Objective:To explore the digital network platform construction of morpghology of laboratory medicine and its effects on clinical teaching.Methods:Laboratory morphological inspection pictures of peripheral blood, bone marrow slices, urinary sediments, parasites, secretions, cavity effusion, medical microorganisms and chromosome specimens were collected to build a digital network platform for online learning, practical training, and examination by applying Authorware multimedia software, Access database, and Web interface. Afterwards thirty interns on laboratory medicine were randomized into two groups: traditional teaching group and software teaching group for morphological assay examination. The differences in theoretical scores, exam time, practical operation scores, and satisfaction rates between two groups were statistically analyzed by t test and Pearson Chi-square test using SPSS 13.0. Results:The software teaching group showed significantly higher theoretical and practical scores [(88.0 ± 6.4); (85.3 ± 7.1)] than traditional teaching group [(76.3±8.1); (80.3±7.9)] (both P=0.000 1), and its theoretical exam time [(93.7 ± 10.5) minutes] was significantly shorter than traditional teaching group [(115.8±16.2) minutes] ( P=0.033 8). The questionnaire survey results showed that software teaching group showed higher satisfaction rates in the aspect of teaching content systematization, diversity of teaching methods, clinical learning interest and fairness of assessment than traditional teaching group, with statistical significance ( P<0.05). Conclusion:The software teaching model could improve quality and efficiency in teaching morphological assay, enhance students' learning autonomy and professional skills, and provide a powerful platform to adapt to vocational innovation of laboratory medicine education.

目的 调查乙型肝炎病毒(HBV)基因型、核苷(酸)类药物(NAs)耐药基因突变对湖北十堰地区慢性乙型肝炎(CHB)患者肝硬化、肝癌(HCC)的影响.方法 将521例HBV-DNA阳性CHB住院患者分为CHB组和CHB合并肝部病变组(包括肝硬化代偿、失代偿和HCC);对HBV基因型、逆转录酶主要耐药基因突变位点,血清透明质酸(HA)、层黏蛋白(LN)、Ⅲ型前胶原N端肽(PⅢNP)、Ⅳ型胶原(Ⅳ-C)以及甲胎蛋白(AFP)、糖类抗原125(CA125)、糖类抗原199(CA199)、癌胚抗原(CEA)水平进行检测.结果 感染C基因型H B V的患者肝脏病变比例高于B型(46.0％v s.34.1％;χ2=7.128,P=0.008),其肝硬化、肝癌O R值分别为1.34(1.04～1.73)、1.84(1.04～3.26);且C基因型血清LN、PⅢNP、Ⅳ-C、AFP和CA125水平高于B型(t=2.713、4.226、4.381、3.661、2.349;P分别为0.007、<0.001、<0.001、<0.001、0.019).有N A s用药史患者肝部病变比例低于无N A s用药史(33.1％v s.44.2％;χ2=6.785,P=0.009),其O R为0.75(0.60～0.93);且272例有N A s用药史患者中,耐药突变型患者的肝部病变比例、血清学指标与野生型均无统计学差异(均P>0.05).结论 本地CHB住院患者感染C基因型HBV的较B型更易产生肝脏病变;NAs药物治疗与低的肝脏病变发生率有关,而RT区主要耐药基因突变对肝脏病变无明显影响.

目的 调查湖北省十堰地区慢性乙型肝炎(CHB)患者HBV基因型、逆转录酶(RT)区耐药基因突变与血清病毒学指标的相关性.方法 对521例HBV-DNA定量阳性CHB住院患者进行基因分型、RT主要耐药性基因位点突变以及血清ALT和AST活性、HBsAg、HBV-DNA检测.结果 本地共检出B型323例(62.0％)、C型187例(35.9％)、D型3例(0.6％)、BC混合型8例(1.5％).其中121例(23.2％)存在RT区主要耐药基因突变;272例有核苷(酸)类(NAs)用药史患者中C基因型突变率51.5％(68/132),高于B型26.8％ (37/138)(x2=26.238,P＜0.001).突变型患者血清ALT、AST、HBsAg、HBV-DNA均高于野生型(t=2.514,1.986,4.851,6.265;P=0.012,0.047,＜0.001,＜0.001),主要突变模式M204V血清HBsAg和HBV-DNA水平亦高于野生型(t=3.247,2.805;P=0.001,0.005).结论 该地CHB住院患者主要以感染B型HBV为主,而C基因型较B型更易发生RT区耐药基因突变,且基因型、RT区耐药基因突变均与血清病毒学指标相关.

Objective To study the effects of CHROM agar Candida medium in the isolation and identification of clinical Candida.Methods A total of 500 clinical specimens were inoculated on blood agar,Sabouraud and CHROM agar medium,respectively,and then incubated and identified by VITEK-YBC and drug sensitive tests were perormed.Results A total of 200,296,296 Candida isolations were obtained from blood agar,Sabouraud and CHROM agar medium respectively,and their specificity were 67.6%,78.3% and 100%.About 94.2% of the Candida Albicans,C.tropicalis,C.glabrata and C.krusei could be correctly identified by CHROM agar medium.Conclusion CHROM agar Candida medium can be used in the primary screening and rapid diagnosis of clinical Candida,providing basis for the drug selection.

目的:探讨银屑病患者血细胞相关参数、C反应蛋白(CRP)及血脂的变化在银屑病发病中的作用.方法:对89例寻常型银屑病患者血常规、CRP及血脂进行检测,并与正常对照组进行综合对比分析.结果:银屑病组与对照组比较:银屑病组平均红细胞体积(MCV)、红细胞体积分布宽度(RDW-CV)、血小板压积(PCT)、平均血小板体积(MPV)、血小板分布宽度(PDW) 和大血小板比率(PCT)明显升高(P<0.05),进行期银屑病组显著升高(P<0.01);稳定期银屑病患者组CRP浓度与对照组比较差异有显著性(P<0.05);消退期银屑病患者组与对照组比较差异无显著性(P>0.05).血清TC、TG、LDL-c及APOB均明显升高(P<0.01),apoA1、HDL-c下降(P<0.01),脂蛋白a仅进行期银屑病组升高显著(P<0.05),其他两组轻度升高但差异无显著性(P>0.05).结论:银屑病患者血细胞相关参数、CRP水平及血脂均有明显变化,联合监测对于判断病情转归和指导临床治疗具有重要意义.