Table of Content

30 September 2026, Volume 41 Issue 9

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Serum 25-hydroxyvitamin D combined with apo A1/apo B ratio for screening osteoporosis among patients with atherosclerosis

JIA Qi, HOU Yuli, LIU Jing, GAO Shuo, LI Wen, SONG Qiao, WANG Peichang

2026, 41(9):  827-833.  DOI: 10.3969/j.issn.1673-8640.2026.09.001

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Objective To investigate the clinical value of apolipoprotein A1（apo A1）/apolipoprotein B（apo B）ratio and serum 25-hydroxyvitamin D [25（OH）D] in atherosclerosis（AS）complicated with osteoporosis（OP）. Methods From January 2024 to May 2025，122 AS patients were enrolled from Xuanwu Hospital，Capital Medical University. The clinical data were collected，and routine biochemical indicators，bone turnover markers and 25（OH）D levels were determined. The patients were classified into 2 groups based on the presence or absence of OP，simple AS group（68 cases）and AS+OP group（54 cases）. Logistic regression analysis was used to identify factors for OP. Pearson or Spearman correlation analysis was used to assess correlations among variables. Receiver operating characteristic（ROC）curves were used to evaluate the diagnostic performance of single and combined determinations for diagnosing OP in AS patients. Results In AS+OP group，blood glucose（Glu）and alkaline phosphatase（ALP）levels were higher than those in AS group（P<0.05），while apoA1，apo A1/apo B ratio，sodium，chloride and 25（OH）D levels were lower（P<0.01）. No statistical significance was observed between the 2 groups regarding age，gender，triglyceride（TG），total cholesterol（TC），high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），LDL-C/HDL-C ratio，apo B，total protein（TP），albumin（Alb），globulin（Glb），potassium，calcium，phosphorus，or collagen typeⅠcross-linked C-telopeptide（CTX）（P>0.05）. Lower apo A1/apo B ratio and 25（OH）D levels were identified as risk factors for OP in AS patients [odds ratios（OR）were 0.444 and 0.915，95% confidence intervals（CI）0.215-0.919 and 0.852-0.984，P<0.05]. In AS patients，apo A1/apo B ratio and 25（OH）D showed positive correlations with OCN and CTX（P<0.01）and negative correlations with ALP（P<0.05）. The areas under curves（AUC）for single determinations using apo A1/apo B ratio，25（OH）D，ALP，OCN，CTX and the combined determination of apo A1/apo B ratio+25（OH）D were 0.656，0.660，0.648，0.645，0.586 and 0.791，respectively. Conclusions Serum 25（OH）D and apo A1/apo B ratio are associated with OP in AS patients，and their combined determination may help screen high-risk individuals for AS-related OP.

Application role of serum chitinase 3-like protein 1 in diabetic nephropathy

YE Yali, KE Qinjian, GUO Ningyan, ZHANG Misha, LUO Man, LIN Sicheng

2026, 41(9):  834-839.  DOI: 10.3969/j.issn.1673-8640.2026.09.002

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Objective To investigate the application role of serum chitinase 3-like protein 1（CHI3L1）levels in diabetic nephropathy（DN）. Methods A total of 216 type 2 diabetes mellitus（T2DM）patients from Sanmen People's Hospital from June 2023 to June 2024 were enrolled. According to the results of urinary albumin-to-creatinine ratio（UACR），they were classified into simple diabetes mellitus（SDM）group（121 cases），early diabetic nephropathy（EDN）group（52 cases）and clinical diabetic nephropathy（CDN）group（43 cases）. The blood routine test，biochemical indicators，UACR and serum CHI3L1 levels were performed and determined. Logistic regression analysis was used to evaluate the influencing factors of DN occurrence. The CHI3L1 levels were classified into 4 intervals by quartile method [Q1（<34.55 ng·mL^-1），Q2（34.55-<55.11 ng·mL^-1），Q3（55.11-115.50 ng·mL^-1），Q4（>115.50 ng·mL^-1）]，and the relationship between CHI3L1 levels and the occurrence of DN was analyzed. Spearman correlation analysis was used to evaluate the correlation between serum CHI3L1 and other indicators. Results Compared with SDM group，both EDN and CDN groups showed higher proportions of males and patients with diabetic peripheral vascular neuropathy，as well as elevated levels of CHI3L1，serum creatinine（SCr），uric acid（UA），cystatin C（Cys C），homocysteine（Hcy）and serum amyloid A（SAA），along with a lower estimated glomerular filtration rate（eGFR）（P<0.05）. EDN group also exhibited higher levels of C-reactive protein（CRP）（P<0.05）. In CDN group，the proportion of patients with a history of hypertension，as well as urea and neutrophil-to-lymphocyte ratio（NLR），were increased（P<0.05）. Compared with EDN group，CDN group had higher proportions of diabetic peripheral vascular neuropathy and elevated levels of CHI3L1，SCr，urea，UA，Cys C，Hcy and SAA，along with a lower eGFR（P<0.05）. There was no statistical significance among the 3 groups in terms of age，high-density lipoprotein cholesterol（HDL-C），low-density lipoprotein cholesterol（LDL-C），platelet（PLT）count，or glycated hemoglobinA_1c（HbA_1c）（P>0.05）. The Q4 of CHI3L1 and Hcy were independent risk factors for DN occurrence [odds ratios（OR）were 6.06 and 1.18，95% confidence intervals（CI）were 1.69-21.66 and 1.02-1.37，P<0.05]. Serum CHI3L1 was positively correlated with UACR，SCr，urea，Cys C，Hcy，CRP，SAA and NLR（r values were 0.570，0.339，0.285，0.484，0.177，0.232，0.166 and 0.158，P<0.05），and it was negatively correlated with eGFR（r=-0.370，P<0.05）. Conclusions The serum CHI3L1 level in patients with DN is increased，and the risk of DN occurrence increases with the increase of CHI3L1 level. Serum CHI3L1 can be used as an assessment indicator for the risk of DN occurrence in T2DM patients.

