目的 评价新型抗酸杆菌集菌法检测痰标本抗酸杆菌的应用价值.方法 对2019年1月1日至2020年5月15日在湘潭市岳塘区管理的传染病信息报告系统结核病管理系统中登记在案的416例肺结核患者的痰标本,同时采用新型抗酸杆菌集菌法、液基夹层杯法、直接涂片抗酸染色法进行抗酸染色镜检,比较3种方法的阳性检出率.随机取10份直接涂片抗酸阳性(++++)的标本,5份BD960液体培养结核分枝杆菌阳性的标本,设定不同配比的消化集菌液及水浴时间处理后,再接种至BD960液体培养基,评价新型抗酸杆菌集菌法灭活集菌的安全性.跟踪10例初治或复治失败患者不同随访时间段的痰抗酸杆菌涂片结果,以新型抗酸杆菌集菌法阳性为对照,比较新型抗酸杆菌集菌法与液基夹层杯法对抗酸杆菌的检出差异.结果 新型抗酸杆菌集菌法、液基夹层杯法、直接涂片抗酸染色法抗酸杆菌的阳性检出率分别为44.7％(186/416)、40.1％(167/416)、26.2％(109/416),且3种方法两两比较,阳性检出率差异有统计学意义(P<0.05).安全性试验发现,新型抗酸杆菌集菌法处理的阳性标本,用BD960液体培养未见分枝杆菌生长.10例初治或复治失败患者不同随访时间段的痰标本,在观察时间段内随着治疗时间的推移,新型抗酸杆菌集菌法均可以检出,而液基夹层杯法漏检8例.结论 新型抗酸杆菌集菌法提高了肺结核患者痰标本抗酸杆菌的阳性检出率,且生物安全性高,特别是在初治或复治失败患者中较液基夹层杯法更有优势.

目的 了解2014-2017年湘潭市第一人民医院临床分离肺炎克雷伯菌对抗菌药物的耐药性变迁.方法 采用VITEK 2 Compact微生物分析仪对细菌进行鉴定和药敏试验,K-B法为补充,对湘潭市第一人民医院2014-2017年肺炎克雷伯菌分布与耐药性进行回顾性分析.结果 肺炎克雷伯菌对头孢唑啉(＞30％)耐药率一直偏高,对哌拉西林/他唑巴坦(2.9％～14.1％)、头孢哌酮/舒巴坦(3.6％～16.8％)、头孢他啶(13.2％～25.8％)、头孢吡肟(8.6％～19.8％)、头孢曲松(27.8％～35.o％)、头孢替坦(2.o％～20.8％)以及碳青霉烯类耐药率有明显上升,尤其是碳青霉烯类抗生素四年间上升了约5倍,而亚胺培南(1.8％～11.1％)、美罗培南(2.4％～11.9％)从2016年开始上升幅度增大.氟喹诺酮类及氨基糖苷类耐药性亦有增长趋势.耐药性较稳定的抗生素是复方新诺明(24.9％～～30.5％)、米诺环素(16.5％～19.3％).2014-2017年该菌产ESBLs亦有上升(30.2％～36.4％).结论 临床分离的肺炎克雷伯菌对常用抗菌药物的耐药性4年间呈普遍上升趋势.

目的 通过比较不同标本来源的肺炎克雷伯菌耐药性特征,使抗菌药物的使用更具特异性.方法 分离湘潭市第一人民医院2016-2017年临床不同部位送检标本的肺炎克雷伯菌,采用VITEK2 Compact微生物分析仪对细菌进行鉴定和药敏试验,K-B法作为补充.结果 2016-2017年临床送检的各类标本共检出肺炎克雷伯菌758株,其中痰液检出370株(48.8％),尿液172株(22.7％),血液102株(13.5％),其他各类114株(15.0％);产超广谱β 内酰胺酶(ESBLs)阳性菌株284株(37.5％).与血液标本分离菌株耐药率比较,痰液和尿液的肺炎克雷伯菌对各种抗菌药物的耐药率均较血液高;其中痰液标本的分离菌株对哌拉西林、头孢哌酮/舒巴坦、哌拉西林/他唑巴坦、头孢曲松、头孢吡肟、头孢西丁、氨曲南、亚胺培南、阿米卡星、庆大霉素、妥布霉素、环丙沙星、左氧氟沙星、复方磺胺甲噁唑的耐药率差异有统计学意义(P<0.05);尿液标本分离菌株对头孢曲松、头孢吡肟、头孢西丁、氨曲南、亚胺培南、庆大霉素、妥布霉素、环丙沙星、左氧氟沙星、复方磺胺甲噁唑的耐药率差异有统计学意义(P<0.05).结论 按照不同标本类型进行药敏试验,可以更准确反映菌株的耐药性状况,更好地指导临床抗菌药物的选用.

