目的 研究血清成纤维细胞生长因子21(FGF-21)和血小板衍生生长因子-BB(PDGF-BB)及外周血单个核细胞纤维化蛋白(FBRS)水平诊断慢性乙型肝炎(CHB)患者肝纤维化程度的效能.方法 2020年1月～2021年1月我院收治的CHB患者92例,行肝穿刺活检,采用ELISA法测定血清FGF-21和PDGF-BB水平,采用实时荧光定量PCR法测定外周血单个核细胞(PBMCs)FBRS mRNA水平,使用Fibroscan行肝脏硬度检测(LSM).应用受试者工作特征(ROC)曲线下面积(AUC)分析各指标诊断显著性肝纤维化的效能.结果 经肝组织病理学检查,发现非显著性肝纤维化(S0～1期)49例,显著性肝纤维化(S2～4期)43例;显著性肝纤维化组血清FGF-21水平为(228.8±52.6)ng/ml,显著低于非显著性肝纤维化组[(289.3±57.9)ng/ml,P<0.05],血清PDGF-BB水平为(84.7±32.9)pg/ml,显著高于非显著性肝纤维化组[(44.7±18.5)pg/ml,P<0.05],PBMCs FBRS水平为(8.7±3.2),显著高于非显著性肝纤维化组[(4.4±1.8),P<0.05],LSM为(15.6±3.9)kPa,显著高于非显著性肝纤维化组[(7.6±1.8)kPa,P<0.05];FGF-21、PDGF-BB、FBRS和LSM诊断显著性肝纤维化的最佳截断点分别为249.0(ng/ml)、63.5(pg/ml)、7.4和11.2(kPa),其AUC分别为0.800、0.714、0.690和0.960,诊断的敏感度和特异度分别为69.8％和79.6％、69.8％和69.4％、65.1％和73.5％及93.3％和98.0％,四项指标联合诊断的AUC为0.989,其敏感度和特异度分别为95.3％和63.3％.结论 联合应用血清FGF-21、PDGF-BB、FBRS和LSM可以提高诊断CHB患者肝纤维化程度的灵敏性,但特异性仍不高,需要进一步研究.

目的 探讨并评价SPRINTER XL/Europattern全自动荧光免疫分析系统检测血清抗核抗体性能验证方案.方法 根据WS/T 505-2017《定性测定性能评价指南》和《医学实验室质量和能力认可准则在临床免疫学定性检验领域的应用说明》的具体要求建立抗核抗体检出限、诊断符合率和精密度性能验证方案.结果 全自动荧光免疫分析系统检测抗核抗体最低检出限大于33.33IU/ml,该浓度阳性检出率为100％;检测系统诊断灵敏度=20/20×100％=100％,诊断特异性=20/20×100％=100％,诊断符合率=40/40×100％=100％;阴性样本、弱阳性样本、阳性样本批内精密度和中间精密度核型结果稳定,荧光强度一致,符合率为100％.结论 全自动荧光免疫分析系统检测抗核抗体检出限、诊断符合率及精密度性能稳定,能够满足实验室要求.

目的:分析自身免疫性肝病(AILD)抗体谱检测在AILD诊断中的应用效果.方法:选取本院2019年06月～2020年05月诊治的80例自身免疫性肝病患者作为本次试验观察组,选取同期80例健康体检者作为对照组,两组均给予AILD抗体谱检测,回顾性分析两组检测效果.结果:观察组的抗体谱(LKM-1、AMA-M2、SP100、LC-1、gp-210和SLA/LP)阳性检出率与对照组相比,观察组均明显偏高(P<0.05);有原发性胆汁性胆管炎(PBC)组的AMA-M2、gp-210和SP100阳性检出率与自身免疫性肝炎(AIH)相比,PBC组均明显偏高(P<0.05);AIH组的LKM-1、LC-1和LA/LP阳性检出率与PBC组相比,AIH组均明显偏高(P<0.05);AIH-Ⅱ型和AIH-Ⅲ型患者的LC-1阳性检出率与AIH-Ⅰ型相比均明显偏低(P<0.05),AIH-Ⅰ型和AIH-Ⅲ型患者的LKM-1阳性检出率与AIH-Ⅱ型相比均明显偏低(P<0.05),AIH-Ⅰ型和AIH-Ⅱ型患者的SLA/LP阳性检出率与和AIH-Ⅲ型相比均明显偏低(P<0.05).结论:给予自身免疫性肝病患者AILD抗体谱检测能够获取到比较显著的诊断效果,为肝病患者的临床分型和鉴别诊断提供重要参考依据,具有推广价值.

