目的 建立并优化一套适用于多个院区的生化检验报告自动审核系统,缩短检验报告周转时间,提高检验效能.方法 按照行业指南标准,针对53项临床生化检验项目,在检验信息系统中设计开发6类自动审核规则,并对其临床应用效果进行优化和验证.通过对标本的实验室内报告周转时间、危急值报告时效、自动审核通过率等关键指标进行评估,持续优化审核规则.结果 创建617条规则,以291765个已审核结果作为模板进行验证,优化规则细节,在3个院区分别设置不同的规则,最终人工审核与自动审核符合率达到100％,其中住院患者标本和非住院患者标本的自动审核通过率分别为67.3％和82.1％,住院患者和非住院患者检验报告的实验室内周转时间分别缩短了30.4％和41.1％.结论 人工审核规则限制是确定自动审核率的最关键步骤,依托检验科信息系统建立的自动审核规则完全适用于一院三址模式,能够降低人工审核比例、缩短标本周转时间,提高检验质量和效率.

目的 采用间接法探索正常妊娠早期女性在本室应用全自动电化学发光分析仪及配套试剂,检测游离甲状腺素(FT4)和促甲状腺素(TSH)的参考区间.方法 选择2021年1月至2021年12月在北京积水潭医院产科门诊建档定期产检的2972例妊娠早期女性的FT4和TSH数据纳入研究;通过K-S检验分析数据的正态性,非正态数据使用Box-Cox转换,通过箱式图法剔除离群值,并用Hoffman法根据95％可信区间(即2.5th为下限和97.5th为上限)初步建立正常妊娠早期女性FT4、TSH的参考区间,结果与其他参考区间的比较用RCV进行验证.结果 采用间接法初步建立本室北京昌平地区正常妊娠早期女性的参考区间为:FT4(13.6～21.4pmol/L),TSH(0.086～3.870mIU/L);TSH参考区间与厂商提供的成人参考区间有差异,大于RCV;FT4参考区间与《妊娠和产后甲状腺疾病诊治指南》中提供的参考区间没有差异,均小于RCV.结论 初步建立了本实验室正常妊娠早期女性FT4、TSH检测的参考区间;间接法适用于FT4、TSH参考区间的建立,简单经济且更贴近受检人群的特点.

目的 调查不同妊娠期、不同年龄孕妇体内维生素E(VE)营养状态,探讨 α-生育酚作为评价指标的适用性.方法 回顾性研究,选取2016年10月至2017年10月期间在北京积水潭医院回龙观院区产科规律产检的孕妇,1840例孕妇均遵医嘱在妊娠早、中、晚期进行血液采集,采用高效液相色谱法(HPLC)检测血清中 α-生育酚水平.结果 α-生育酚水平随孕周增加而增加(F=6409.353,P<0.001),同时VE增多率也由妊娠早期的0.33％、妊娠中期的9.51％,增至妊娠晚期的34.18％;在妊娠早、中期,孕妇年龄越大 α-生育酚水平越高(F=11.376、P<0.001,F=6.282,P<0.001),在妊娠晚期虽然差别不具有统计学意义(F=2.343、P=0.071),但是随着孕妇怀孕年龄的增大,α-生育酚水平有增高的趋势.结论 北京市昌平地区的孕妇在妊娠期间VE水平按目前的分层标准,极少存在缺乏的表现,异常主要表现为VE增多.α-生育酚水平随孕周增加而增加,怀孕年龄越大 α-生育酚水平越高.但是在分析临床检测数值时,应该充分考虑年龄、特别是妊娠期间血脂生理性增多对循环中 α-生育酚水平的影响,审慎做出VE过剩的结论.