Predictive value of serum AT1-AA and sTWEAK for adverse pregnancy outcomes in patients with gestational diabetes mellitus

ZHANG Limei, LIU Hua, ZHANG Lin, YAN Xiuyun, GUO Ruiqing

2026, 41(9):  840-845.  DOI: 10.3969/j.issn.1673-8640.2026.09.003

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Objective To investigate the predictive value of serum angiotensin Ⅱ type 1 receptor autoantibody （AT1-AA） and soluble tumor necrosis factor-like weak inducer of apoptosis（sTWEAK）for adverse pregnancy outcomes in patients with gestational diabetes mellitus（GDM）. Methods A total of 128 GDM patients and 74 healthy pregnant females（control group）were enrolled from Shijiazhuang Maternal and Child Health Hospital from February 2022 to February 2023. The GDM patients were classified into good pregnancy group（70 cases）and adverse pregnancy group（58 cases）according to their pregnancy outcomes. The clinical data were collected，and blood glucose，blood lipid-related indicators and serum AT1-AA and sTWEAK levels were determined. Pearson correlation analysis was used to evaluate the correlation between serum AT1-AA and sTWEAK in GDM patients. Multivariate Logistic regression analysis was used to evaluate the influencing factors of adverse pregnancy in GDM patients. The efficacy of single and combined determinations of serum AT1-AA and sTWEAK in judging adverse pregnancy in GDM patients was evaluated using receiver operating characteristic（ROC）curve. Results Compared with control group，fasting plasma glucose（FPG），glycated hemoglobin A_1c（HbA_1c），fasting insulin（FINS），homeostasis model assessment for insulin resistance（HOMA-IR），total cholesterol（TC），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），AT1-AA and sTWEAK levels in good pregnancy group and adverse pregnancy group were higher（P<0.001）. The FPG，HbA_1c，FINS，HOMA-IR，AT1-AA and sTWEAK levels in adverse pregnancy group were higher than those in good pregnancy group（P<0.05）. There was no statistical significance in age，body mass index，number of pregnancies，gestational weeks and high-density lipoprotein cholesterol（HDL-C）levels among the 3 groups（P>0.05）. Serum AT1-AA and sTWEAK in GDM patients were positively correlated （r=0.465，P<0.05）. Elevated FPG，FINS，AT1-AA，sTWEAK and HOMA-IR were all risk factors for adverse pregnancy in GDM patients（P<0.05）. The areas under curves（AUC）of single determinations of FPG，FINS，HOMA-IR，AT1-AA，sTWEAK and the combined determination of AT1-AA and sTWEAK for judging adverse pregnancy in GDM patients were 0.605，0.714，0.689，0.831，0.834 and 0.949，respectively. Conclusions The combined determination of serum AT1-AA and sTWEAK has predictive efficacy for adverse pregnancy outcomes in GDM patients，and it may be used as a biomarker for prognosis evaluation of GDM patients.

Roles of sST2，IL-6 and CRP in prognosis assessment of patients with end-stage heart failure who undergo left ventricular assist device implantation

