Laboratory Medicine

Expert consensus on the clinical application of anti-dsDNA antibodies in systemic lupus erythematosus

Shanghai Center for Clinical Laboratory Quality Control, Shanghai Center for Rheumatology and Immunology Clinical Quality Control, Shanghai Immunology Association

2026, 41(3): 205-216. DOI: 10.3969/j.issn.1673-8640.2026.03.001

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Systemic lupus erythematosus（SLE）is a highly heterogeneous systemic autoimmune disease，with positive anti-nuclear antibodies（ANA）in peripheral blood being a typical feature. Over 95% of SLE patients have positive ANA. ANA can be further classified into various antibodies based on different autoantigens，among which anti-double-stranded DNA（dsDNA）antibodies are specific to SLE and are one of the important serological markers for disease diagnosis，disease monitoring and treatment response assessment. However，there are many methods used for the determination of anti-dsDNA antibodies. Due to the diversity of methodologies，differences in commercial kits，lack of reference materials，insufficient standardization of calibrators and traceability，and variations in determination linear ranges and cut-off values，the comparability and consistency of anti-dsDNA antibody determination results among different medical institutions are relatively low. This has led to obstacles in mutual recognition of determination results and caused certain differences in the interpretation of anti-dsDNA antibody determination results in different medical institutions，resulting in uncertainties in disease diagnosis and the lack of a unified standard for disease monitoring. Shanghai Center for Clinical Laboratory Quality Control，Shanghai Center for Rheumatology and Immunology Clinical Quality Control and Shanghai Immunology Association，based on a thorough review of domestic and international evidence-based medical evidence and expert opinions，and in consideration of the current domestic clinical practice situation，have formulated the "Expert Consensus on the Clinical Application of Anti-dsDNA Antibodies in Systemic Lupus Erythematosus". This expert consensus provides detailed elaboration on the clinical application value of anti-dsDNA antibodies in SLE，comparisons and applications of determination methods，establishment and performance verification of reference materials and so on，offering evidence-based guidance and practical references for the determination and interpretation of anti-dsDNA antibodies in SLE patients.

Discussion on the application of high-throughput metagenomic sequencing of pathogens in the diagnosis of pulmonary infections in adults

HE Lixian

2026, 41(3): 217-222. DOI: 10.3969/j.issn.1673-8640.2026.03.002

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In recent years，metagenomic next-generation sequencing （mNGS）technology has developed rapidly in the research and application of infectious diseases，especially in pulmonary infections. It has played a positive role in the diagnosis of infections caused by rare pathogens that are difficult to determine by traditional methods. However，the mNGS technology still has limitations that need to be overcome. The positive threshold standards are not unified，and there are misjudgements in the determination of Candida，Mycobacterium tuberculosis and Pneumocystis jiroveci. This review focuses on the research direction and development of mNGS technology from the perspective of microbial diagnosis management.

Neddylation UBC12 promotes esophageal cancer cell proliferation by regulating polycomb protein RING1

XIAN Jingrong, ZHU Jing, SHAO Wenqi, XIONG Ying, PAN Baishen, WANG Beili, GUO Wei

