.015

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Objective To evaluate the performance of GenoType MTBDRplus VER2.0 for determining Mycobacterium tuberculosis and drug resistance in sputum specimens. Methodse Smear,MGITTM 960 liquid culturing,liquid drug susceptibility test and GenoType MTBDRplus VER2.0 were used. Using MGITTM 960 liquid culturing and liquid drug susceptibility test as standards,the sensitivity,specificity of GenoType MTBDRplus VER2.0 and the consistency with MGITTM 960 liquid culturing were analyzed,and the samples with different results were further performed for sequencing. Results Compared with MGITTM 960 liquid culturing and liquid drug susceptibility test,the sensitivity and specificity of GenoType MTBDRplus VER2.0 for the determination of Mycobacterium tuberculosis were 90.85% and 94.34%. The sensitivities for sputum with smear-positive and culturing-positive and sputum with smear-negative and culturing-positive were 93.75% and 85.96%. The sensitivity and specificity of liquid drug susceptibility test to rifampin were 100.00% and 97.3%,and those to isoniazide were 84.44% and 96.94%. Conclusions GenoType MTBDRplus VER2.0 is a rapid and effective method for determining Mycobacterium tuberculosis.

Application and comparison of 3 identification systems in microbiological external quality assessment

CHEN Rong, JU Yang, LIU Zhanmin

2017, 32(5):  415-420.  DOI: 10.3969/j.issn.1673-8640.2017.05.16

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Objective To evaluate matrix-assisted laser desorption/ionization time of flight mass spectrometry（MALDI-TOF MS）,Vitek 2 Compact and MicroScan WalkAway 96 plus automatic microbial identification systems in microbiological external quality assessment. Methodse A total of 61 isolates of quality control strains with different runs were identified by MALDI-TOF MS,Vitek 2 Compact and MicroScan WalkAway 96 plus. The results of 3 identification systems were compared. Results The accuracy rates of MALDI-TOF MS,Vitek 2 Compact and MicroScan WalkAway 96 plus for identifying 26 isolates of Gram-negative bacilli were 88.4%,100.0% and 84.6%,the accuracy rates for identifying 15 isolates of Gram-positive cocci were 100.0%,100.0% and 86.7%,the accuracy rates for identifying 8 isolates of yeast-like fungi were 100.0%,100.0% and 87.5%,and the accuracy rates for identifying other 12 isolates were 100.0%,83.3% and 41.7%,respectively. Conclusions The accuracy rates of the 3 identification systems for Gram-positive cocci,Gram-negative bacilli and yeast-like fungi are good. For fastidious bacteria and Gram-positive bacilli,the accuracy rates of MALDI-TOF MS and Vitek 2 Compact are higher than those of MicroScan WalkAway 96 plus.

Performance of CytoDiff flow cytometry for determining blasts in peripheral blood

GUO Ping, CHEN Liting, SONG Weixing, SHI Hourong, WANG Jianbiao

2017, 32(5):  421-426.  DOI: 10.3969/j.issn.1673-8640.2017.05.017

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Objective To investigate the performance of CytoDiff flow cytometry for determining blasts in peripheral blood. Methodse A total of 976 patients were enrolled in Hematology Department of Ruijin Hospital from April 2015 to March 2016. White blood cell （WBC） differentiation was performed by hematology analyzer,CytoDiff flow cytometry and morphology differentiation. The consistency was analyzed between hematology analyzer and CytoDiff flow cytometry with morphology differentiation as standard method. Results The average time required to analyze 20 samples was approximately 60 min for CytoDiff flow cytometry,and the manual operation time was about 15 min. The correlations of WBC differentiation were good among hematology analyzer,CytoDiff flow cytometry and morphology differentiation. The r was 0.959 between CytoDiff flow cytometry and morphology differentiation,and the r of neutrophils,lymphocytes,monocytes,eosinophils,basophils and immature granulocytes were 0.938,0.893,0.871,0.962,0.833 and 0.786. The r between hematology analyzer and morphology differentiation were 0.902,0.750,0.436,0.860,0.758 and 0.678,respectively. When >1% was set as the cut-off value of blasts on morphology differentiation,there were 235 positive cases among 976 samples,the hematology analyzer appeared "blasts" in 283 samples,and the sensitivity,specificity,positive predictive value and negative predictive value of hematology analyzer were 75.7%,85.8%,62.9% and 91.8%,respectively. When >1% was set as the cut-off value on CytoDiff flow cytometry,there were 239 positive cases,and the sensitivity,specificity,positive predictive value and negative predictive value of CytoDiff flow cytometry were 100.0%,99.5%,98.3% and 100.0%,respectively. Conclusions A cut-off value of 1% of blasts is recommended for CytoDiff flow cytometry,which is a sensitive,specific,accurate and rapid method for determining blasts. CytoDiff flow cytometry meets the demand of clinic for the early determination and the monitor of curative effects,and it has prospect in blast determination.