LIAN Entao, HOU Ze, ZHANG Yuxin, WANG Xinyi, YE Yinnan, JIA Kegang

2026, 41(9):  846-852.  DOI: 10.3969/j.issn.1673-8640.2026.09.004

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Objective To investigate the roles of soluble growth stimulation-expressed gene 2 protein（sST2），interleukin（IL）-6 and C-reactive protein（CRP）in predicting the occurrence of major adverse cardiovascular events（MACE）within 6 months after left ventricular assist device（LVAD）implantation in patients with end-stage heart failure（ESHF）. Methods Totally，50 patients with ESHF who underwent HeartCon LVAD implantation at TEDA International Cardiovascular Hospital from June 2022 to March 2025 were enrolled. The clinical data were collected，and the levels of sST2，IL-6 and CRP were determined before the operation and at 1，7，30，60 and 90 d after the operation. All the patients were followed up for 6 months. The occurrence of MACE（including death and rehospitalization due to right heart failure）was recorded. The patients were classified into non-MACE group（45 cases）and MACE group（5 cases）. Cox regression analysis was used to evaluate the influencing factors of MACE after LVAD implantation in ESHF patients. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of each indicator in predicting MACE after LVAD implantation in ESHF patients. Kaplan-Meier survival curve was used to analyze the occurrence of MACE within 6 months after LVAD implantation in ESHF patients. Results Compared with preoperative levels，the levels of sST2，IL-6 and CRP in ESHF patients increased synchronously on the first day after the operation and reached the peak，and then gradually decreased，stabilizing at the 90th day after the operation. The sST2 level on the 30th and 90th day after the operation in MACE group and the IL-6 and CRP levels on the 90th day after the operation in MACE group were higher than those in non-MACE group（P<0.05）. There was no statistical significance in the levels of sST2，IL-6 and CRP between the 2 groups at the other time points（P>0.05）. There was no statistical significance in the incidence of MACE within 6 months after LVAD implantation among ESHF patients with different etiologies（dilated cardiomyopathy，ischemic cardiomyopathy）（P>0.05）. The levels of sST2 on the 30th day，CRP on the 60th day after the operation and IL-6 and CRP levels on the 90th day after the operation were risk factors for MACE occurrence within 6 months after LVAD implantation in LVAD patients（P<0.05）. The areas under curves（AUC）for predicting MACE after LVAD implantation in ESHF patients by sST2 on the 30th day and IL-6 and CRP on the 90th day were 0.875，0.785 and 0.796，respectively. According to the optimal cut-off values of sST2 on the 30th day and IL-6 and CRP on the 90th day，ESHF patients were classified into high-level and low-level groups. The incidence of MACE within 6 months after the operation was higher in high-level groups of sST2 on the 30th day，IL-6 on the 90th day and CRP on the 90th day than in low-level groups（P<0.05）. Conclusions The sST2 on the 30th day and IL-6 and CRP on the 90th day after LVAD implantation have certain predictive value for the occurrence of MACE within 6 months after ESHF patients undergoing LVAD implantation.

Mechanism of etoposide-induced gene 24 in regulating the immune function of CD8⁺ T cells and influencing the progression of thyroid cancer

XU Baoguo, KE Yubi, ZHANG Yue, GUO Chenming

2026, 41(9):  853-859.  DOI: 10.3969/j.issn.1673-8640.2026.09.005

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Objective To investigate the effect of etoposide-induced gene 24 （EI24） on the immune function of CD8⁺ T cells in the tumor microenvironment of thyroid cancer，as well as the regulatory mechanism of EI24 on the progression of thyroid cancer. Methods Totally，2 mL of venous blood was collected from 10 healthy subjects at the First Affiliated Hospital of Xinjiang Medical University from January to June 2024. Peripheral blood mononuclear cells （PBMC） were isolated using the immunomagnetic bead method，and CD8⁺ T cells were selected. The EI24 gene blank sequence，overexpression sequence and siRNA sequence of EI24 were constructed and transfected into CD8⁺ T cells. The cells were co-cultured with the thyroid cancer cell line SW579 at a ratio of 5∶1 for 48 h. The expression levels of PD-1，CD28 and CD69 on the surface of CD8⁺ T cells，the secretion levels of interferon-gamma（IFN-γ）and tumor necrosis factor-alpha（TNF-α），the apoptosis rate and the expression levels of EI24 gene，autophagy-related genes [microtubule-associated protein 1A/1B-light chain 3（LC3），p62] and apoptosis-related genes [cysteine-containing aspartate-specific protease-3（Caspase-3），Bcl-2] were determined. The proliferation，invasion and apoptosis of SW579 cells were also determined. Results Compared with blank control group，the relative expression levels of EI24 mRNA and protein in CD8⁺ T cells of overexpression group were increased （P<0.05），and the expressions of PD-1，CD28 and CD69 were increased（P<0.05）. The secretion levels of IFN-γ and TNF-α were increased（P<0.05），while the relative expression levels of LC3，p62 and Caspase-3 mRNA and protein were decreased（P<0.05），the apoptosis rate was decreased（P<0.05），and the relative expression levels of Bcl-2 mRNA and protein were increased（P<0.05）. The proliferation and invasion abilities of SW579 cells were decreased（P<0.05），and the apoptosis rate was increased（P<0.05）. In the low-expression group，the relative expression levels of EI24 mRNA and protein were decreased（P<0.05），and the expressions of PD-1，CD28 and CD69 were decreased（P<0.05）. The secretion levels of IFN-γ and TNF-α were decreased（P<0.05），while the relative expression levels of LC3，p62 and Caspase-3 mRNA and protein were increased （P<0.05），and the apoptosis rate was increased（P<0.05）. The proliferation and invasion abilities of SW579 cells were increased （P<0.05），and the apoptosis rate was decreased （P<0.05）. Conclusions High expression of EI24 gene can inhibit autophagy and apoptosis of CD8⁺ T cells，enhance their immune killing function，and thereby inhibit the malignant progression of thyroid cancer.