2026, 41(3): 223-232. DOI: 10.3969/j.issn.1673-8640.2026.03.003

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Objective To investigate the molecular mechanism of neddylation UBC12 regulating esophageal cancer cell proliferation. Methods Proteomic analysis was used to screen for downstream targets of UBC12. The expression of RING1 in esophageal cancer patients was analyzed based on the Cancer Genome Atlas（TCGA）database. Esophageal cancer cells with UBC12 knockdown（UBC12 knockdown group）and negative control（NC）cells（NC group），as well as esophageal cancer cells overexpressing（OE）RING1（OE group）and mock（MOCK）-transfected control cells（MOCK group），were established. The effects of RING1 on esophageal cancer cell proliferation were assessed using CCK-8 and colony formation assays. High-throughput sequencing was performed to analyze differentially expressed genes between OE and MOCK groups，followed by bioinformatic analysis. The expression levels of RING1 and UBC12 mRNA in esophageal cancer cells were determined. Protein degradation assays were conducted to analyze the regulatory mechanism of UBC12 on RING1 protein. Cancer tissues and adjacent normal tissues（2 cm from tumor margins） were obtained from 30 esophageal cancer patients at Zhongshan Hospital of Fudan University between January 2017 and December 2018. Immunohistochemical staining was used to determine RING1 protein expression，and all the patients were followed up until March 2025. Kaplan-Meier survival curves were used to analyze patient survival. Results TCGA analysis results showed that RING1 expression was lower in cancer tissues compared to adjacent normal tissues（P<0.001）. Esophageal cancer patients with high RING1 expression exhibited longer overall survival and disease-free survival than those with low RING1 expression. Both cell proliferation viability and the number of cell colonies formed were lower in OE group than those in MOCK group（P<0.05）. Differentially expressed genes between OE and MOCK groups were enriched in biological processes such as axon development and axonogenesis，cellular components including ciliary base and chromatin-remodeling complex，molecular functions such as FAD binding and SMAD binding，pathways including aminoacyl-tRNA biosynthesis，oxidative phosphorylation，RNA transport，protein export and eukaryotic ribosome biogenesis were suppressed in OE group. Compared to NC group，RING1 protein expression was increased in UBC12 knockdown group，while no statistically significance was observed in RING1 mRNA relative expression（P>0.05）. The relative expression of UBC12 mRNA was higher than that of RING1 mRNA in 5 esophageal cancer cell lines（EC1，EC109，K30，K450 and K510）（P<0.05），and UBC12 protein expression was negatively correlated with RING1 protein expression（r=-0.7085，P=0.18）. With prolonged cycloheximide（CHX） treatment，RING1 protein expression in UBC12 knockdown group gradually became higher than in NC group，indicating an extended RING1 protein half-life. RING1 protein expression was lower in cancer tissues than in adjacent normal tissues from esophageal cancer patients（P<0.05）. Esophageal cancer patients with high RING1 expression had a longer overall survival than those with low RING1 expression（Log-rank χ²=4.188，P=0.040 7）. Conclusions UBC12 promotes the proliferation of esophageal cancer cells by regulating RING1，suggesting that it may serve as a novel therapeutic target for esophageal cancer.

Relationship between serum Tau protein and neuron-specific enolase levels after craniocerebral trauma surgery and the cognitive function of patients

WANG Yanbin, LIU Jiahao, LIN Changfu

2026, 41(3): 233-238. DOI: 10.3969/j.issn.1673-8640.2026.03.004

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Objective To investigate the relationship between serum Tau protein and neuron-specific enolase （NSE） levels and cognitive function in patients after craniocerebral trauma surgery. Methods A total of 110 patients with craniocerebral trauma at the Third People's Hospital of Henan Province from April 2021 to December 2023 were enrolled. The patients were classified into cognitive impairment group（45 cases）and non-cognitive impairment group（65 cases）based on the postoperative mini-mental state examination（MMSE）score. The serum Tau protein and NSE levels before surgery（craniocerebral trauma 2 h）and after surgery 24 h were determined. Pearson analysis was used to evaluate the correlation between serum Tau protein，NSE levels and postoperative MMSE score. Logistic regression analysis was used to assess the influencing factors of postoperative cognitive impairment after craniocerebral trauma. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of serum Tau protein and NSE in judging postoperative cognitive impairment after craniocerebral trauma. Results The proportion of patients with cognitive impairment and hypertension and the proportion of general anesthesia in cognitive impairment group were higher than those in non-cognitive impairment group（P<0.05），and the Glasgow coma scale（GCS）score was lower in cognitive impairment group（P<0.05）. Serum Tau protein and NSE levels in cognitive impairment group before and after surgery were higher than those in non-cognitive impairment group（P<0.05）. Serum Tau protein and NSE levels in both groups after surgery were lower than those before surgery（P<0.05）. Serum Tau protein and NSE were negatively correlated with postoperative MMSE score（r values were -0.529 and -0.537，respectively，P<0.05）. Hypertension，decreased GCS score，elevated serum Tau protein and elevated NSE were risk factors for postoperative cognitive impairment in patients with craniocerebral trauma（P<0.05）. The areas under curves（AUC）of single and combined determinations of serum Tau protein and NSE in judging postoperative cognitive impairment in patients with craniocerebral trauma were 0.792，0.751 and 0.875，respectively. Conclusions Serum Tau protein and NSE levels are elevated in patients with postoperative cognitive impairment after craniocerebral trauma. Serum Tau protein and NSE have certain value in the risk assessment of postoperative cognitive impairment after craniocerebral trauma.