目的 调查北京市昌平地区不同妊娠期、不同年龄段孕妇血清维生素A(VA)的营养状态,为妊娠期合理补充维生素提供参考.方法 选择2016年10月至2017年10月在北京积水潭医院回龙观院区产科规律产检的孕妇1840人,分别在其妊娠早、中、晚期三个时间段采集血液,用高效液相色谱法(HPLC)检测血清中VA水平.结果 孕妇血清VA水平在妊娠晚期下降明显,低于妊娠早期和中期(F=711.916,P<0.001),VA缺乏及边缘型缺乏率由妊娠早期的3.86％、妊娠中期的2.39％,增至妊娠晚期的18.48％.在妊娠早期,≤30岁孕妇血清VA水平低于>30岁孕妇,差异有统计学意义(t=-6.290,P<0.001).≤30岁孕妇在妊娠早期发生VA缺乏及边缘型缺乏的比例(4.79％)高于>30岁孕妇(2.64％),差异有统计学意义(χ2=6.153,P=0.046).结论 北京市昌平地区的孕妇在妊娠期间VA水平异常主要表现为以边缘型缺乏为主,而妊娠晚期VA缺乏及边缘型缺乏率增加需加强重视,对缺乏状况予以及时纠正;妊娠早期要加强对≤30岁孕妇血清VA营养水平的监测.

Objective To investigate the clinical characteristics and prognostic factors of patients with multiple myeloma(MM) and following second primary malignancy(SPM).Methods A retrospective study was performed on 280 cases of MM patients who were admitted from January 2005 to December 2016.The cases of SPM were selected,the clinical manifestations,diagnosis,treatment process and prognostic factors were analyzed.Results The 280 cases were continuously followed up,the median following-up time was 37 months,4 cases of secondary plasma cell leukemia(sPCL) were observed,the morbidity was 1.4％ (4/280);the mean age of patients with sPCL was 65 years,the overall survival time was 37 months,the median survival time was 3.5 months after diagnosis of MM with sPCL.Five cases of SPM were observed,the morbidity was 1.8％ (5/280);the mean age of patients with SPM was 59 years,the overall survival time was 19 to 135 months,median survival time was 42 months.The subtype were lung cancer(n =1),bladder cancer (n =1),acute myeloid leukemia (n =1),diffuse large B cell lymphoma (n =2),60.0％ (3/5) were hematological malignant tumor.Initial treatment regimens included alkylation agents,immunological regulator and bortezomib.Three patients (60.0％) were completely relieved after treatment.The median survival time between MM patients and MM patients with SPM had no statistically significant difference(P ＞ 0.05).The median survival time of MM patients with SPM was longer than that of MM patients with sPCL,and the difference was statistically significant (P ＜ 0.05).Conclusion The prognosis is bad,overall survival time is short and the median overall survival time is extended in MM patients with SPM compared to the MM patients with secondary plasma cell leukemia.

Objective To study the effectiveness of the laboratory diagnosis of multiple myeloma(MM)patients with immun-ofixtion electrophoresis (IFE),protein electrophoresis (SPE)and immunoglobulins and light chain quantitative analysis. Methods Selected 192 MM patients and 30 healthy controls during June 2012 to December 2013 and analyzed the results of IFE,SPE and immunoglobulins,and light chain quantitative analysis in MM patients.Results M protein bands were seen in 120 cases (62.5%)by using SPE and M protein were positive in 174 cases (90.6%)among the 192 MM patients by using IFE.IFE showed that IgG were maximum type of the M protein (106 of 192,55.2%).There were IgG-λ type 66 cases (34.4%),IgA type 36 cases (18.8%)and free light chain type 24 cases (12.5%).Immunoglobulins of different immuno-phenotypes had higher than the nomal group with serum immunoglobulin and light chain quantitative analysis (P <0.05). The detection rate was 67.7% (130/192).Whateverκ-type M protein orλ-type M protein,the ratio ofκ/λwas significantly abnormal (P <0.05).The detection rate was 85.4% (164/192).Conclusion The better detection rate of immunological techniques such as immunofixtion electrophoresis and immunoglobulins quantitative analysis might provide valuable basis for the diagnosis and treatment of MM clinically and prevent misdiagnosis.