Roles of serum PDK1 and SFRP4 in prognosis assessment of non-small cell lung cancer patients

ZHAO Fang, JIANG Guorong, SHI Shuyue, XIAO Jian, MA Shaolin, LI Runpu

2026, 41(9):  860-866.  DOI: 10.3969/j.issn.1673-8640.2026.09.006

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Objective To investigate the correlation between serum pyruvate dehydrogenase kinase 1 （PDK1），secreted frizzled-related protein 4 （SFRP4） and the clinical pathological characteristics of patients with non-small cell lung cancer （NSCLC），as well as their value in prognosis assessment. Methods A total of 104 NSCLC patients （NSCLC group） and 100 patients with benign lung diseases （benign disease group） were enrolled from Baoding Second Central Hospital from May 2020 to May 2022. The clinical data were collected，and the levels of serum PDK1 and SFRP4 were determined. The NSCLC patients were followed up for 3 years，and they were classified into death group（46 cases）and survival group（58 cases）according to their prognosis outcomes. Cox regression analysis was used to evaluate the influencing factors of prognosis in NSCLC patients. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of PDK1 and SFRP4 in predicting patient mortality. The survival situation of NSCLC patients was analyzed using Kaplan-Meier survival curve. Results The serum PDK1 level in NSCLC group was higher than that in benign disease group（P<0.001），and the serum SFRP4 level was lower than that in benign disease group（P<0.001）. There was statistical significance in serum PDK1 and SFRP4 levels among NSCLC patients with different TNM stages，differentiation degrees and lymphatic metastasis（P<0.05）. There was no statistical significance in serum PDK1 and SFRP4 levels among NSCLC patients of different ages，genders and histological types（P>0.05）. Compared with survival group，the serum PDK1 level in death group was increased（P<0.001），and the serum SFRP4 level was decreased（P<0.001）. TNM stage Ⅲ， lymphatic metastasis，elevated serum PDK1 and decreased serum SFRP4 were all risk factors for death in NSCLC patients（P<0.05）. A combined determination model of TNM stage， lymphatic metastasis and serum PDK1 and SFRP4 was constructed using Logistic regression analysis. The areas under curves（AUC）of single and combined determination model of serum PDK1 and SFRP4 for determining the death of NSCLC patients were 0.820 and 0.817，respectively. The 3-year survival rate of high-level PDK1 group （29.27%） was lower than that of low-level group（71.43%）（Log-rank χ²= 19.872，P<0.001）；the 3-year survival rate of low-level SFRP4 group（20.41%）was lower than that of high-level group（76.36%）（Log-rank χ²= 23.141，P<0.001）. Conclusions The serum PDK1 and SFRP4 levels in NSCLC patients are related to tumor low differentiation，high TNM stage and lymphatic metastasis. Serum PDK1 and SFRP4 have certain value in prognosis assessment of NSCLC patients，and they may be prognostic markers.

Role of serum CTRP3 and Metrnl in the diagnosis of type 2 diabetes mellitus complicated with microvascular lesions

WANG Qian, CHU Lulu, ZHANG Wenting, WANG Ya

2026, 41(9):  867-871.  DOI: 10.3969/j.issn.1673-8640.2026.09.007

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Objective To investigate the role of serum C1q tumor necrosis factor-related protein 3（CTRP3）and meteorin-like protein（Metrnl）in the diagnosis of type 2 diabetes mellitus（T2DM）complicated with microvascular lesions. Methods A total of 215 patients with T2DM （T2DM group） and 215 healthy subjects （healthy control group） were enrolled from Kailuan General Hospital from August 2021 to January 2024. T2DM patients were classified into lesion group（104 cases）and non-lesion group（111 cases）based on whether they had microvascular lesions. The clinical data were collected，and serum CTRP3 and Metrnl levels were determined. Multivariate Logistic regression analysis was used to evaluate the influencing factors of microvascular lesions in T2DM patients. Receiver operating characteristic （ROC） curve was used to evaluate the efficacy of serum CTRP3 and Metrnl in diagnosing microvascular lesions in T2DM patients. Results The serum CTRP3 and Metrnl levels in T2DM group were lower than those in healthy control group （P<0.001），and there was no statistical significance in the other indicators between the 2 groups（P>0.05）. Compared with non-lesion group，the serum CTRP3，Metrnl and high-density lipoprotein cholesterol（HDL-C）levels in lesion group were decreased（P<0.001），while the serum total cholesterol（TC），triglyceride（TG）and low-density lipoprotein cholesterol（LDL-C）levels were increased （P<0.001）. There was no statistical significance in the other indicators between the 2 groups（P>0.05）. Decreased serum CTRP3 and Metrnl levels were risk factors for microvascular lesions in T2DM patients [odds ratios（OR）were 0.276 and 0.124，95% confidence intervals（CI）were 0.138-0.552 and 0.055-0.278，P<0.001]. The areas under curves （AUC） of single and combined determinations of serum CTRP3 and Metrnl for diagnosing microvascular lesions in T2DM patients were 0.816，0.810 and 0.882，respectively. Conclusions The combined determination of serum CTRP3 and Metrnl plays a role in the diagnosis of microvascular lesions in T2DM.