Construction of a prediction model for thrombosis in patients with autoimmune diseases based on multiple indicators and its clinical application

GUO Zhengbin, HU Lina, ZHANG Rui, CHEN Jie, ZHANG Jing, DAN Gang

2026, 41(3): 239-244. DOI: 10.3969/j.issn.1673-8640.2026.03.005

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Objective To analyze the influencing factors of thrombosis in patients with autoimmune diseases and construct a nomogram model，and to evaluate its clinical application value. Methods A total of 250 patients with autoimmune diseases from the General Hospital of Western Theater Command of People's Liberation Army from January 2021 to December 2023 were enrolled，including 17 cases of antiphospholipid syndrome（APS） and 233 cases of systemic lupus erythematosus（SLE）. All the patients were randomly classified into a training set and a validation set at a ratio of 7︰3. The clinical data and laboratory determination results were collected. All the patients were followed up for 3 years and were classified into thrombosis group（40 cases） and non-thrombosis group（210 cases） based on the occurrence of thrombosis. LASSO regression analysis was used to screen variables and construct nomogram model. The clinical value of the nomogram model was evaluated by receiver operating characteristic（ROC） curves，calibration curves and decision curves. Results In the training set，the proportion of patients >50 years old，the proportion of patients with hypertension，the positive rate of lupus anticoagulant（LA） and activated partial thromboplastin time（APTT）in thrombosis group were higher than those in non-thrombosis group（P<0.05）. Five influencing factors（age，hypertension，lupus nephritis，APTT，LA）were screened out by the LASSO regression model，and a nomogram model was constructed. In the training set and validation set，the areas under curves（AUC） of the nomogram model for predicting thrombosis in APS and SLE patients were 0.79 and 0.81，respectively. The predicted probability of thrombosis in APS and SLE patients was close to the actual probability（Hosmer-Lemeshow χ² values were 8.615 and 12.192，P>0.05）. Within the threshold probability range of 0.1-0.7，the nomogram model had a good net benefit，with the maximum net benefit being 0.18. Conclusions The nomogram model constructed based on age，hypertension，lupus nephritis，APTT and LA for predicting thrombosis in APS and SLE patients has high clinical value and can play a role in the prediction and identification of thrombotic events in APS and SLE patients.

Correlation between endothelial cell-specific molecule-1，sphingosine 1-phosphate receptor 3 and the severity and prognosis of Mycoplasma pneumonia pneumonia

