临床医学的发展要求检验人员能参与到临床检验结果的分析与解释中,培养复合型高级医学检验专业人才的目标成为临床迫切需求.该文描述了四川大学华西医院从2004年起启动高级住院检验技师培训的毕业后教育培训过程及内容,对毕业5年以上的高级住院检验技师在医教研等方面的综合能力进行分析,认为高级住院检验技师培养模式加强了学员综合素质和个人能力提升,达到了设定的培养目标,能培养满足社会需要的实用型高级检验人才.

Introduction: This study aimed to explore the significance and cut-off values of FMS-like tyrosine kinase 3-internal tandem duplications mutant allelic ratio (FLT3-ITD MR) in prognostic evaluation of acute myeloid leukemia (AML) patients. Methods: This study enrolled 249 Chinese AML patients. The exons 14 and 15 of FLT3 gene were amplified by genomic polymerase chain reaction. GeneScan and single nucleotide sequencing were also performed. Participants were grouped into high- and low-ratio FLT3-ITD MR (FLT3-ITD MRhigh and FLT3-ITD MRlow) applying the median of FLT3-ITD MR as the cut-off ratio, and patients without FLT3-ITD were grouped as FLT3-wild type (wt). Duration of complete remission (CR), relapsed remission and overall survival (OS) were examined. Results: FLT3-ITD was detected in 58 patients. The medians of FLT3-ITD MR were 0.31 and 0.29 for all AML and non-M3 patients, respectively. For all patients, FLT3-ITD MRhigh group had the lowest CR rate among these 3 groups (p < 0.001). The FLT3-wt group, FLT3-ITD MRlow and FLT3-ITD MRhigh group had the median OS of 36.00 months (range: 2.00-92.00 months), 12.00 months (range: 1.00-78.00 months) and 14.00 months (range: 0.00-79.00 months), respectively. Subjects in FLT3-ITD MRhigh group had 2.675 times (95% CI: 1.726-4.146; p < 0.001) and 1.879 times (95% CI: 1.061-3.328; p = 0.031) higher death risk than those in FLT3-wt group and FLT3-ITD MRlow group, respectively. For non-M3 patients, the median OS was 35.00 months (range: 2.00-92.00 months), 9.5 months (range: 1.00-74.00 months) and 10.00 months (range: 1.00-38.00 months) in the FLT3-wt group, FLT3-ITD MRlow group and FLT3-ITD MRhigh group, respectively. Non-M3 patients in FLT3-ITD MRhigh group had 3.301 times (95% CI: 1.423-7.661; p = 0.005) higher death risk than those in FLT3-wt group. Conclusion: The present study found that FLT3-ITD MR is closely related to CR and OS in AML patients. Furthermore, FLT3-ITD MR may serve as an independent prognostic factor for OS in non-M3 AML patients. Classifying risk grades based on FLT3-ITD MR is crucial for individualized treatment and prognostic evaluation.

目的 对系统性红斑狼疮(SLE)骨髓形态进行分析,探讨其在SLE诊断中的意义.方法 回顾性分析73例活动期SLE患者骨髓象 、外周血象及自身抗体结果 .结果患者血液系统受累表现明显,73例患者中67例患者(91.8％)骨髓增生明显活跃或活跃,70例患者(95.9％)粒系增生活跃,35例患者(47.9％)淋巴细胞相对减少,63例患者(86.3％)红系增生活跃或明显活跃,42例患者(57.5％)巨核细胞增多.在外周血象中,20例患者(27.4％)白细胞减少,47例患者(64.4％)有不同程度的贫血,21例患者(28.8％)血小板减少.血小板减少组的骨髓巨核细胞数显著低于血小板正常组,差异有统计学意义(P=0.028).结论 SLE累及多器官,骨髓可能为SLE的靶器官之一;血液系统受累较为普遍,骨髓形态学检查对SLE有十分重要的诊断意义.