Analysis of metabolic and coagulation characteristics in patients with bisalbuminemia

GUO Shuli, ZHAO Jin, GOU Rong, CHEN Cheng, JIANG Minjie, WANG Changmin

2026, 41(9):  872-878.  DOI: 10.3969/j.issn.1673-8640.2026.09.008

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Objective To investigate the epidemiological characteristics of bisalbuminemia and its relationship with metabolic indicators. Methods A total of 396 127 patients who underwent serum protein electrophoresis（SPE） testing at the People's Hospital of Xinjiang Uygur Autonomous Region from January to December 2014 were enrolled. Totally，105 patients with bisalbuminemia（bisalbuminemia group） were identified，and 105 control subjects without bisalbuminemia（control group）were matched from the remaining patients in a 1∶1 ratio according to age，gender，ethnicity and blood sampling time（± 1 month）. The clinical data and routine biochemical and immunological determination results were collingected. The bisalbuminemia patients were classified into metabolic syndrome（MS）group（67 cases）and non-MS group（38 cases）. Among the 28 patients with repeated SPE testing records，they were classified into persistent group（15 cases）and transient group（13 cases）according to whether the bisalbumin band persisted. Spearman correlation analysis was used to evaluate the correlation between various indicators and bisalbuminemia. Multivariate Logistic regression analysis was used to assess the risk factors for bisalbuminemia. Results There was no statistical significance in clinical data between bisalbuminemia group and control group（P>0.05）. The levels of glucose（Glu），triglyceride（TG），low-density lipoprotein cholesterol（LDL-C），lipoprotein（a）[Lp（a）]，total bile acid（TBA），gamma-glutamyltransferase（GGT），alkaline phosphatase（ALP），uric acid（UA），fibrinogen（Fib），D-dimer（DD） and alpha₁-globulin in bisalbuminemia group were higher than those in control group（P<0.05）. The levels of Glu，TG，DD and the proportion of diabetes mellitus in transient group were higher than those in persistent group（P<0.05）. The levels of TG，Lp（a），TBA，UA，Fib，DD，GGT，ALP and alpha₁-globulin in MS group were higher than those in non-MS group（P<0.01）. Serum Glu，TG，Lp（a），TBA，UA and DD were positively correlated with bisalbuminemia（r values were 0.579，0.706，0.555，0.701，0.708 and 0.634，respectively，P<0.001）. TG≥2.3 mmol·L^-1 and Lp（a）>300 mg·L^-1 were risk factors for bisalbuminemia（P<0.05）. Conclusions Bisalbuminemia is related to metabolic disorders and hypercoagulable state，suggesting that it may be associated with an increased risk of multiple system abnormalities.

Comparison of 4 anti-phospholipase A2 receptor antibody determination methods in the diagnosis of primary membranous nephropathy

WANG Junfen, YU Qi, LOU Jiatao, FAN Qiuling, ZHANG Rulin, ZHANG Rong, SUN Yi

2026, 41(9):  879-883.  DOI: 10.3969/j.issn.1673-8640.2026.09.009

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Objective To investigate the performance of 4 methods [enzyme-linked immunosorbent assay （ELISA），indirect immunofluorescence assay（IFA），flow luminescence immunoassay（FLIA）and chemiluminescence immunoassay（CLIA）] in determining anti-phospholipase A2 receptor（PLA2R）antibodies in the diagnosis of primary membranous nephropathy（PMN）. Methods A total of 103 patients with PMN（PMN group），177 patients without PMN（non-PMN group）and 40 healthy subjects（healthy control group）were enrolled from Shanghai General Hospital from September 2023 to June 2024. The clinical data were collected，and serum anti-PLA2R antibodies were determined using the 4 methods. The optimal cut-off value for determining anti-PLA2R antibodies in diagnosing PMN was obtained using receiver operating characteristic（ROC）curve，and the cut-off value was verified using the serum samples of healthy control group. Results The sensitivities of IFA，CLIA，FLIA and ELISA for determining serum anti-PLA2R antibodies were 84.47%，82.52%，78.64% and 63.11%，respectively. The specificities were 100%. The areas under curves（AUC）for determining serum anti-PLA2R antibodies in diagnosing PMN by ELISA，FLIA and CLIA were 0.988 2，0.988 7 and 0.970 7，respectively. The cut-off values were set at 2.730 RU·mL^-1， 7.015 U·mL^-1 and 3.705 U·mL^-1，respectively，which could improve the sensitivity without significantly reducing the specificity. The cut-off value of IFA was 1∶10，and its diagnostic efficacy for PMN was the highest. Conclusions Among the 4 methods，IFA has the highest sensitivity，followed by CLIA and FLIA，and ELISA has the lowest. When the cut-off values of ELISA，FLIA and CLIA are set at 2.730 RU·mL^-1，7.015 U·mL^-1 and 3.705 U·mL^-1，respectively，the diagnostic sensitivity of PMN could be improved without significantly reducing specificity.