MA Xiaomiao, LIU Feng, CHEN Fenting

2026, 41(3): 245-250. DOI: 10.3969/j.issn.1673-8640.2026.03.006

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Objective To investigate the relationship between endothelial cell-specific molecule-1（ESM-1），sphingosine 1-phosphate receptor 3（S1PR3）and the severity of Mycoplasma pneumonia pneumonia（MPP）in children，as well as their value in prognosis assessment. Methods A total of 106 children with MPP（MPP group）and 106 healthy children（healthy control group）were enrolled from Ankang Maternal and Child Health Hospital from January 2021 to January 2024. All the MPP children were classified into severe group（69 cases）and mild group（37 cases）according to the clinical pulmonary infection score（CPIS）and clinical symptoms. All the children were classified into good prognosis group（64 cases）and poor prognosis group（42 cases）according to the CPIS score after one course of treatment. The levels of serum ESM-1 and S1PR3 and the pulmonary function indicators [time to peak tidal expiratory flow（TPTEF/Te%），volume at peak tidal expiratory flow（VPTEF/VT%）and respiratory rate（RR）] were determined. Pearson or Spearman correlation analysis was used to evaluate the correlation between various indicators. Logistic regression analysis was used to assess the influencing factors of poor prognosis in MPP children. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of various indicators in predicting poor prognosis of MPP children. Results The serum ESM-1 and S1PR3 levels in MPP group were higher than those in control group（p<0.001）. The ESM-1，S1PR3 and RR in severe group were higher than those in mild group（P<0.001），while TPTEF/Te%，VT and VPTEF/VT% were lower in severe group（P<0.05）. The serum ESM-1 and S1PR3 levels of MPP children were positively correlated with RR and disease severity（P<0.001），and they were negatively correlated with TPTEF/Te%，VT and VPTEF/VT%（p<0.001）. The serum ESM-1，S1PR3 levels and the proportion of bronchial inflation signs in poor prognosis group were higher than those in good prognosis group（P<0.001）. ESM-1 and S1PR3 were independent risk factors for poor prognosis in MPP children [odds ratios（OR）were 2.985 and 2.832，95% confidence intervals（CI）were 1.563-5.700 and 1.452-5.525，respectively，P<0.01]. The areas under curves（AUC）of ESM-1，S1PR3 single and combined determinations for predicting poor prognosis of MPP children were 0.856，0.855 and 0.939，respectively. Conclusions The serum ESM-1 and S1PR3 levels in MPP children are increased and are related to the disease severity. The combined determination of ESM-1 and S1PR3 has a predictive value for the prognosis of MPP children.

Relationship between serum MASP-2 and sB7-H1 levels and the clinical characteristics and prognosis of patients with advanced hepatocellular carcinoma

HE Hongmei, ZHANG Xinglong, ZHANG Jing, SHI Yanan

2026, 41(3): 251-257. DOI: 10.3969/j.issn.1673-8640.2026.03.007

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Objective To investigate the relationship between serum levels of mannose-binding lectin-associated serine protease 2（MASP-2）and soluble B7 homologue 1（sB7-H1）and the clinical pathological characteristics and prognosis of patients with advanced hepatocellular carcinoma（HCC）. Methods A total of 87 patients with advanced HCC，87 patients with chronic hepatitis B and 87 healthy subjects from Handan First Hospital from January 2019 to January 2021 were enrolled. The clinical data were collected，and serum levels of MASP-2，sB7-H1，alanine aminotransferase（ALT），aspartate aminotransferase（AST），prealbumin（PA）and alpha-fetoprotein（AFP）were determined. Receiver operating characteristic（ROC）curve analysis was used to evaluate the predictive value of serum MASP-2 and sB7-H1 for the death of HCC patients. Kaplan-Meier survival curve was used to analyze the 1-year survival status of HCC patients. Relative risk（RR）was used to assess the influence of serum MASP-2 and sB7-H1 levels on the risk of death in HCC patients，and multivariate Cox TNM stage regression analysis was used to evaluate the influencing factors of death in HCC patients. Results Serum AFP，ALT，AST，MASP-2 and sB7-H1 levels were progressively increased in healthy control group，benign disease group and HCC group（P<0.05），while serum PA levels were progressively decreased（P<0.05）. HCC patients with TNM stage Ⅳ and portal vein tumor thrombus had higher serum MASP-2 and sB7-H1 levels than those with TNM stage Ⅲ and no portal vein tumor thrombus（P<0.05）. The proportions of TNM stage Ⅳ，microvascular invasion and AFP≥400 ng·mL^-1 in death group were higher than those in survival group（P<0.05），while there was no statistical significance in the other clinical data between the 2 groups（P>0.05）. The areas under curves（AUC）of serum MASP-2 and sB7-H1 for predicting the death of HCC patients were 0.736 and 0.770，respectively. The optimal cut-off value obtained from the ROC curve was used to distinguish high levels from low levels. The 1-year survival rates of high-level groups of MASP-2 and sB7-H1 were lower than those of low-level groups of MASP-2 and sB7-H1，respectively（P<0.05）. The death risk of patients with high level of MASP-2 was 3.214 times higher than that with low level，and the death risk of patients with high level of sB7-H1 was 3.490 times higher than that with low level. High level of MASP-2，high level of sB7-H1，microvascular invasion，AFP≥400 ng·mL^-1 and TNM stage Ⅳ were all risk factors for death within 1 year in HCC patients（P<0.05）. Conclusions Serum MASP-2 and sB7-H1 levels are related to the TNM stage，portal vein tumor thrombus status and 1-year mortality of patients with advanced HCC，and they may be used as biomarkers for the condition and prognosis assessment of advanced HCC patients.