Objective To analyze the use of direct immunofluorescence in rapid detection of a variety of respiratory viruses. Methods 230 cases of patients with respiratory tract infection admitted in our hospital from January, 2013 to May, 2013 were divided into adults group (105 cases) and children group (125 cases). All of them were tested 7 kinds of virus antigens, including FluA, FluB, PIV1, PIV2, PIV3, RSV and ADV with direct immunofluorescence. Results Of the 230 cases of respiratory infection, the virus detection was positive in 85 cases, the detection rate was 37.0%. Of which, the respiratory syncytial virus was the highest (50 cases, 21.7%), followed by FluA(16 cases , 6.9%) and FluB(14 cases, 6.0%). The age was older, the detection rate of respiratory virus was lower. In the children group, 55 cases was positive (44.0% ), significantly higher than that of adult group (30 cases, 28.6%), the difference was statistically significant (P0.05), and the highest detection rate in both groups was respiratory syncytial virus, 27.2% and 15.2%, respectively. Conclusion Respiratory infection is closely related with 7 kinds of virus antigens, FluA, FluB, PIV1, PIV2, PIV3, RSV and ADV. With high sensitivity and specificity and easy standardization, direct immunofluorescence can rapidly detect the viruses and can meet the requirements of laboratory for virus detection, so it should be applied in clinical.

Objective To PCR-SSCP screening of non-small cell lung cancer with EGFR gene mutation clinical value analysis.Methods Sampling method in 2010 January to 2012 year in July in our hospital of non small cell lung cancer patients a case in 100 as the research object,adopt DNA sequencing method and PCR-SSCP method studied mutation detection of EGFR gene,and DNA sequencing as a gold standard,the PCR-SSCP accuracy evaluation.Results DNA sequencing method detected 32 cases occurring in patients with EGFR mutations in 31 cases,the detection rate is 31%,with PCR-SSCP method to detect mutations in 34 cases,the detection rate was 34%,the difference between the two groups is not statistically significant(P 0.05).Conclusion PCR-SSCP method in non small cell lung cancer EGFR gene mutation screening of high accuracy,worthy of the attention.

目的探讨通过检测鳞状上皮癌抗原(SCC-Ag)及肿瘤相关糖类抗原CAl25在中晚期宫颈鳞状细胞癌治疗前后的水平,预测肿瘤复发和转移的价值。方法采集120例中晚期宫颈癌患者治疗前后的血清样本,用电化学发光免疫测定法测定SCC-Ag和CAl25水平,并进行分析。结果中晚期宫颈癌血清SCC-Ag、CAl25的水平随肿瘤分期升高而升高(P<0.05)。治疗后SCC-Ag、CAl25的水平逐渐下降。分析表明血清SCC-Ag、CAl25水平在治疗后下降至2.0 ng/mL和35 U/mL以下,其复发转移率明显下降,差异有统计学意义(P<0.01)。结论治疗后SCC-Ag、CAl25下降程度可以作为预测治疗后复发和转移的依据。

Objective To discuss the association between serum levels of IL-8 and IGF-1 and glucose control in adolescents with type 1 diabetes.Methods All of 140 cases of adolescents with type 1 diabetes were divided into the good control group(n = 60) and poor control group(n = 80) according to the HbA1c level.Results The levels of serum IL-8 and HbA1c were significantly lower in the good control group than in the poor control group,while the serum IGF-1 was considerably increased,all P < 0.01.The serum IL-8 was related to the HbA1c positively but negatively to the IGF-1,and the IGF-1 level was associated positively with HbA1c.Conclusion Increased IL-8 and reduced IGF1 prove to be the glucose control,and monitoring both levels can assist in judging the metabolic control and improving the prognosis.

