目的 比较分析儿童腺病毒肺炎的常见实验室检查结果.方法 回顾性分析2017年12月-2019年3月广州市第一人民医院诊断为腺病毒肺炎的84例住院患儿,将其分为3型腺病毒感染组(n=36)和7型腺病毒感染组(n=37),轻症腺病毒肺炎组(n=56)和重症腺病毒肺炎组(n=28),分析比较两组间实验室检查结果.结果 幼龄及7型腺病毒与重症肺炎显著相关,7型腺病毒感染组的白细胞(WBC)、血小板(PLT)、血红蛋白(HGB)、肌酐(Cr)、尿素氮(BUN)、碱性磷酸酶(ALP)及钙(Ca)水平均低于3型腺病毒感染组,而血清天门冬氨酸氨基转移酶(AST)、肌酸激酶(CK)、乳酸脱氢酶(LDH)及α-羟丁酸脱氢酶(HBDH)水平均高于3型腺病毒感染组,差异有统计学意义(P＜0.05);重症腺病毒肺炎组Ca、HGB及ALP水平显著低于轻症腺病毒肺炎组,血清丙氨酸氨基转移酶(ALT)、γ-谷氨酰转移酶(GGT)、AST、LDH、HBDH、C反应蛋白(CRP)水平以及出现血尿、蛋白尿的频率均高于轻症腺病毒肺炎组,差异有统计学意义(P＜0.05).结论 重症腺病毒肺炎早期主要出现贫血及酶学异常升高,临床要重视这些指标的检查.

目的 通过血常规分析和C反应蛋白(CRP)水平检测,探讨其对儿童甲型和乙型流感的辅助诊断价值,为临床治疗提供参考依据.方法 选择3069名甲型流感患儿、2307名乙型流感患儿、855名健康儿童,统计分析血常规参数以及CRP水平.采用ROC曲线分析血常规对甲乙型流感的区分效能.结果 甲组白细胞计数(WBC)均值高于正常组,乙组则相反,甲乙组中性粒细胞百分比(Neut％)、中性粒细胞与淋巴细胞百分比比值(NLR)、单核细胞百分比(Mono％)的均值高于正常组,甲乙组淋巴细胞百分比(Lymph％)、血小板计数(PLT)的均值低于正常组.甲组中性粒细胞计数(Neut#)、单核细胞计数(Mono#)、CRP、PLT的均值均高于乙组,Lymph％和淋巴细胞计数(Lymph#)的均值低于乙组.甲组在WBC>13×109/L、Neut％>70.7、Lymph％<19.1的构成比高于乙组.NLR预测甲型流感临界值为2.08(敏感度为75.9％,特异度为89.4％),预测乙型流感临界值为2.11(敏感度为50.5％,特异度为89.8％).结论 血常规参数和CRP水平变化可用于判断流感患儿是否存在细菌感染,指导临床用药;NLR作为一种新型预测标志物,其变化可以对区分甲型、乙型流感,尤其是甲型流感具有临床价值.

目的 探讨红细胞膜脂肪酸与慢性心力衰竭(CHF)的相关性.方法 利用气相色谱质谱仪检测2019年5月至2020年4月该院收治的308例CHF患者和100例体检健康者的红细胞脂肪酸水平,按照美国纽约心脏病协会(NYHA)分级标准,CHF患者分为Ⅱ级组101例、Ⅲ级组107例、Ⅳ级组100例,对比健康人群与不同分期慢性心力衰竭患者之间红细胞脂肪酸、Omega-3指数水平,并分析其与CHF的相关性.结果 不同分期的CHF患者的二十碳五烯酸(EPA)、二十二碳六烯酸(DHA)、花生四烯酸(AA)、油酸水平有显著差异,其EPA、DHA水平均随着CHF程度的增加而降低,且均明显低于对照组;而AA、油酸水平均随着CHF程度的增加而升高,且均明显高于对照组,差异均有统计学意义(均P<0.05).但对照组与不同分期之间的CHF患者的月桂酸、亚油酸、软脂酸及硬脂酸水平比较差异无统计学意义(P>0.05).各组的单不饱和脂肪酸(MUFA)、Omega-3脂肪酸、Omega-6脂肪酸水平、Omega-3指数差异均有统计学意义(P<0.05),但各组间的饱和脂肪酸(SFA)水平差异无统计学意义(P>0.05).Spearman相关性分析表明,CHF分级与EPA、DHA、Omega-3脂肪酸、Omega-3指数呈负相关关系,与AA、油酸、Omega-6脂肪酸呈正相关关系(P<0.01).结论 EPA、DHA、Omega-3脂肪酸及Omega-3指数在CHF患者红细胞膜中表达降低,而AA、油酸、Omega-6脂肪酸及MUFA表达升高;且Omega-3脂肪酸、Omega-3指数与CHF的发生发展有关,其低表达可能预示CHF程度增高.