Predictive value of mitochondrial membrane potential changes in effector-memory T cells and inflammatory indicators for short-term neurological functional recovery in elderly patients with sepsis-associated encephalopathy

SHI Yiwen, ZHANG Yajuan, LIU Yuan, ZHANG Yuanyuan, FU Jing

2026, 41(9):  884-890.  DOI: 10.3969/j.issn.1673-8640.2026.09.010

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Objective To investigate the value of mitochondrial membrane potential（MMP）indicators and inflammatory indicators of effector-memory T cells（Tem）in judging the short-term neurological functional recovery of elderly patients with sepsis-associated encephalopathy（SAE）. Methods A total of 158 elderly SAE patients from Huai'an Second People's Hospital from October 2020 to October 2025 were enrolled. They were classified into good recovery group and poor recovery group according to the neurological functional recovery status for 14 d after treatment. The clinical data were collected，and the T cell subsets，CD4⁺CD45RA^-CD62L^-Tem（referred to as CD4⁺ Tem）MMP and the percentage of low MMP cells in this subset of cells（referred to as CD4⁺Tem MMP-Low%），CD8⁺CD45RA^-CD62L^-Tem（referred to as CD8⁺Tem）MMP and the percentage of low MMP cells in this subset of cells（referred to as CD8⁺Tem MMP-Low%），whole blood cell counts，C-reactive protein（CRP）and procalcitonin（PCT）were determined. The neutrophil/lymphocyte ratio（NLR），systemic immune-inflammation index（SII），systemic inflammatory response index（SIRI）were calculated. Multivariate Logistic regression analysis was used to evaluate the influencing factors of poor neurological functional recovery in elderly SAE patients. Receiver operating characteristic（ROC）curve was used to evaluate the efficacy of single and combined determinations of various indicators in judging the poor short-term neurological functional recovery of elderly SAE patients. Results The CD4/CD8 ratio，CD4⁺Tem MMP，CD8⁺Tem MMP in poor recovery group were lower than those in good recovery group（P<0.001），while CD4⁺Tem MMP-Low%，CD8⁺Tem MMP-Low%，NLR，SII，SIRI，CRP and PCT were higher than those in good recovery group（P<0.001）. Decreased CD4/CD8 ratio and increased CD4⁺Tem MMP，CD8⁺Tem MMP，NLR were all risk factors for poor neurological functional recovery in elderly SAE patients（P<0.05）. The areas under curves（AUC）of CD4/CD8 ratio，CD4⁺Tem MMP，CD8⁺Tem MMP，NLR single and combined determinations in judging poor neurological functional recovery of elderly SAE patients were 0.669，0.679，0.717，0.720 and 0.835，respectively. Conclusions CD4/CD8 ratio，Tem MMP combined with NLR can effectively predict the short-term neurological functional recovery of elderly SAE patients and can provide a reference for early clinical intervention.

Role of MALDI-TOF MS in the homology analysis of vancomycin-resistant Enterococcus faecium

KANG Beipei, ZHENG Tian, FU Xiaorui, YANG Peihong, HE Wenfang, ZHOU Shan, ZHOU Ke

2026, 41(9):  891-895.  DOI: 10.3969/j.issn.1673-8640.2026.09.011

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Objective To analyze the role of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry （MALDI-TOF MS） in the homology analysis of vancomycin-resistant Enterococcus faecium （VREFm）. Methods Totally，31 non-repetitive clinical isolates of VREFm from the First Affiliated Hospital of Airforce Medical University from November 2017 to November 2024 were collected. Bacterial identification and in vitro drug susceptibility tests were performed using VITEK Compact automatic bacterial identification and drug susceptibility testing instrument. The vancomycin resistance was rechecked using disk diffusion method and microbroth dilution method. The vancomycin resistance genes were detected by fluorescence quantitative polymerase chain reaction （qPCR），and homology analysis was conducted using MALDI-TOF MS. Cluster analysis was performed using VITEK-MS SARAMIS Premium software and validated by multilocus sequence typing （MLST）. Results All the 31 VREFm isolates were resistant to vancomycin，teicoplanin，penicillin，ampicillin，levofloxacin，ciprofloxacin and erythromycin. The resistance genotypes were all vanA genes. Protein mass peak clustering analysis showed that the 31 VREFm isolates could be classified into 5 major clusters. Compared with the validation results，the 27 of 31 VREFm isolates belonged to the first cluster of MALDI-TOF MS，including 19 ST78 types，4 ST80 types and 4 ST17 types；1 isolate each in the second，third，fourth and fifth clusters，namely ST389，ST192，ST78 and ST80 types. Conclusions MALDI-TOF MS has certain limitations in the homology analysis of VREFm，the consistency with MLST results is poor，and its resolution ability is weak，unable to distinguish ST types highly related to VREFm.

