目的 用光学比浊法检测血小板聚集率,评估缺血性脑卒中患者二级预防阿司匹林抵抗的疗效.方法 征集脑卒中后阿司匹林治疗者,随机分为基础治疗对照组和基础治疗+三七(3 g/d)治疗组,连续检测血小板聚集率变化,以治疗前、治疗14 d、治疗30 d为时间点采集数据,分析治疗前后血小板聚集率变化差异.结果 两组基础治疗后抗血小板聚集率不达标,血小板聚集率分别为(26.30±3.30)％,(26.20±3.35)％,差异无统计学意义(P=0.590);加用三七治疗14 d,对照组和治疗组血小板聚集率分别为(25.89±2.46)％,(15.12±3.42)％,差异有统计学意义(P=0.042);加用三七治疗30 d,对照组和治疗组血小板聚集率分别为(24.35±2.97)％,(10.30±2.62)％,差异有统计学意义(P=0.025).结论 添加中药三七治疗脑卒中阿司匹林抵抗患者可使血小板聚集率下降,达到抗血小板聚集治疗的标准.

目的:比较血栓四项与血栓弹力图对脓毒血症合并弥散性血管内凝血(DIC)的早期诊断价值.方法:选取脓毒血症患者215例,根据中国弥散性血管内凝血诊断积分系统(CDICS)评分分为显性DIC组(CDICS评分≥7分)、非显性DIC组(5分≤CDICS评分<7分)以及未发生DIC的对照组(CDICS评分<5分).比较三组血栓四项[凝血酶-抗凝血酶复合物(TAT)、血栓调节蛋白(TM)、组织纤溶酶原激活物-纤溶酶原激活物抑制剂-1复合物(t-PAI-C)、纤溶酶-α2纤溶酶抑制物复合物(PIC)]及血栓弹力图参数[凝血因子激活时间(R)、血块形成的速率(K)、弹力图最大切角(α角)、弹力图最大振幅(MA)].采用受试者工作特征(ROC)曲线分析上述指标的诊断效能.对两种检测方法与CDICS评分结果进行Kappa一致性分析.结果:显性DIC组TM、TAT、PIC、t-PAI-C、R、K、α角均高于非显性DIC组,MA低于非显性DIC组(P<0.05).血栓四项和血栓弹力图单独检测结果虽然有效,但诊断效能低于CDICS评分.血栓四项及血栓弹力图参数与CDICS评分具有弱至中等的一致性(P<0.05).结论:在脓毒血症合并DIC的早期诊断中,血栓四项阳性诊断率更高,但无法快速、全面地评估凝血全貌,不可代替血栓弹力图的动态监测,临床可以将两者联合应用,进而提高诊断效能.

Objective To explore the application of platelet alarm information of Sysmex XE-2100 electric resistance method (PLT-I),optics (PLT),Sysmex XN-3000 nucleic acid staining method (PLT-F) and cella vision DM96 at low values of platelet count.Methods 182 patients with platelet count ＜100 * 109/L measure by XE-2100 automatic blood cell analyzer (impedance method) (PLT-I) were selected.The specimens from the patients were detected with XE-2100 automatic blood cell analyzer (optical method) (PLT-O),XN-3000 blood cell analyzer (staining method) (PLT-F),DM96 automatic blood cell morphology analyzer and Sysmex sp-1000i automatic push piece dyeing instrument (DM96).The alarm information was divided into abnormal platelet histogram (Plt Abn Dst),thrombocytopenia (Thrombocytopenia) and platelet aggregation (Plt Clumps).The correlation of PLT-I,PLT-O,PLT-F and DM96 was analyzed.Results The abnormal imformation of platelet histogram and platelet aggregation of PLT-O and PLT-I was not different (P＞0.05).There were differences abnormal imformation of platelet histogram and platelet aggregation between PLT-O and PLT-F,between PLT-I and PLT-F,between PLT-Oand DM96 and between PLT-I and DM96 (P＜0.05).There were no diferences of thrombocytopenia between PLT-O and PLT-I,between PLT-O and PLT-F and between PLT-I and PLT-F (P＞0.05).There were diferences of thrombocytopenia between PLT-O and DM96,between PLT-F and DM96 and between PLT-Iand DM96 (P＜0.05).Conclusion In the low value of platelet (＜100* 109/L) count,the different warning information should choose different counting methods.In the instrument tip PLT Abn DST and PLT Clumps alarm information,the reticulocyte red channel optical method of platelet count cannot be corrected platelet count must be by nucleic acid staining method (PLT-F) or DM96 platelet count,and the instrument tip thromboeytopenia alarm information must use DM96 in order to pass the inspection of the platelet count issued a report.