Objective To analyze the application of relationship of homocysteine,high sensitive C-reactive protein,lipid metabolism in the patients with hypertensive disorder complicating pregnancy(HDCP).Methods 90 patients with HDCP were chosen.There were 16 patients with mild pre-eclampsia,19 patients with serious pre-eclampsia and 8patients with eclampsia among them.For comparison,36 health late pregnance women and 40non-pregnance women were chosen randomly in the same period.Results The levels of Hcy、hs-CRP、TG、TC、LDL-C and ApoB with HDCP were higher than those of health late pregnance women and non-pregnance women(P0.05).The levels of HDL-C 与ApoA1with HDCP were lower than groups of health late pregnance women and non-pregnance women(P0.05).The levels of Hcy、hs-CRP in the group of eclampsia were higher than the mild pre-eclampsia group(P0.05)and the serious pre-eclampsia group(P0.05),the serious pre-eclampsia group were higher than the mild pre-eclampsia group(P0.05).Lipid metabolism indicators had no significant difference among three groups.But the levels of TG、TC、LDLC and ApoB had a rising trend,HDL-C and ApoA1 had a lower trend.Conclusion The indexes of Hcy,hs-CRP and lipid metabolism has a close relationship with HDCP,the combination detection had important guiding significance for determining the disease progression of HDCP and improving the pregnancy outcome.

Objective To investigate the clinical significance of homocysteine（Hcy）and glycated hemoglobin（Hb A1c）in patients with diabetic retinopathy.Methods From March2013 to February 2015,a total of 168 patients with diabetes from Beijing Jishuitern Hospital were divided into diabetic retinopathy group（76 cases,32 male,44 female,average age 62.97±12.46）and non-diabetic ret-

Objective In this research with the method of Alu -PCR we investigate the integration of hepatitis B virus ( HBV) DNA in human hepatocarcinoma cell line (PLC/PRF/5) genome DNA.Methods We at first extracted the genome DNA from PLC/PRF/5 cells, and then the potential integration fragments of HBV DNA and human genome DNA were amplified with according to the Alu -PCR after three rounds PCR .The Alu-PCR amplification products were observated with agarose gel electrophoresis , then integration positive electrophoresis bandings were chipped and purified for nucleic acid sequencing .At last he bioinformatics information was acquired by blast online.Results Through agarose gel electrophoresis after Alu -PCR amplification, we got four potential integration bindings , among which we got three integration sequences of HBV DNA in human genome DNA .These integration sequences could be individually located in the human chromosome of 03p21.31, 05p15.33, 12q13 and 12-q14.1.Conclusion With Alu-PCR we can accurately measure the integration of HBV DNA in human genome DNA , and Alu-PCR can be a a convenience and economic method in the study of HBV DNA ′s integration in human genome DNA .

目的 探讨25-羟基维生素D[25(OH)D]与甲状旁腺激素(PTH)的变化关系,以及对骨代谢的影响.方法 排除影响维生素D(VD),PTH以及骨代谢的情况,选取2013年10月～2014年5月门诊就诊的757例研究对象,年龄52.88±14.23岁.按照25(OH)D浓度不同分成4组,按照PTH水平不同分成2组.检测血清中25(OH)D,PTH,Ca,P,tPINP,β-CTX和OC的水平.对25(OH)D与PTH进行相关分析,对不同分组方式下各参数进行比较和统计分析.结果 在整个研究范围内25(OH)D浓度介于3.07～42.46 ng/ml,血清25(OH)D与PTH均呈现负相关关系(r=-0.214,P＜0.001).但是对于25(OH) D＜30 ng/ml的研究对象,其PTH升高的比例是10.30％;＜20ng/ml的研究对象,其PTH升高的比例仅有10.91％;＜12 ng/ml的研究对象,其PTH升高的比例也只有13.04％.随着25(OH)D缺乏程度的加重,PTH高于正常参考范围的比例并没有明显增加.控制年龄和性别的影响,协方差分析显示两种分组方式下骨标志物的变化差异均无统计学意义(F=0.001～3.951,P值均＞0.05).根据IOM的分类标准,VD的缺乏率高达52％,VD的不足率达到34％,能达到VD充足标准的比例只有14％.结论 25(OH)D与PTH的水平呈负相关.PTH在反映25(OH)D缺乏程度方面作用有限.VD缺乏现象较普遍,应引起临床的重视.