目的 评价血清乳酸脱氢酶(lactate dehydrogenase,LDH)在骨髓细胞形态相似难以区分的伯基特淋巴瘤(burkittlymphoma,BL)和急性淋巴细胞白血病(acute lymphoblastic leukaemia,ALL)鉴别诊断中的价值,并确定其相应的临床诊断阈值.方法 回顾2007年1月1日-2019年3月31日在四川大学华西医院骨髓细胞形态学初诊为伯基特淋巴瘤的患者66例,采用流式细胞免疫分析技术(FCM)进行确诊.进一步分析初诊时患者血清LDH水平,并借助受试者工作特征曲线(receiver operatingcharacteristic curve,ROC)确定诊断阈值.结果 形态学初诊为BL的66例患者中,经FCM确诊,有35例BL,31例B-ALL.确诊为BL的患者血清LDH水平显著高于B-ALL(P ＜0.001).ROC曲线下面积为0.871.当诊断界值为1100.5 IU/L时,诊断特异性为77.4％,灵敏度为88.6％.结论 LDH可作为骨髓细胞形态相似难以区分的伯基特淋巴瘤与急性淋巴细胞白血病鉴别诊断的重要辅助指标,伯基特淋巴瘤的最佳临床诊断阈值为LDH≥1 100.5 IU/L.

Chemokine ligand 12(CXCL12) mediates signaling through chemokine receptor 4(CXCR4), which is essential for the homing and maintenance of Hematopoietic stem cells (HSCs) in the bone marrow. FLT3-ITD mutations enhance cell migration toward CXCL12, providing a drug resistance mechanism underlying the poor effects of FLT3-ITD antagonists. However, the mechanism by which FLT3-ITD mutations regulate the CXCL12/CXCR4 axis remains unclear. We analyzed the relationship between CXCR4 expression and the FLT3-ITD mutation in 466 patients with de novo AML to clarify the effect of FLT3-ITD mutations on CXCR4 expression in patients with AML. Our results indicated a positive correlation between the FLT3-ITD mutant-type allelic ratio (FLT3-ITD MR) and the relative fluorescence intensity (RFI) of CXCR4 expression in patients with AML (r = 0.588, P ≤ 0.0001). Moreover, the levels of phospho(p)-STAT5, Pim-1 and CXCR4 proteins were positively correlated with the FLT3-ITD MR, and the mRNA levels of CXCR4 and Pim-1 which has been revealed as one of the first known target genes of STAT5, were upregulated with an increasing FLT3-ITD MR(P < 0.05). Therefore, FLT3-ITD mutations upregulate the expression of CXCR4 in patients with AML, and the downstream signaling intermediates STAT5 and Pim-1 are also involved in this phenomenon and subsequently contribute to chemotherapy resistance and disease relapse in patients with AML. However, the mechanism must be confirmed in further experiments. The combination of CXCR4 antagonists and FLT3 inhibitors may improve the sensitivity of AML cells to chemotherapy and overcome drug resistance.

目的 评价FA160型粪便自动分析仪(简称FA160)检测粪便隐血的效能.方法 将FA160及配套卡型便潜血试剂(简称W试剂)作为仪器法,将单独采用W试剂或条形便潜血试剂(简称A试剂)手工检测作为手工法.对仪器法和手工法的最低检测限、检测范围进行评估,同时评价仪器法的携带污染.同时采用仪器法和手工法检测232例临床粪便标本,比较2种方法粪便隐血试验(FOBT)的阳性率.比较2015年手工法与2016年仪器法FOBT的阳性率.结果 仪器法和手工法检测血红蛋白(Hb)的最低检测限为0.1μg/mL,检测范围为0.1～2000.0μg/mL.携带污染试验结果显示仪器法无携带污染.手工法2种试剂的总符合率为96.55％,一致性较好(Kappa=0.87),但W试剂阳性率高于A试剂(P=0.008).仪器法与手工法的总符合率为93.53％,仪器法与W试剂手工法的一致性较好(Kappa=0.85),2种方法FBOT阳性率差异无统计学意义(P>0.05);仪器法与A试剂手工法的一致性较好(Kappa=0.78),但2种方法的FOBT阳性率差异有统计学意义(P=0.000).2015年(手工法)与2016年(仪器法)FOBT阳性率差异无统计学意义(P>0.05).结论 FA160可用于临床粪便标本的检测.

血常规检查是临床诊断中的三大常规检查项目之一,在血液性疾病的筛查和诊断中有非常重要的作用.检验人员在使用自动化血液分析仪进行血常规检测时应注意仪器提示的报警信息,以减少漏检和误报的发生.我们通过对1例血常规漏检异常细胞的病例进行回顾和反思,以提高检验结果的准确性.

