Aims: The red blood cell distribution width-to-platelet ratio (RPR) has been reported to be an indicator of hepatic fibrosis in patients with chronic hepatitis B (HBV), nonalcoholic fatty liver disease (NAFLD) or chronic hepatitis C (HCV). However, no research has explored the RPR in all patients with hepatic fibrosis. There is a recognized need to establish whether the RPR could assess hepatic fibrosis and reflect the severity of fibrosis, regardless of the patient's etiology. Methods: Quantitative data from 1282 patients who underwent liver biopsy between January 2010 and December 2014 at the Second Affiliated Hospital of Zhejiang University School of Medicine were included. The etiologies included HBV or HCV infection, NAFLD, schistosomiasis, granulomatous liver disease, and vascular abnormalities. Five noninvasive models were calculated for all patients based on laboratory parameters. The degrees of fibrosis severity were evaluated based on the Metavir scoring scale. Results: The RPR demonstrated the best accuracy of predicting hepatic fibrosis among the selected five models (0.75, p < .001) regardless of etiology. In addition, the RPR values increased with advanced hepatic fibrosis progression. Furthermore, combining the RPR with the white blood cell (WBC) count improved the accuracy of grading hepatic fibrosis as reflected by the likelihood ratio (LR + 9.03, LR - 0.49). Conclusion: The RPR is a useful indicator for hepatic fibrosis, regardless of etiology, and can reflect the severity of fibrosis. This study supports further clinical development of the RPR both in a stepwise manner or in combination with inflammatory parameters to improve the accuracy of scoring hepatic fibrosis.

肝纤维化是肝脏对各种病因所致的慢性、非自限性肝损伤的一种可逆的创伤修复反应.准确诊断肝纤维化、预测肝纤维化严重程度,对诊疗工作极为重要.肝脏活组织检查仍是肝纤维化的金标准,但其无法满足动态预测肝纤维化严重程度及动态监测疗效.临床迫切需要无创、可重复、快速检测的诊断指标.我国Chen等[1]提出基于乙肝的红细胞平均分布宽度-血小板比率(red cell volume distribution width-platelet ratio, RPR)模型.Chen等[1]研究发现该模型诊断乙肝性肝纤维化患者时的诊断效能优于纤维化4-指数(Fibrosis-4 index, FIB-4) 模型、 AST/血小板比值(AST/platelet ratio index, APRI)模型等其他模型;但未深入研究RPR对非乙肝性肝纤维化的诊断效能以及在肝纤维分级诊断中的临床价值.

目的 了解黏质沙雷菌在医院感染中的分布及耐药情况,为临床用药提供依据.方法 收集本院2009年1月-2013年12月临床分离的205株黏质沙雷菌,统计不同标本检出情况,并用VITEK-2 Compact鉴定,用K-B纸片扩散法进行敏感性试验.结果 分离到的205株黏质沙雷菌最多来自于痰液,占72.2％,其次是尿液,占13.7％;对头孢噻吩、头孢呋辛、头孢西丁、氨苄西林、氨苄西林/舒巴坦、呋喃妥因的耐药率达到95％以上;而对头孢吡肟、头孢替坦、复方新诺明、阿米卡星、头孢哌酮/舒巴坦的耐药率＜10％;耐药率为20％～ 50％的抗菌药物有哌拉西林、头孢曲松、头孢他啶、庆大霉素、奈替米星、环丙沙星、左氧氟沙星.结论 黏质沙雷菌检出率较高,对抗菌药物的耐药情况差异较大,因此根据药敏试验结果合理应用抗菌药物十分重要.

OBJECTIVE:To explore the alone and joint diagnostic value of serum golgi protein 73 (GP73), alpha-fetoprotein (AFP) and the percentage of lectin-reactive aipha-fetoprotein (AFP-L3) of primary hepatic carcinoma (PHC), and provide a novel method for diagnosis for PHC and screening for high-risk population.METHODS:ELISA was used to detect the serum level of GP73, AFP and AFP-L3% in 81 cases of PHC,176 cases chronic hepatitis and liver cirrhosis, 30 cases other tumber cancer and 40 cases of health people.RESULTS:The sensitivity of GP73, AFP and AFP-L3% in PHC is 77.78%, 62.69% and 51.85%, and the specificity is 84.55%, 86.99% and 96.34%, respectively. Joint detection could increase the sensitivity up to 88.89%.CONCLUSION:GP73 was a high sensitivity mark for dignosis of PHC, while AFP-L3% was a high specificity mark for dignosis of PHC. The joint detection could improve PHC diagnostic performance.

目的:检测肺结核合并糖尿病患者外周血CD4+ CD25+调节性T(Treg)细胞,探讨Treg细胞在疾病发生发展中的作用.方法:采用流式细胞技术多色荧光分析法,对81例肺结核合并糖尿病患者、63例肺结核患者及38例健康对照者外周血中Treg细胞测定,观察肺结核合并糖尿病患者与肺结核患者、健康对照者之间的差别.结果:肺结核合并糖尿病组与肺结核组外周血Treg细胞增多,两组间比较:t=2.24,P＜0.05；肺结核合并糖尿病组与健康对照组外周血Treg细胞比较:t=3.79,P＜0.01;肺结核组与健康对照组外周血Treg细胞比较:t=2.77,P＜0.01.肺结核合并糖尿病初治组和复治组外周血Treg细胞比较:t=2.19,P＜0.05；相关性分析显示肺结核合并糖尿病组中血糖浓度与Treg细胞数量之间呈正相关(r=0.269,P＜0.01).结论:肺结核合并糖尿病患者外周血Treg细胞数量增多,诱导免疫耐受,在疾病的发生发展中起到一定作用.

目的研究血清高尔基体蛋白（GP73）检测对原发性肝癌（primary hepatic corrcinoma,PHC）的临床价值。方法采用ELISA对81例PHC、67例乙型肝炎、89例肝炎肝硬化、15例急性肝炎、45例重型肝炎、30例其他恶性肿瘤疾病和30名健康人的血清GP73进行检测,采用化学发光法检测相应人群的血清AFP的量,同时对两者进行比较。结果以ROC曲线确定诊断PHC的GP73临界值为162.7ng/ml时,GP73检测的敏感性为81.5%,特异性为84.5%;GP73水平与AFP和原发性肝癌癌灶大小无相关性;在AFP值小于400ng/ml患者中,GP73阳性率仍有73.2%（30/41）。结论 GP73对PHC诊断有较好的敏感度,结合AFP检测尤其是对AFP低值的小肝癌患者的早期诊断具有重要的临床应用价值。