目的:研究血浆同型半胱氨酸水平与颈动脉斑块的相关性.方法:2012-06-01至2013-06-01在我院神经内科263例≥40岁的非脑卒中住院患者,根据血浆同型半胱氨酸水平分为正常组(n=139)和同型半胱氨酸升高组(n=124),并采用超声测定所有患者的颈动脉斑块.用单因素分析及Logistic回归分析血浆同型半胱氨酸水平与发生颈动脉斑块的关系.结果:单因素分析结果显示性别、年龄、体重指数(BMI)、吸烟、高血压病史、同型半胱氨酸是颈动脉斑块的危险因素(P＜0.05).Logistic回归结果示,在校正了其他混杂因素后,同型半胱氨酸水平升高增加了颈动脉斑块发生的风险(优势比=1.89,95％可信区间1.01～3.55,P=0.047).结论:血浆同型半胱氨酸水平增高是颈动脉斑块发生的独立危险因素.

Objective To explore the significance of the human serum reference material improving the trueness of T-Bil results from clinical laboratories.Methods Twelve clinical laboratories in Beijing were selected for the investigation.Firstly,national primary reference materials GBW09184 and GBW09185 were detected with the routine measuring system of serum T-Bil,respectively.Then,GBW09185 was detected again based on the GBW09184 instead of routine calibrators.Next,the trueness of measurement results was evaluated with metrology traceability,statistics acceptability and clinical acceptability,respectively.The variation of measurement results from 12 laboratories was also analyzed.Results The ranges,mean values,biases and total variations of measurement results for GBW09184 and GBW09185 by the routine measuring system of serum T-Bil from 12 laboratories were 95.7~137.8 μmol/L and 35.3~57.4 μmol/L,116.6 μmol/L and 47.7 μmol/L,+7.9% and +7.0%,and 10.25% and 12.80%,respectively.According to the metrology traceability,statistics acceptability and clinical acceptability standards,there were 17%(2/12),33%(4/12) and 33%(4/12) of laboratories with true measurements,respectively.After the routine measuring system of serum T-Bil was calibrated with GBW09184,the range,mean value,bias and total variation of measurement results for GBW09185 from 11 laboratories except No.4 lab were 40.7~57.3 μmol/L,46.3 μmol/L,+3.8% and 9.70%,respectively.According to the metrology traceability,statistics acceptability and clinical acceptability standards,there were 36%(4/11),64%(7/11) and 64%(7/11) of laboratories with true measurements,respectively.Conclusion In Beijing,the trueness of the obtained results with the routine measuring system of serum T-Bil from 80% of clinical laboratories could not meet the traceability requirement of ISO17511.The human serum reference materials could improve the trueness of the measurement results from clinical laboratories obviously.

人体血清胆碱酯酶(cholinesterase,CHE)、总胆汁酸(total bile acid,TBA)及前白蛋白(prealbumin,PA)的常规检测,越来越广泛应用于临床肝脏疾病的诊疗.血清CHE、TBA及PA均受到肝脏合成及分解代谢的影响,这些指标一般受患者饮食及治疗影响较小,能较全面地反映肝脏功能,其水平变化有助于肝病患者临床判断病情及预后.为此,本研究联合检测CHE、TBA、PA变化来研究3者在各种肝病中的临床价值.

目的 了解鲍曼不动杆菌对常用抗菌药物的耐药性变迁及临床分布情况,为有效的临床治疗和医院感染控制提供实验室依据.方法 收集2009年1月至2009年12月我院临床分离出202株鲍曼不动杆菌,分析其耐药率及临床分布情况.采用Phoenix 100微生物自动分析进行细菌鉴定及药敏试验.结果 202株鲍曼不动杆菌占当年病原菌检出率总数的11.3%(202/1781),其中有145株来自痰标本(71.8%).202株鲍曼不动杆菌对哌拉西林的耐药率最高(90.6%),其次为氨曲南(89.6%)和头孢噻肟(78.7%);对亚胺培南耐药率较低(36.6%),对其他抗菌药物的耐药率均在35%～65%之间;且均对黏菌素敏感.202株鲍曼不动杆菌共检出122株多重耐药(multidnlg resistant,MDR)菌株,烧伤病房MDR菌株检出率最高(81.1%),其次为重症监护病房(72.7%)和呼吸内科(64.4%).结论 鲍曼不动杆菌是医院感染中重要的条件致病菌,通过监测鲍曼不动杆菌的耐药性变化,可指导临床合理用药,减缓细菌耐药发生,防止鲍曼不动杆菌引起的医院感染.