目的 探讨血浆超敏肌钙蛋白I(hs?cTnI)对心肌梗死和脑血管意外患者的临床诊断效果.方法 随机选取2016年6月至2017年12月本院收治的急性冠脉综合征患者197例,分为不稳定性心绞痛(UA)组(48例)和急性心肌梗死(AMI)组(149例),AMI组又分为急性非ST段抬高性心肌梗死(NSTEMI)(53例)和急性ST段抬高性心肌梗死组(STEMI)(96例),同时选取脑血管意外(CVA)组(45例),健康对照组30例,采用贝克曼公司最新的Accuc TnI 3+检测试剂,监测病人和正常人血浆hs?cTnI变化,同时检测传统的心肌标记物,并做对比研究.结果 对照组,UA组,NSTEMI组,STEMI组和CVA组病人血清hs?cTnI浓度分别为(0.01±0.01)ng/mL,(0.08±0.03)ng/mL,(2.07±0.58)ng/mL,(2.12±0.64)ng/mL,(0.05±0.03)ng/mL,NSTEMI组和STEMI组hs?cTnI浓度均明显高于正常对照组(P<0.05);AMI患者胸痛时间<3 h、<6 h和<24 h组hs?cTnI的ROC曲线下面积分别为0.86(95％CI:0.79～0.93)、0.99(95％CI:0.97～1.01)和0.99(95％CI:0.95～1.01),明显高于传统心肌标记物肌红蛋白(MYO)、肌酸磷酸激酶同工酶(CK?MB)和超敏C反应蛋白(hs?CRP);AMI患者胸痛时间<3 h、<6 h和<24 h组中,hs?cTnI阳性检出率分别为72.0％、94.7％和100.0％;UA组和CVA组病人hs?cTnI的阳性检出率分别为35.4％和13.3％.结论 定量检测血浆hs?cTnI含量对于早期心梗的诊断具有非常重要的应用价值.

Objective To study the NTpro-BNP, cTnI and hs-CRP changes of patients with acute heart failure(AHF)and its clinical significance. Methods 342 patients with AHF and 30 healthy persons were selected as observation group and control group. NTpro-BNP, cTnI, hs-CRP and LVEF level of two groups and mortality during the follow-up period were analyzed. Relationship between NTpro-BNP, cTnI, hs-CRP and LVEF, and value of them unitedly predicting mortality of patients were analyzed.Results NTpro-BNP, cTnI, hs-CRP of observation group were higher than that of the control group while LVEF was lower than that of the control group;Compared with T0, NTpro-BNP, cTnI, hs-CRP of observation group in T2, T3, T4 were reduced while LVEF increased;Patients with more serious heart failure had higher NTpro-BNP, cTnI, hs-CRP and lower LVEF (P<0.05). NTpro-BNP, cTnI, hs-CRP of survived patients in observation group were lower while LVEF was higher(P<0.05). NTpro-BNP,cTnI and hs-CRP of AHF patients were negative correlated with LVEF and value of them predicting good prognosis.Conclusion NTpro-BNP, cTnI, hs-CRP of AHF patients are related to its heart function and the value of them unitedly predicting prognosis is good, thus they may used cardiac function and prognosis evaluation reference index of AHF patient.

ObjectiveTo evaluate the accuracy of VITEK 2 Compact automated microorganism analysis system for the determination of imipenem-resistantAcinetobacter baumannii to amikacin,and to investigate the existence of 16S rRNA methylase gene.Methods The drug susceptibilities of 72 isolates of imipenem-resistantAcinetobacter baumannii and 15 isolates of imipenem-sensitiveAcinetobacter baumannii to amikacin were determined by VITEK 2 Compact, Kirby-Bauer method and E-test. 16S rRNA methylasearmA gene was determined by polymerase chain reaction(PCR). Results Among the 72 isolates of imipenem-resistantAcinetobacter baumannii,the drug susceptibility results were consistent between Kirby-Bauer method and E-test. The minimal inhibitory concentration(MIC)of 69 isolates was 4-≥64μg/mL by VITEK 2 Compact,while the results of Kirby-Bauer method and E-test showed being resistant. The MIC of 3 isolates were≤2μg/mL by VITEK 2 Compact,while there were 2 isolates being sensitive by Kirby-Bauer method and E-test. The resistant double-ring phenomenon was found in 59 isolates. The positive rate of carryingarmA gene was 92.9%(65/70)by Kirby-Bauer method and E-test. Among the 15 isolates of imipenem-sensitiveAcinetobacter baumannii, the MIC to amikacin was≤2μg/mL,and the results were in accordance with those of Kirby-Bauer method and E-test. ConclusionsVITEK 2 Compact is not reliable for the determination of imipenem-resistantAcinetobacter baumannii to amikacin. The resistant double-ring phenomenon might be related with carryingarmA gene.