Role of serum lncRNA HOTTIP and lncRNA HULC expression in multiple myeloma monitoring and prognosis judgement

SHAO Yu, WANG Pin, ZHOU Mo

2026, 41(3): 258-264. DOI: 10.3969/j.issn.1673-8640.2026.03.008

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Objective To investigate the role of peripheral blood long non-coding RNA（lncRNA）HOTTIP and lncRNA HULC expression in multiple myeloma（MM）monitoring and prognosis assessment. Methods Totally，67 MM patients from Yancheng Third People's Hospital（the Affiliated Hospital of Jiangsu Vocational College of Medicine）from January 2021 to January 2023 were enrolled as MM group. All the patients were classified into stage Ⅰ group（20 cases），stage Ⅱ group（31 cases）and stage Ⅲ group（16 cases）according to the International Staging System（ISS）. All the patients were followed up for 2 years，and they were classified into death group（22 cases）and survival group（45 cases）based on prognosis. Totally，67 healthy subjects were enrolled as healthy control group. The clinical data were collected，and the relative expression levels of serum lncRNA HOTTIP and lncRNA HULC were determined. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of each indicator in determining the ISS stage and death of MM patients. Cox regression analysis was used to assess the influencing factors of death in MM patients. The survival status of MM patients was analyzed using Kaplan-Meier survival curve. Results The relative expression levels of serum lncRNA HOTTIP and lncRNA HULC in MM group were higher than those in healthy control group（P<0.001）. The relative expression levels of serum lncRNA HOTTIP and lncRNA HULC in stage Ⅰ group，stage Ⅱ group and stage Ⅲ group were increased successively（P<0.001）. The areas under curves（AUC）of single and combined determinations of serum lncRNA HOTTIP and lncRNA HULC in determining the ISS stage of MM patients as stage Ⅲ were 0.830，0.852 and 0.910，respectively. The serum levels of lncRNA HOTTIP and lncRNA HULC in death group were higher than those in survival group（P<0.001）. The ISS stage，lncRNA HOTTIP and lncRNA HULC were all risk factors for the death of MM patients（P<0.001）. The AUC of single and combined determinations of serum lncRNA HOTTIP and lncRNA HULC for predicting the death of MM patients were 0.850，0.873 and 0.937，respectively. The 2-year survival rate was lower in high-expression groups of lncRNA HOTTIP and lncRNA HULC compared to their low-expression groups（P<0.01）. Conclusions The expressions of serum lncRNA HOTTIP and lncRNA HULC are related to the severity and mortality of MM，which may serve as molecular markers for the assessment of MM monitoring and prognosis.

Role of serum Lp-PLA2 in disease assessment of children with early-stage chronic kidney disease