Drug susceptibility analysis of clinical isolates of Mycobacterium tuberculosis from a tertiary specialty hospital in Shanghai，2023-2025

MA Xu, YU Fangyou, YANG Jinghui, WAN Baoshan, WU Xiaocui

2026, 41(9):  896-901.  DOI: 10.3969/j.issn.1673-8640.2026.09.012

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Objective To analyze the drug susceptibility profiles and their trends of Mycobacterium tuberculosis（MTB） clinical isolates to 12 anti-tuberculosis drugs at Shanghai Pulmonary Hospital of Tongji University，from 2023 to 2025. Methods A total of 8 195 tuberculosis patients were enrolled from January 2023 to December 2025 at Shanghai Pulmonary Hospital of Tongji University. MTB was isolated and cultured，followed by in vitro drug susceptibility testing（DST） for 12 anti-tuberculosis drugs，and minimum inhibitory concentrations（MIC） were determined. Only the first isolate from each patient was included. The clinical data were collected. Results Among the 8 195 MTB isolates，64.38%（5 276 isolates） were collected from male patients，and 47.56%（3 898 isolates） were collected from elderly patients（>60 years）. The main clinical specimens were sputum（38.06%，3 119 cases） and bronchoalveolar lavage fluid（28.80%，2 360 cases）. Resistance to at least one anti-tuberculosis drug MTB was observed in 30.98%（2 539 isolates） ，with multidrug-resistant（MDR） MTB accounting for 7.99%（655 isolates） and pre-extensively drug-resistant MTB for 4.00%（328 isolates）. The resistance rate to cycloserine decreased annually（P<0.05），while resistance to ethambutol significantly declined in 2025（P<0.05）. No significant changes were observed in resistance rates to the other 10 drugs，including amikacin，isoniazid and rifampicin（P>0.05）. From 2023 to 2025，MDR-TB isolates showed statistical significance in resistance rates to ethambutol，moxifloxacin，ofloxacin and cycloserine（P<0.05）. The resistance rate of pre-extensively drug-resistant MTB to ethambutol in 2025 was lower than those in 2023 and 2024. High-level resistance was predominant among isolates resistant to amikacin，kanamycin，rifampicin and streptomycin，whereas low-level resistance was more common in those resistant to cycloserine and ethambutol. Conclusions Between 2023 and 2025，there was no significant change in overall MDR and pre-extensively drug-resistant MTB at Shanghai Pulmonary Hospital of Tongji University. However，resistance rates to cycloserine and ethambutol decreased. High-level resistance remains prevalent in amikacin，kanamycin，rifampicin and streptomycin-resistant isolates. Continuous in vitro DST monitoring of MTB is essential to guide rational use of anti-tuberculosis drugs in clinical practice.

Establishment and verification of a fuzzy comprehensive evaluation model for biosafety management in secondary pathogen microorganism laboratories

JI Yunqian, ZANG Changhai, WANG Dong

2026, 41(9):  902-906.  DOI: 10.3969/j.issn.1673-8640.2026.09.013

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Objective To establish a secondary pathogen microorganism laboratory biosafety management evaluation model based on analytic hierarchy process （AHP） and fuzzy comprehensive evaluation，providing a quantitative basis for laboratory biosafety improvement and dynamic supervision by health authorities. Methods The Delphi method was used to establish an evaluation system consisting of 6 primary and 24 secondary indicators. The indicator weights and the judgment matrix and membership parameters were determined through expert consultation. The weights of each indicator were calculated using the AHP method，and the multi-level comprehensive evaluation was completed using fuzzy operators to achieve quantitative scoring and grade evaluation of laboratory biosafety. A fuzzy evaluation matrix was established according to expert scoring. An example of a secondary pathogen microorganism laboratory was selected for verification. Results The establishment of the AHP-fuzzy comprehensive evaluation biosafety management evaluation model can，handle subjective fuzziness，and output visualized quantitative evaluation results. The verification results showed that the comprehensive score of laboratory biosafety was 3.872，and the grade was good. Conclusions The evaluation results of this model can provide a scientific basis for the precise improvement of laboratory biosafety，the establishment of a dynamic supervision mechanism by the authorities，and the implementation of hierarchical management strategies.