目的 探讨乙型肝炎病毒(HBV)相关性肝癌(HCC)患者人类白细胞抗原(HLA)Ⅰ类(A、B、C)等位基因多态性分布特征.方法 用基于Illumina平台GenDx NGSgo分型方法对101例HCC患者(试验组)和186例健康者(对照组)进行HLA-Ⅰ基因分型,并进行统计学分析.结果 与对照组比较,试验组HLA-ⅠB*44:03基因频率(2.97％vs.0.81％)更高,HLA-ⅠA*02:01基因频率(5.45％vs.10.48％)和HLA-ⅠC*03:03基因频率(2.48％vs.6.72％)更低,差异有统计学意义(P<0.05).结论 携带不同HLA-Ⅰ等位基因与HBV阳性患者发展成为HCC有一定的相关性.

Objective To verify and evaluate the sensitivity of serum total-β human chorionic gonadotropin (T-βHCG) test with Beckman Coulter Access DXI800 chemiluminescence immunoassay analyzer.Methods Firstly,the precision and accuracy of Beckman Coulter Access DXI800 system was examined by verification test,with reference to the Clinical Laboratory Standards Institute(CLSI)EP17-A documents.Then,blank and low-concentration samples were tested by the chemiluminescence immunoassay analyzer.The value of serum T-βHCG and the relative light units(RLU)were recorded.The lower limit of detection(LLD),biological detection limit(BLD)and functional sensitivity(FS)of serum T-βHCG were determined by using appropriate statistical methods based on the data distribution.Results The mean RLU of blank samples for T-βHCG detection was 10 224.18 (standard deviation:400.85).The precision and accuracy of Beckman Coulter Access DXI800 system met the performance requirements of CLIA'88 regulations.The mean T-βHCG levels in a series of lower concentration samples were 0.015,0.109,0.507,1.060,2.418,and 4.614 IU/L respectively;and the inter-day CV%of their RLU values were 2.76,3.00,6.62,4.31,3.00,and 2.84 respectively.The LLD,BLD and FS of serum T-βHCG was 0.17 IU/L,0.10 IU/L and 0.50 IU/L,respectively.All the results were superior to the analytical performance declared by the manufacturer.Conclusions The analytical sensitivity of Beckman Coulter Access DXI800 system for serum T-βHCG detection is consistent with clinical requirements.The verification protocol and experimental method are simple,practical and feasible.

目的采用六西格码(6σ)质量管理方法对血气分析的室内质量控制(quality controls,QC)进行回顾性分析,以评价血气分析仪的性能。方法利用制程能力指数(Cp,Cpk)和Westgard标准化的6σ医学性能决定图对雷度ABL800血气分析仪6个月的QC结果进行分析。再以Cp1.33标准,6σ量度对其接受能力进行评价。结果 pH,PCO2,PO2的Cp和Cpk值分别为1.95,1.93;1.74,1.71;1.60和1.45。上述指标结果优于Cp1.33标准规范,达到6σ质量管理要求制程能力Ⅱ级或以上。结论 6σ质量管理可确保雷度ABL800血气分析仪的性能完全符合CLIA′88能力验证计划的分析质量要求。

Objective To explore the efficiency and safety of velcade regimen treating multiple myeloma (MM).Methods Totally 11 MM patients during August 2008 to May 2011 treated with VD regimen were analyzed retrospectively.VD regimen was adopted.Then VAD regimen was used.Halidomide combined with prednisone and mafalan were given during stable stage.Results The median follow-up period was 24 months.After one VD course,the main side effects were as follow:one peripheral nerve numbness,two restless multilingual,two lung infection (bacter and fungal),one diarrhea and two zoster.Conclusions VD regimen can be used to treat MM.

Objective To explore the clinical significance of fms-like tyrosine kinase3(FLT3) expression in evaluation prognosis of acute myeloid leukemia(AML) prognosis.Methods 50 patients with AML were selected.AML patients with normal karyotype were 20 cases,the abnormal karyotype were 30 cases.3ml bone marrow before themotherapy was aspirated respectively,and the FLT3 gene expression in leukemia cells was detected with polyenzyme chain react(PCR).Results The FLT3 expression rate in AML patients with normal karyotype was 5.0％,and was 26.7％ in AML patients with abnormal karyotype,33.3％ in AML patients with refractory-relapse,and 4.5％ in AML patients with continue remission.The FLT3 expression rate was related with high leukemia cells percentage in bone marrow and high blood cells count in peripheral blood,and was not related with Franch America British(FAB) classification.The free-disease survival(FDS) and overall survived(OS) was shorter in FLT3 expression AML patients than that in no FLT3 expression AML patients.There was a statistical significance between the former and the latter( x2 =4.17,P ＜0.05 ).Conclusion FLT3 was a kind of worse factor in AML patients prognosis,and could guide clinical individual treatment in AML.