背景 脑脊液标本病原菌培养是颅内感染诊断的金标准,目前临床多采用血培养瓶对脑脊液标本进行培养,阳性报警后再经过传代培养方可进行菌种鉴定和药敏试验,其耗时长,不利于临床及时诊治,有必要改进方法提高报告时效.目的 探讨HB&L(人体生物体液)微生物培养系统快速培养脑脊液阳性标本后进行菌种鉴定和药敏试验的准确性和时效性.方法 收集2021年1月-2022年1月我中心血液培养仪报阳性的脑脊液样本37例,分别进行常规分离培养和HB&L快速培养,以激光解析电离飞行时间质谱仪(MALDI-TOF MS)进行鉴定,以VITEK-2 Compact细菌鉴定药敏仪进行药敏试验.以常规培养法为金标准,评价HB&L快速培养法鉴定结果的正确率和药敏结果的符合率,比较两种方法的周转时间.结果 共分离鉴定出37株菌株,其中11株凝固酶阴性葡萄球菌、1株金黄色葡萄球菌、1株粪肠球菌、2株纹带棒杆菌、1株蜡样芽孢杆菌、6株鲍曼不动杆菌、6株肺炎克雷伯菌、3株铜绿假单胞菌、2株大肠埃希菌、1株阴沟肠杆菌、1株嗜麦芽窄食单胞菌和2株真菌.HB&L快速培养法菌种鉴定正确率为100％.与常规法药敏试验结果比较,HB&L快速培养法鉴定革兰阴性菌时替加环素、阿米卡星和米诺环素药物符合率为94.44％,其他抗菌药物符合率为100％;革兰阳性菌,红霉素符合率为92.31％,其他抗菌药物符合率为100％;HB&L快速培养法标准总符合率为98.90％,一般错误为0.82％,严重错误为0,极严重错误为0.27％.HB&L快速培养法菌种鉴定和药敏试验的周转时间相比常规法分别缩短22.10 h和24.77 h,差异有统计学意义(P<0.001).结论 HB&L联合MALDI-TOFMS和VITEK-2Compact可用于脑脊液培养阳性样本进行快速鉴定和药敏试验,回报时间缩短24 h,为临床及时治疗提供依据.

目的 探讨红细胞平均体积(MCV)对XN-2000血液分析仪电阻抗法(PLT-I)和荧光染色法(PLT-F)计数患者血小板结果的影响.方法 采用Sysmex XN-2000血液分析仪对286例患者抗凝血分别用PLT-I和PLT-F进行血小板计数,计数结果根据MCV大小分为3组,A组:MCV<72 fL,B组:72 fL≤MCV≤82 fL,C组:MCV>82 fL;将两种方法检测的血小板结果进行统计学分析.结果 A组PLT-I和PLT-F两种方法计数结果差异有统计学意义(P<0.05),B组和C组这两种方法计数结果差异均无统计学意义(P<0.05).结论 临床进行血常规血小板计数检测时,MCV越大,PLT-I和PLT-F二者计数结果差异越不明显,MCV<72 fL时,PLT-I和PLT-F血小板计数结果有明显差异,提示MCV<72 fL时采用PLT-F对血小板计数结果进行复检,可有效避免小红细胞导致的血小板计数假性增高.

Objective To investigate the influence of long sea voyage working environment on the symbiotic microorganisms and their relationship with their hosts .Methods The periumbilical microbial sam-ples from the operating workers of long sea voyage before and after operation were collected .Then 16S rRNA V4 section amplification ,sequencing and whole metagenome shotgun high-throughput sequencing were per-formed .Moreover the bacterial community structure ,kinds and microorganism metabolic function change were analyzed .The peripheral blood was collected from the workers of long sea voyage operation and shore-based operation for conducting the blood routine analysis .Results After 105 d ocean sailing ,the diversity of perium-bilical microbial community in the workers with long sea voyage operation decreased and the relative abun-dance of Firmicutes increased ,w hile w hich of Proteobacteria decreased ;w hich of Staphylococcus increased , while which of Corynebacteria decreased ,the differences were statistically significant (P<0 .05) ,the relative a-bundance of pathogenic bacteria or conditional pathogenic bacteria ,especially Staphylococcus epidermidis and Staphylococcusaureus aureus ,increased significantly .T he functional gene analysis indicated that the expres-sion of periumbilical microbial infection related genes increased after the long sea voyage operation .Compared with shore-based operation workers ,the proportion of workers with peripheral blood lymphocytes abnormal elevation in the long sea voyage group increased significantly ,the difference was statistically significant (P<0 .05) .Conclusion The periumbilical skin symbiotic microorganisms may reflect the health conditions in the workers with long sea voyage operation .

Objective Two identification systems,Matrix assisted laser desorption ionization time of flight mass spectrometry system and VITEK 2 Compact were compared for the efficiency of identification of clinically relevant bacteria.Methods The 558 selected clinical isolates tested in this study were isolated from clinical samples of blood,urine,cerebrospinal fluid,secretion,sputum et al,and were obtained from the navy general hospital from Aug 2015 to Sep 2015,then the isolated strains were identification with the use of Bruker Biotyper bacterial identification system and VITEK 2 Compact bacterial identification system at the same time,at last the identification result identified by the two devices were compared.Results the 558 strains bacteria from clinical samples were divided into 28 genuses by Bruker Biotyper and were divided into 24 genuses by VITEK 2 Compact.There are 22 genera that were identified by both two devices,among the result of two devices,the agreement rate of identification of species reached 91.0％,the agreement rate of identification of genus reached 94.8％.While,the salmonella which take a rate of 0.2％ in clinical isolates are identified to genus by both two instrument.The agreement rate of identification of species of gram-negative bacteria was not significantly more than gram-positive bacteria and fungus(P ＞0.05).Conclusion The Bruker Biotyper system is rapid,accurate,and convenient,low cost in the identification and diagnosis in the clinical laboratory.Still,the database needs to be further improved.

目的 探讨海上长远航特殊作业环境对船员口腔颊黏膜共生细菌及口腔免疫功能的影响.方法 采集长远航作业人员作业前后口腔颊黏膜细菌样本和抗凝全血样本,扩增16S rRNA基因片段V4区并应用二代高通量测序方法分析口腔颊黏膜细菌群落组成;应用实验室常规方法检测作业人员血常规参数的变化.结果 硬壁菌门和变形菌门为口腔颊黏膜含量最高的细菌,在细菌属水平上链球菌属含量最高.与长远航前相比,长远航作业后期口腔颊黏膜细菌中硬壁菌门含量升高,变形菌门和放线菌门含量下降.主坐标分析结果提示长远航前后2个不同时期颊黏膜细菌趋向于分为2个类群,且长航后细菌种类更加集中.长远航后期作业人员全血检测发现粒细胞百分比下降,淋巴细胞百分比上升,差异具有统计学意义(P＜0.01).结论 海上长远航特殊环境导致作业人员口腔颊黏膜共生菌群改变,可能对长远航作业中健康管理具有一定提示作用.