Analysis of dynamic trends in peripheral blood cell parameters among apparently healthy adults in Chengdu

WANG Shuang, MENG Qiang, LIU Shiyao, FU Yang, JIANG Hong

2026, 41(9):  907-912.  DOI: 10.3969/j.issn.1673-8640.2026.09.014

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Objective To analyze the trends in peripheral blood cell parameters among apparently healthy adults in Chengdu，and to provide a reference for establishing relevant reference intervals. Methods Retrospective analysis was conducted on blood cell test results from 273 229 apparently healthy adults（148 581 males and 124 648 females）at the Health Examination Center of West China Hospital，Sichuan University，collected in 2011，2016 and 2021，including 13 474 cases in 2011，97 936 cases in 2016 and 161 819 cases in 2021. The subjects were classified into 3 age groups：18-40 years，41-60 years and >60 years. The differences in gender，red blood cell（RBC）count，hemoglobin（Hb），platelet（PLT）count，white blood cell（WBC）count，the absolute value of neutrophils（NEUT#），the absolute value of lymphocytes（LYMPH#） and the absolute value of monocytes（MO#）were compared. Results There was statistical significance in RBC count，Hb，PLT count，WBC count，NEUT#，LYMPH# and MO# in 2011，2016 and 2021（P<0.001），with PLT count and MO# showing an upward trend. Subgroup analysis adjusting for gender and age revealed that PLT count and MO# continued to increase significantly，while the other parameters showed fluctuating changes characterized by initial increases followed by decreases. Conclusions Blood cell parameters among apparently healthy adults in Chengdu changed to varying degrees from 2011 to 2021. The reference intervals for adult peripheral blood cell parameters in Southwest China should be established according to local conditions.

Analysis of clinical laboratory quality indicators for Shanghai's tertiary public hospitals from 2020 to 2024

YANG Xue, WANG Qing, JIANG Lingli, ZHOU Jing, HU Xiaobo

2026, 41(9):  913-918.  DOI: 10.3969/j.issn.1673-8640.2026.09.015

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Objective To analyze the performance of quality indicators across the entire process in clinical laboratories of Shanghai's tertiary public hospitals，and to comprehensively assess the overall testing quality. Methods The data on 15 quality indicators and information system development from 72 tertiary public hospitals' clinical laboratories in Shanghai between 2020 and 2024 were collected. The P₂₅，P₅₀ and P₇₅ values for each indicator，along with their corresponding σ levels and 5-year trends，were calculated. In 2024，the quality levels of these 15 indicators were compared against the quality standards recommended by the International Federation of Clinical Chemistry and Laboratory Medicine（IFCC）Working Group on Laboratory Errors and Patient Safety（WG-LEPS）. Results Among the 72 laboratories，69 laboratories adopted information systems to collect quality data. Among levels of the 15 quality indicators，the P₅₀ values for internal quality control implementation rate and interlaboratory comparison participation rate increased from 96.85% （σ=3.4） and 45.05% （σ=1.6） in 2020 to 98.99% （σ=3.8） and 91.53% （σ=2.9） in 2024，respectively. The medians of pre-analytical turn-around times for inpatient and outpatient specimens decreased from 80 and 30 min in 2020 to 68 and 25 min in 2024. For pre-analytical indicators，the P₅₀ σ levels for specimen type error rate，specimen container error rate，specimen volume error rate and coagulation rate in anticoagulated specimens remained stable at 5.0. The blood culture contamination rate maintained a P₅₀ σ level of 4.0. The median of pre-analytical turn-around time for emergency tests decreased from 23 min in 2020 to 20 min in 2024. For analytical and post-analytical indicators，the P₅₀ σ levels for coefficient of variation failure rate in internal quality control，external quality assessment participation rate，external quality assessment failure rate，incorrect test report rate，critical value notification rate and timely critical value notification rate remained stable at 6.0. The median of laboratory turn-around times for inpatient，emergency and outpatient specimens decreased from 123，52 and 100 min in 2020 to 115，46 and 90 min in 2024，respectively. Except for blood culture contamination rate，more than 80% of laboratories met the minimum quality requirements recommended by IFCC. Conclusions The overall quality performance of clinical laboratories in Shanghai's tertiary public hospitals is excellent and shows an upward trend year by year. However，further strengthening of quality control in the pre-analytical phase remains necessary. Application of quality indicators has improved testing quality，but further enhancement of datum quality requires greater standardization of indicators and higher levels of informationalization in datum collection.

Research progress of exosomes in the early diagnosis of breast cancer

LI Xuemin, LI Xiaocong, DING Haitao

2026, 41(9):  922-928.  DOI: 10.3969/j.issn.1673-8640.2026.09.017

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Early diagnosis of breast cancer is crucial for improving patient prognosis. However，existing clinical methods have limitations such as high invasiveness or insufficient sensitivity. Exosomes，as nanoscale vesicles secreted by tumor cells，have emerged as a new type of biomarker in the field of breast cancer liquid biopsy due to their advantages of non-invasive acquisition，high abundance in body fluid，and the ability to carry specific biomolecules. This review systematically focuses on the research progress of exosomes in the early diagnosis of breast cancer，focusing on the biological basis of their use as diagnostic markers，summarizing the latest research results of nucleic acid and membrane protein-based markers，and comparing the advantages，disadvantages and application scenarios of various exosome isolation and determination techniques. Although exosomes show potential for clinical application，their clinical translation still faces challenges such as standardized isolation，heterogeneity interference and high determination costs. In the future，through multi-omics integrated analysis and the development of new determination technologies，it is expected to achieve breakthroughs in the early precise diagnosis of breast cancer using exosomes.