OBJECTIVE To establish a rapid detecting method for Clostridium perfringens on traumatic tissues by type-specific multiplex PCR. METHODS Established a simple and rapid method (TLS method) for purifying the DNA of genomes and plasmids in standard strains of C. perfringens wild strains on surface of open traumatic tissues and detected DNAs by type-specific multiplex PCR. RESULTS All types of C. perfringens could be detected by type-specific multiplex PCR. The sensitivity by PCR for type A of C. perfringens arrived at 7.5× 10~3/ml and a whole run could finish within 5 h; the results by PCR entirely corresponded with those by cultureing. CONCLUSIONS New methods for purifying DNA of genomes and plasmids of C. perfringens are simple and rapid; there are high specificity and sensitivity for detecting DNA by multiplex PCR within short time, which can be practiced in clinical laboratory.

OBJECTIVE To explore the risk factors of gas gangrene after open trauma for its early diagnosis and precaution.METHODS The data of 42 patients with gas gangrene after open trauma from Aug 2003 to Aug 2008,were collected.The risk factors of gas gangrene after open trauma had been retrospectively analyzed from the cause of the injuries,the distribution of latent period,wound,systemic symptoms,laboratory examination and treatment.RESULTS Gas gangrene after injury was related with open wounds for various reasons.Latent period of gas gangrene was 24-72 h.Early risk factors of gas gangrene among them mainly included degloved or avulsed skin-injury(100%),musce trauma(100.00%),contaminated wound and retained foreign bodies(95.24%),weak pulse of peripheral artery(95.24%),nervous injury(90.48%),and lower temperature of skin aound the wound(83.33%).There were obviously systemic symptoms in infective stage but in early stage were not.CONCLUSIONS Gas gangrene is extremely rare in injury patients but it is life-threatening.So more attention should be paid to the risk factors in order to decrease the incidence of gas gangrene after trauma.Improving the prognosis of patients;the wounded locations should be effectively treated early so as to improve the prognosis.

目的:探讨注射用血栓通对肝星状细胞 LX02基因表达的影响及其机制.方法:将103 mg/L的注射用血栓通与人肝星状细胞 LX02 共同孵育 48 h,提取 mRNA,并逆转录成cDNA.与芯片杂交,根据杂交信号强弱筛选相关基因.结果:41 条肝星状细胞基因差异表达,其中表达上调的基因21条,下调基因20条,这些基因主要与能量代谢、细胞黏附、DNA结合、磷酸化、甲基化等相关,还有部分基因功能不详.结论:经注射用血栓通作用后,肝星状细胞基因表达发生变化,其可能通过调控这些基因的表达实现了对肝星状细胞功能的抑制作用.

目的:观察γ-氨基丁酸(GABA)对人肝细胞株Huh-7基因表达的影响.方法:将10μmol/L GABA与Huh-7细胞共同孵育24h,以PBS处理的Huh-7细胞为对照,提取mRNA,并逆转录成cDNA.与芯片杂交,根据杂交信号强弱筛选相关基因.结果:共筛选出27条差异表达的基因,其中11条基因表达下调,16奈基因表达上调,这些基因主要是与细胞增殖、凋亡及免疫功能相关,另外还有部分基因功能不详.结论:GABA对肝细胞基因表达谱有一定作用,GABA可能参与肝细胞功能的调控.

患者,男,25岁,因右手腕机器轧压后离断12 h入住本院. 手外科检查:右前臂自近腕横纹处离断,仅部分肌腱相连.右前臂自肘下肿胀,有压痛.触及皮下有空虚感,断手腕骨及附近组织消失,伤口损伤、污染严重.后行"右手腕清创,断腕再植术",术后抗感染支持治疗.术后24 h内肢体逐渐肿胀、变红,体温升高,换药时见伤口内大量恶臭分泌物及坏死组织.再植手肿胀明显,皮肤红、热、部分变黑,全身生命体征欠稳定,体温40℃.血常规:WBC 16.5×109/L;中性分叶粒细胞0.78;Hb 69.9 g/L.伤口分泌物涂片检查:见2种形态G+杆菌,一种为G+粗大杆菌,有荚膜;另一种为G+短粗杆菌,有芽孢.初步诊断:气性坏疽.