SHEN Xuting, YE Zhicheng, ZHANG Lei, ZHAO Ruonan

2026, 41(3): 265-271. DOI: 10.3969/j.issn.1673-8640.2026.03.009

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Objective To investigate the clinical role of serum lipoprotein-associated phospholipase A2（Lp-PLA2）in the disease assessment of chronic kidney disease（CKD）in children. Methods A total of 192 children with stage G1 to G3b CKD at the Children's Hospital of Fudan University，30 children with acute kidney injury（AKI）and 50 healthy subjects were enrolled. The clinical data were collected，and serum Lp-PLA2 levels and renal function indicators were determined. CKD children were classified into stage G1 group（37 cases），stage G2 group（48 cases），stage G3a group（54 cases）and stage G3b group（53 cases）based on estimated glomerular filtration rate（eGFR）. They were also classified into <6-year-old group（42 cases），7-12-year-old group（93 cases），13-18-year-old group（57 cases）and renal transplantation group（106 cases），non-renal transplantation group（86 cases）. Spearman correlation analysis was used to evaluate the correlation between Lp-PLA2 and renal function indicators. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of Lp-PLA2 in assessing the severity of childhood CKD. Results The serum Lp-PLA2 level in CKD group was higher than those in AKI group and healthy control group（P<0.000 1），and it was increased with the progression of CKD stages（P<0.001）. The Lp-PLA2 levels in <6-year-old group，7-12-year-old group，13-18-year-old group and renal transplantation group，non-renal transplantation group were all increased with the progression of CKD stages（p<0.05），and the differences among the stages were statistically significant（P<0.05）. Lp-PLA2 was positively correlated with serum creatinine（SCr），blood urea nitrogen（BUN）and cystatin C（Cys C）in CKD children（r values were 0.574 8，0.470 3 and 0.514 5，respectively，p<0.05），and it was negatively correlated with eGFR（r=-0.831 4，P<0.05）. The areas under curves（AUC）for SCr，BUN，Cys C and Lp-PLA2 in diagnosing CKD in stage G3a were 0.796，0.732，0.790 and 0.982，respectively，and those for diagnosing CKD in stage G3b were 0.671，0.851，0.817 and 0.903，respectively. Conclusions Lp-PLA2 has potential clinical application value in the assessment of early-stage childhood CKD and can be used as one of the indicators for disease assessment.

Research progress on neutrophil-to-lymphocyte ratio in the diagnosis and treatment of coronary heart disease

XU Hongqiang, PENG Haibo, XU Huan, LUO Zhonglan, XIONG Guanghai, LI Zhen, LUO Jie

2026, 41(3): 291-298. DOI: 10.3969/j.issn.1673-8640.2026.03.014

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Coronary heart disease（CHD）as a common cardiovascular disease，had an increasing incidence and mortality rate year by year，and the age of onset tends to be younger，posing a serious threat to human life safety. It is of significance to find inexpensive，fast and simple diagnostic tools to alleviate the enormous pressure that CHD brings to society. Inflammatory biomarker neutrophil-to-lymphocyte ratio（NLR）had been a novel non-invasive biomarker for assessing the degree of myocardial ischemia in CHD patients，it plays a role in the diagnosis，severity assessment and prognosis judgement of CHD. This review focuses on the epidemiology of CHD，the relationship between inflammation and CHD and the current research status of inflammatory biomarker NLR in the field of CHD，providing a reference for further understanding the potential of NLR in the diagnosis and treatment of CHD.

Research progress on laboratory diagnostic methods for Mycoplasma pneumonia

CHEN Tian, CAI Qinzhen, TAO Yuxuan, WANG Jun, SHANG Yu, WU Mo, TUO Wenbin, YUAN Chunhui, XIANG Yun

2026, 41(3): 299-306. DOI: 10.3969/j.issn.1673-8640.2026.03.015

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Mycoplasma pneumoniae（MP）is one of the main pathogens causing respiratory tract infections，with a relatively high incidence of community-acquired pneumonia（CAP）among children and adolescents. Laboratory determination methods for MP mainly include etiological determination，serological determination and molecular biological determination，each with its own advantages and disadvantages. MP isolation and culture is time-consuming and has low specificity，and it is rarely routinely performed in clinical laboratories. Currently，the main methods used are MP-specific antigen，antibody and polymerase chain reaction（PCR）for MP. In recent years，new determination technologies such as loop-mediated isothermal amplification（LAMP），clustered regularly interspaced short palindromic repeat/associated protein（CRISPR/Cas）and nanobiosensors have made significant progress in the field of MP diagnosis，providing more options for clinical practice. This review focuses on the current status，advantages and disadvantages and application value of common MP determination methods and new laboratory diagnostic technologies，aiming to provide references for the clinical diagnosis and application of MP.

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