<正>外阴阴道念珠菌病(vulvovagina1candidiasis,VVC)包括无症状的阴道寄居及有症状的阴道炎。念珠菌外阴阴道炎一般以阴道为主,可同时合并外阴炎,但偶尔可见到念珠菌外阴炎单独存在。大多数念珠菌外阴阴道炎的症状、体征典型,容易作出诊断;对症状及体征不典型者,要根据有无诱发因素及

Objective To explore the differences of the detection results of electrolyte by blood-gas analysis and biochemistry method,and to compare the clinical significance of the two methods in reference of their laboratory turn around time(TAT).Methods Artery blood and venous blood were collected from 86 inpatients in the First Hospital of Xiangtan.The artery blood was tested for electrolyte by ABL80 Blood-gas Analyzer,and the venous blood was centrifuged and the venous sera were determined for electrolyte by the Abbott Architect C8000 Automatic Biochemistry Analyzer.The laboratory TAT of the two methods from the reception of the specimens to the delivery of the reports was collected and analyzed.Results The potassium concentration in the artery blood determined by the blood-gas analyzer was significantly lower than that in the venous serum detected by the automatic biochemistry analyzer(P<0.01),but the correlation between them was good(r=0.889).The concentrations of sodium,chlorine and calcium measured by the two methods were not statistically different(P>0.05).The TAT of artery blood by blood-gas analysis was sharply shorter than that of venous serum by biochemistry analyzer(P<0.01).Conclusions The potassium concentration in the artery blood determined by the blood-gas analyzer is significantly lower than that in the venous serum detected by the automatic biochemistry analyzer,despite a good correlation between them.The laboratory TAT of artery blood samples by blood-gas analysis is markedly shorter than that of venous serum by biochemistry analyzer.The electrolyte in artery blood determined by blood-gas analysis is helpful to the early diagnosis of emergency or critical conditions.

[目的]比较冰冻血小板与新鲜血小板在血液病及非血液病患者血小板减少、急性出血中应用的有效性与安全性.[方法]选择650例血小板减少症患者,330例患者输注冰冻机采血小板,320例患者输注新鲜机采血小板,输注前及输注后分别测定血小板计数(PLT),比较PLT增加值及临床出血症状改善情况.[结果]输注新鲜机采血小板和冰冻血小板后两组PLT均有显著增加( P ＜0.01),新鲜机采血小板增加优于冰冻血小板( P ＜0.01);止血有效率冰冻血小板优于新鲜机采血小板( P ＜0.01).[结论]输注冰冻血小板可提升血小板数量,止血效果显著,且较安全,临床急需时可用.

目的探讨肝硬化患者凝血功能变化与其肝功能分级的关系。方法测定68例肝硬化患者(肝硬化组)的凝血酶原时间(PT)、激活部分凝血激酶时间(APTT)、纤维蛋白原(FIB)及凝血酶时间(TT),并与40例非肝硬化正常体检者(对照组)的PT、APTT、FIB、TT进行对比分析,同时比较肝硬化不同Child-Pugh分级的PT、APTT、FIB、TT差异。结果肝硬化组较对照组PT、APTT、TT均有明显延长,FIB有显著下降(P均<0.01);根据肝硬化Child-Pugh分级A→B→C顺序,PT、APTT、TT逐渐延长,FIB值逐渐下降,各组间比较均有显著性差异。结论肝硬化患者肝功能受损程度与凝血功能的改变密切相关,且随着肝功能损害程度的加重,凝血障碍愈明显。