MoS₂-based fluorescence sensor for the detection of breast cancer-related microRNA

CAI Bingjie, ZHANG Guojun, LI Yan

2017, 32(5):  427-430.  DOI: 10.3969/j.issn.1673-8640.2017.05.018

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Objective To establish a fast,convenient,sensitive and specific fluorescence sensor based on novel nanomaterial MoS₂ to detect breast cancer-related microRNA（miRNA）. Methodse The fluorescence sensor was fabricated by mixing novel nanomaterial MoS₂ with fluorescent dye-labeled DNA probe. Noncomplementary miRNA,one-base mismatched miRNA and different concentrations of complementary miRNA were introduced to fluorescence sensor for hybridization with DNA probe. The miRNA was detected through monitoring fluorescence signal change before and after DNA probe-miRNA hybridization. Results The pmol/L level of complementary miRNA could be detected within 40 min,and fluorescence sensor could discriminate complementary miRNA from noncomplementary miRNA and one-base mismatched miRNA. Conclusions The novel nanomaterial MoS₂-based fluorescence sensor has the advantages of fast,high sensitivity and specificity,and it is potential for the detection of breast cancer-related miRNA.

Results on lipoprotein（a） determination in external quality assessment

LEI Yanmei, MA Jianguo, LIU Jihong

2017, 32(5):  431-434.  DOI: 10.3969/j.issn.1673-8640.2017.05.019

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Objective To analyze the results of lipoprotein（a） [Lp（a）] determination with different methods in Huizhou First People's Hospital Department of Clinical Laboratory participating external quality assessment （EQA） of the National Center for Clinical Laboratories from 2014 to 2016,and to choose effective methods and reduce the possibility of bias. Methodse A total of 25 EQA results of Lp（a）determination in 5 batches from 2014 to 2016 were statistically analyzed by bias,proficiency testing （PT）,Z score and quality control multi-rules. Results The results of bias met the requirements of EQA. PT scores were all 100,and |Z| was <1.0,which meant satisfaction. Quality control multi-rules showed the 1st and 2nd EQA in 2014 and the 2nd EQA in 2015 had at least 1 sample's results exceeding 50% allowable total error （TEa）,and all of them were against the rules of 5+1_50%TEa,which meant that systematic error was existing. Conclusions The results of Lp（a）determination are satisfactory and meet the requirements of the National Center for Clinical Laboratories,which can be further improved. The sensitivity of quality control multi-rules is higher than other indices of EQA.

Conventional statistics and robust statistics for proficiency testing in laboratory medicine

GUO Xiaojun, ZHU Lingfeng, XU Chong, JU Yi

2017, 32(5):  435-439.  DOI: 10.3969/j.issn.1673-8640.2017.05.020

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Objective To investigate the scopes of conventional statistics（x and s after removal of outliers by Dixon method） and robust statistics [median and normalized interquartile range（NIQR）] for proficiency testing in laboratory medicine. Methodse Participants of the Proficiency Testing Program 2016 on C-reactive protein organized by Shanghai Center for Clinical Laboratory were classified into group A（29 laboratories）,group B（15 laboratories）and group C（9 laboratories）according to determination systems. The results of conventional statistics and robust statistics were analyzed and compared. Results As for group A,the designated values were same for the 2 methods. However,the NIQR and standard uncertainty （u_x）of designated values by conventional statistics were smaller than s and u_x by robust statistics. As for group B,the designated values were close between the 2 methods. Conventional statistics had u_x<0.3σ,and robust method had u_x>0.3σ. As for group C,the designated values were close between the 2 methods. Both methods had u_x>0.3σ. The s of conventional statistics was smaller than the NIQR of robust statistics. Conclusions When the number of participants is >18,robust statistics can be used. When the number of participants is 12-18,conventional statistics may be used. When the number is ≤12,besides conventional statistics should be used,the u_x of designated values should be considered as well.

Status on the diagnosis and treatment of BK virus infection

ZHANG Zhigang, CAO Lu, WANG Xin, ZHAO Qinjian

2017, 32(5):  440-445.  DOI: 10.3969/j.issn.1673-8640.2017.05.021

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：BK virus （BKV） belongs to a subtype of human polyomavirus. Recessive infection rate of BKV in general population is about 80%. With expanded use of organ transplantation in recent years where strong immunosuppression is essential,BKV associated nephropathy（BKVAN）,hemorrhagic cystitis,ureterostenosis and other associated diseases due to the reactivation of latent BKV in immunosuppressed or immunocompromised populations are becoming more of a concern in medical community. Since the prevention measures and effective antiviral drugs for BKV are rather limited,the effective means for reducing BK associated morbidity and mortality due to BKV associated diseases are the early monitoring of viral loads,reducing the usage of immunosuppressant,adjusting immunosuppressant treatment regime and using adjuvant therapies. This review describes the clinical symptoms,biology,mechanisms and the advances in the diagnosis and treatment of BKV at home and abroad.