Objective To explore the correlation of serum HCV-RNA level with liver function indices and blood routine parameters in patients with hepatitis C,and provide the references for the early diagnosis and monitoring the prognosis of hepatitis C.Methods The study population comprised 651 patients who were diagnosed with hepatitis C in the Second Affiliated Hospital of Medical College of Xi' an Jiaotong University.Serum level of HCV RNA was determined by quantitative realtime polymerase chain reaction (real-time PCR).The data obtained were divided into six groups according to the result of HCV RNA level.Then the correlation of serum HCV-RNA level with liver function indices and blood routine parameters was analyzed.Results With the rising level of serum HCV-RNA,the levels of liver function indices including ALT,AST,AST/ALT,GGT and TBIL were all significant increased in hepatitis C patients.However,A/G presented a declining trend with the increase of serum HCV-RNA level.The lowest value and highest value of ALT,AST,AST/ALT,GGT,TBIL and A/G were 32.3±9.7 U/L and 96.2±13.6 U/L,31.1±8.38 U/L and 113.5±15.9 U/L,0.86±0.09 and 1.19±0.11,29.2± 14.5 U/L and 52.7±16.2 U/L,17.2±4.32 μmol/L and 26.0±5.58 μmol/L,0.98±0.07 and 1.35±0.14,respectively.Significant differences in ALT,AST,AST/ALT,GGT,TBIL and A/G were observed among these groups (F value was 457.1,656.4,149.1,40.18,46.56 and 146.98,respectively.all P＜0.01).Moreover,the levels of blood routine parameters including WBC,NEUT％,RBC,H b and PLT were all significant decreased while that of LY％ was increased with the rising level of serum HCV-RNA in hepatitis C patients.The lowest value and highest value of WBC,NEUT％,LY％,RBC,Hb and PLT were (4.30±0.22) ×109/L and (6.02±0.27) × 109/L,(48.13±3.56)％ and (59.28±3.40)％,(31.05±3.41) ％ and (38.81 ± 4.65)％,(3.73 ± 1.70) × 1012/L and (4.65± 1.88) × 1012/L,(122.01±5.58) g/L and (135.37 ±8.50)g/L,(102.65± 16.87) × 109/L and (148.21 ± 14.40) × 109/L,respectively.There was no significant difference in RBC among groups (F=1.926,all P＜0.05).However,the differences in other blood routine parameters than RBC among groups were statistically significant (F value of WBC,NEUT％,LY％,Hb and PLT was 349.0,132.145,43.65,38.91 and 52.21,respectively.all P＜0.01).Conclusion Serum HCV-RNA level was correlated with routine liver function indices and blood routine parameters.It is important to perform the combined detection of serum HCV-RNA level,routine liver function indices and blood routine parameters in hepatitis C patients,which can help to guide diagnosis and to evaluate the prognosis.

Application of CBE teaching mode in professional practice of laboratory medicine interns can improve the professional competence of interns ,stimulate interest and motivation of learning ,im-prove operational and clinical response capability ,satisfy the job requirements ,achieve induction op-eration requirements ,and achieve efficient clinical communication .In this paper ,we have an example in the blood cell morphology examination .The laboratory medicine interns were divided into three groups .We explore effect of CBE teaching mode in professional practice of laboratory medicine in-terns .