目的了解乳腺癌患者放疗导致骨髓造血功能抑制和恢复过程中白细胞（WBC）、血小板（PLT）、网织红细胞百分率（RET%）、高荧光强度网织红细胞百分率（HFR%）、中荧光强度网织红细胞百分率（MFR%）的动态变化情况。方法选择乳腺癌患者68例为放疗组,选择健康体检者36例为对照组,采用Sysmex全自动血细胞分析仪XT-2000i检测放疗前和放疗后第7、14、21、28、35、42天外周血WBC、PLT、RET%、HFR%、MFR%,对照组与放疗前比较及放疗组放疗前后各项指标的变化。结果放疗前组网织红细胞参数与正常对照组的RET%和HFR%比较,与放疗前的差异有统计学意义（P＜0.05）。放疗组放疗前后组网织红细胞参数比较差异均有统计学意义（P＜0.05）,第7天,WBC、RET%、HFR%和MFR%已开始下降,差异有统计学意义（P＜0.05）;第14、21、28天,WBC、PLT、RET%、HFR%和MFR%持续下降,显著低于放疗前,差异有统计学意义（P＜0.05）;第35天,WBC和PLT持续低于放疗前,差异有统计学意义（P＜0.05）;第42天,WBC和PLT恢复到正常水平,低于放疗前水平,HFR%和MFR%持续增高,显著高于放疗前水平,差异有统计学意义（P＜0.05）。结论 WBC、PLT、RET%、HFR%和MFR%5项参数可作为评价乳腺癌患者放疗后骨髓造血功能受抑和开始恢复的敏感指标,帮助临床医师及时调整治疗方案,不失时机地给予各种支持疗法及化疗时机的选择,具有重要的临床意义。

目的比较3种检验方法对阴道分泌物中念珠菌的检出率。方法 1 510例阴道分泌物标本采用直接涂片法、细菌培养法和快速培养法同时检测。结果快速培养法的阳性率为23.2%,其灵敏度为94.8%,特异度为99.2%;直接涂片法阳性率为12.6%,细菌培养法阳性率为23.6%。直接涂片法阳性率较低,快速培养法的阳性率高。结论外阴阴道念珠菌快速培养法是一种方便、快速、准确的阴道分泌物念珠菌的检测方法。

Objective detection of HPV-DNA typing of liquid-based cervical cytology combined (TCT) on the significance of cervical cancer screening and clinical value.Methods will be our hospital 564 cases of women simultaneously TCT,PCR fluorescent detection of cervical HPV-DNA and biopsy examination,was detected by membrane hybridization HPV genotypes 23 (low risk type:HPV6、11、42、43、45、and high-risk types:HPV16、18、31、33、35、39、45、51、52、53、56、58、59、66、68、73、83、MM4) and liquid-based cytology (TCT)As screening for cervical cancer and precancerous lesions.Comparison of TCT on the detection rate of abnormal cervical cells and the TCT joint PCR detection of HPV-DNA fluorescence detection rate of HPV infection,the pathological diagnosis as the gold standard. Results PCR detection of HPV-DNA fluorescence total detection rate of 21.0%,histology-positive case detection rate of 70.9%, case detection rate of histologically negative 4.5%,respectively,significantly higher than the TCT,was very significant difference, P0.01.One single type HPV infection, accounting for 34% of low risk, high risk 60%,and type II mixed infections accounted for more than 6%.Conclusions HPV genotyping is a valuable adjunct to diagnostic techniques,combined with cytology,is the best cervical cancer screening program can significantly improve the diagnostic accuracy and early detection of precancerous lesions.

[目的]观察单采新鲜血小板与冰冻血小板的临床疗效.[方法]观察比较输注单采新鲜血小板与冰冻血小板在非血液病患者与血液病患者中24 h后的血小板变化水平及临床疗效.[结果]289例次非血液病输注单采新鲜血小板与冰冻血小板病例,输后血小板上升值与输注前相比有显著性差异(P<0.05),两组输注的疗效无明显差异(P＞0.05);114例次血液病患者输注单采新鲜血小板与冰冻血小板病例,输注单采新鲜血小板后的血小板上升值与输注前相比有明显差异(P<0.05),输注冰冻血小板后上升值与输注前相比,无明显差异(P＞0.05),输注新鲜血小板后上升值明显高于输注冰冻血小板后上升值(P<0.05).两组输注的疗效无明显差异(P＞0.05).[结论]输注单采新鲜血小板或冰冻血小板均能达到控制及预防出血的治疗作用,对于血液病单采新鲜血小板的升外周血血小板的效果优于冰冻血小板,冰冻血小板可作为抢救危重患者时代替单采新鲜血小板.