Objective To study the prevalence and sequence homology of virulence genes exoUand exoSin 53 strains of pandrug-resistant Pseudomonas aeruginosa.Methods The virulence genes exoUand exoS were detected by PCR.Sequence homology was analyzed by BOX-PCR.Results Of the 53 clinical isolates of pandrug-resistant Pseudomonas aeruginosa,the exoS+/exoU-genotype was identified in 40 strains,exoU+/exoS-genotype in 10 strains,exoS+/exoU+ genotype in 1 strain,and exoS-/exoU-genotype in 2 strains.BOX-PCR results showed that 41 exoS+isolates belonged to 24 genotypes,and 11exoU+strains could be grouped into 7 genotypes.Conclusions The prevalence of virulence genes is high in clinical isolates of pandrug-resistant Pseudomonas aeruginosa.BOX-PCR fingerprint analysis combined with sequence homology analysis is helpful for effective monitoring and control of hospital pandrug-resistant pseudomonas aeruginosainfection.

Objective To evaluate the clinical value of high-sensitivity cardiac troponin T(hs-cTnT) in early diagnosis of acute myocardial infarction. Methods The study included 67 patients with AMI and 58 patients without AMI. Serum samples from patients receiving treatment within 3 hours after the onset of suspected AMI symptoms were analyzed for the conventional cardiac troponin I (cTnI) and hs-cTnT with immunoassay. Results The sensitivity and specificity of cTnI in AMI patients was 68.7%and 53.4%, respectively. For hs-cTnT, the sensitivity and specificity was 74.6% and 51.7%, respectively. Both the area under the receiver operating characteristic curvers (ROC) (was 0.659) and positive rate(was 70.2%) in hs-cTnT was higher than those in cTnI assay(0.639,59.7%). Conclusion hs-cTnT is more suitable than cTnI for the early diagnosis of AMI.

Objective To study the amikacin anticoagulant dependence on a variety of false thrombocytopenia platelet aggregation of dissociation, to explore the mechanism of dissociation. Methods ① Confirmed in one as a result of reliance on false anticoagulant thrombocytopenia in patients with anticoagulant EDTA and sodium citrate anticoagulation add amikacin (6.5 mg/ml blood) at different time detection of platelet in order to make a control solution (not-Jiading kanamycin anti-clotting). ②Observed in patients with non-platelet-Jiading kanamycin, after the blood-Jiading kanamycin and 1 hour after the Jiading-kanamycin, collagen, ADP, arachidonic acid induced platelet aggregation release. Results 1 : 9 in patients with anticoagulant sodium citrate appear together, 1 hour after the blood-Jiading kanamycin after the number of platelet solution and there was no significant difference. The aggregation of platelets in patients was with the release of higher test results than in the reference. Conclusion As the platelet-dependent anticoagulant on a variety of pseudo-disease reduction in platelet function reference, amikacin may be to strengthen the response to the release of platelet aggregation.

目的:评估敏感型心肌钙蛋白Ⅰ早期诊断急性心肌梗死(AMI)临床应用价值。方法:应用发光免疫法分别测定疑似心梗患者症状发生后3h内就诊的67例AMI患者和58例非AMI患者同一份血清标本中敏感型心肌肌钙蛋白Ⅰ(hs-cTnI)、标准型心肌钙蛋白I(cTnI)。结果:两种检测方法对AMI患者检测的敏度和特异性:cTnI为68.7%和53.4%;hs-cTnI为71.6%和63.8%。hs-cTnI检测的接受者操作特征(ROC)曲线的曲线下面积为0.755,诊断灵敏度为67.2%均高于标准cTnI检测(0.639,59.7%)。结论:hs-cTnI检测早期诊断AMI的准确性和灵敏度优于标准型cTnI检测。

Objective To evaluate the prevalence and resistance of qnr gene in clinical isolates of Enterobacter cloacae.Methods The qnrA,qnrB and qnrS gene in 57 strains of ciprofloxacin-resistant Enterobacter cloacae isolates were detected by PCR;Susceptibility of Enterobacter cloacae isolates to fluoroquinolones and other antimicrobial agents was tested by agar dilution.Results The resistant rate to 5 fluoroquinolones was from 89.5% to 100% and that to ampicillin,tetracycline,ceftriaxone,cefmetazole,gentamicin and imipenem was 100%,64.9%,87.7%,93%,49.1% and 100%,Among the 57 Enterobacter cloacae strains,there were 19 strains(33.3%) carrying qnrA gene,15 strains(26.3%) carrying qnrB gene,2 strains(3.5%) carrying qnrS gene,8 strains carryign qnrA gene and qnrB gene,only one strain carriying qnrA gene andqnrS gene,1 strains carrying qnrB gene and qnrS gene.Conclusion The qnr gene is prevalent in our hospital,qnr positive strains were multi-drug resistant,so more attention should be paid to survey and detect those strains.

Objective To evaluate the effect of sample storing time on plasma carbon dioxide combining power. Methods To detect the plasma CO2CP concentration in 80 samples in different time with dry chemistry method. Results The results show significant difference in 90,120 minutes when uncapped the samples containers compared to that in 0 minite(P0.05), the result in 150 minutes is significantly lower than that in 0 minite (P0.01). Conclusions CO2CP should be determined within 60 minutes.