Objective To evaluate a kind of modified reticulocyte(Ret) staining solution.Methods The observation test of the modified Ret staining solution was performed under the microscope,counted the staining time,analyzed the effective life and tested its accuracy and precision.Results The modified Ret staining samples had a lot of characters,such as not easily fade,few residues,clear visual field and bright background,etc.Compared with the routine staining solution-brilliant cresyl blue,the staining time was short(5 min) and the effective life was long(30 months).The accuracy of the modified staining solution was consistent with that of the brilliant cresyl blue(P 0.05),but the precision of the modified staining solution was better than that of the brilliant cresyl blue.Conclusion The modified Ret staining solution is an excellent staining.It is worthy to be spreaded in practice.

Objective To explore the dynamic change of the reference range of normal newborn reticulocyte count and relationship to the day age of newborn by 18° × 4 fan-shaped peep-plate method.Methods Counted of reticulocyte of 415 normal newborns from age of 1 day to 10 days with 18° × 4 fan-shaped peep-plate method,and compared the result counted with Miller peep-plate method recommended by International Committee for Standardisation in Hematology(ICSH).Divided the values into groups by the newborn day age and different detecting method,then deal with the results with SPSS 12.0 software.Results Compared the reference range of newborn reticulocyte by the 18° × 4 fan-shaped peep-plate method of 1 d age(3.09 %-6.81 %)with those of 2 d(3.00 %-6.34 %),7 d(0.27 %-1.15 %)with those of 8 d(0.32 %-1.28 %),8 d with those of 9 d(0.34 %-1.38 %),9 d with those of 10 d(0.35 %-1.53 %),and all the differences had no statistical significance(P > 0.05).Compared the reference range of newborn reticulocyte counted by the 18° × 4 fan-shaped peep-plate method of 2 d age with those of 3 d(1.93 %-4.03 %),3 d with those of 4 d(1.35 %-3.13 %),4 d with those of 5 d(1.26 %-1.98 %),5 d with those of 6 d(0.72 %-1.45 %),6 d with those of 7 d,and the statistical significant difference were found among these groups(P < 0.01).Furthermore,the difference results in newborn reticulocyte values counted by the 18° × 4 fan-shaped peep-plate method had no statistical significance with the results of that counted by the Miller peep-plate method(P > 0.05).Conclusion There is a variation along with the reference range of newborn reticulocyte and their day age,and existing a low value period.Therefore the 18° × 4 fan-shaped reticulocyte enumerative peep-plate method can take the place of the Miller peep-plate to determine the reticulocyte value of the newborn.Thus the definite reference range of the newborn reticulocyte establishes the foundation to laboratory performing and clinical application.

【Objective】To explore diagnostic value of combining detection of CEA、AFP 、CA125 and CA199 for relapse in postoperative gastric cancer.【Methods】In 118 postoperative gastric cancer patients,there were 46 cases with recurrent or metastatic carcinoma after operation and 25 cases without recurrent cancer when followed up.CEA、AFP 、CA125 and CA199 were detected and analysed before operation,after opration with or without recurrence when followed up.【Results】The level of all tumour indexes declined after operation.The level of all tumour indexes rose in cases with recurrent or metastatic carcinoma.The level of tumour indexes in cases with recurrence were higher than in cases with metastatic carcinoma.Seventy six point eight per cent cases with positive result of combining detection of CA125 and CA199 were cases with recurrent or metastatic carcinoma.Accurate diagnosis rate was 91.9% in combining detection of CEA 、CA125 and CA199,and it was 95.5% in combining detection of CEA、 AFP、CAl25 and CA199.【Conclusion】Combining detection of CEA、AFP、CA125 and CA199 has important clinical value to detect tumour relapse in postoperative gastric cancer patients.

幽门螺旋杆菌(Helicobacter Pylori,HP)与慢性胃炎(CG)、消化性溃疡(PU)复发,发展关系很明确,而且,HP也是胃癌的一个重要致病因素[1].目前,国内外学者都积极寻找根治HP的方法.