Objective:To study the correlation of serum PDCD5 and Bax contents with the pathological features of tumor lesions in patients with lung cancer.Methods:Patients with lung cancer who underwent surgical treatment in West China Hospital between June 2014 and March 2017 were selected as the lung cancer group for the study,the serum specimens were collected before surgery,and the lung cancer lesion and adjacent lesion were taken after surgery;the healthy subjects who underwent physical examination in West China Hospital during the same period were selected as the control group,and the serum samples were taken during the physical examination;the contents of PDCD5 and Bax in serum as well as the contents of PDCD5 and Bax,and the expression of proliferation genes and invasion genes in the lung cancer lesion and adjacent lesion were measured.Results:PDCD5 and Bax contents in serum of lung cancer group were significantly lower than those of control group,PDCD5 and Bax contents in lung cancer lesion were significantly lower than those in adjacent lesion,and the PDCD5 and Bax contents in serum of patients with lung cancer were positively correlated with the PDCD5 and Bax contents in lung cancer lesion;C-myc,RACK1,CatL,MMP2 and N-cadherin mRNA expression in lung cancer lesion were significantly higher than those in adjacent lesion and negatively correlated with PDCD5 and Bax contents in serum whereas LAST1,PAQR3,TCF21,E-cadherin,TIMP1 and TIMP2 mRNA expression were significantly lower than those in adjacent lesion and positively correlated with PDCD5 and Bax contents in serum.Conclusion:The decrease of PDCD5 and Bax in serum of patients with lung cancer is closely related to the aggravation of cancer cell proliferation and invasion in tumor lesions.

目的 分析MicroRNA-191(miR-191)与T淋巴母细胞性淋巴瘤(T-LBL)的相关性及其可能机制.方法 回顾性将40例T-LBL患者(观察组)及40例淋巴结反应性增生(LRH)患者(对照组)作为研究对象,通过荧光实时定量PCR法测定对照组淋巴结组织与观察组肿瘤组织中miR-191的表达水平,进而分析其与预后效果的关系.将反义miR-191慢病毒载体转染的Jurkat细胞为A组,阴性对照载体转染的Jurkat细胞为B组,未转染的Jurkat细胞为C组;构建阴性对照载体与反义miR-191慢病毒载体,并对T-LBL细胞系Jurkat细胞进行转染,并采用相同方法对miR-191的表达水平进行检测.结果 相比对照组,观察组患者miR-191表达水平显著升高(P＜0.01).将miR-191表达水平的中位数(1.84)作为临界值,将观察组患者分为低表达组(13例)、高表达组(27例).T-LBL患者高表达组3年总生存率较低表达组显著降低(P＜0.05).A组Jurkat细胞转染后miR-191表达水平(0.53±0.03)较B组(1.02±0.06)、C组(1.00)显著降低(P＜0.05),而B组、C组表达水平的比较,并无显著差异(P＞0.05).A组Jurkat细胞转染2d后,其G1期细胞比率较B组、C组明显增加(P＜0.05),S期细胞比率较B组、C组明显减少(P＜0.05),而三组G2/M期细胞比率的比较,并无显著差异(P＞0.05);A组细胞凋亡率较B组、C组明显升高(P＜0.05).结论 miR-191可能参与T-LBL的病理过程,故可考虑作为治疗T-LBL的潜在靶点.

Objective To detect the difference between the peroxidase (POX) by cytochemical staining and cytoplasm myeloperoxidase (cMPO) by flow cytometry in acute leukemia cells,and provide a more accurate basis for the classification of leukemia.Methods The positive rate of POX in acute leukemia cells was detected by cytochemical staining.The positive rate of cMPO in acute leukemia cells was detected by flow cytometry.Then the positive rate of POX and cMPO,and the positive cells score were analyzed.Results The positive rate and the positive cells scores between POX and cMPO in acute lymphoblastic leukemia were significantly different (P＜0.05),the positive rate and the positive cells scores of POX were significantly higher than those of cMPO.The positive rate between POX and cMPO in acute nonlymphoblastic leukemia (ANLL) had significant differences (P＜0.05),the positive rate of cMPO was higher than that of POX;but no difference was found between POX and cMPO positive cells scores in ANLL (P＞0.05).In acute myelocytic leukemia (AML)-M 1 subtype,significant difference was found in the positive rate between POX and cMPO (P=0.006);cMPO positive rate was significantly higher than that of POX,but the POX positive cells score was significantly higher than that of cMPO (P=0.001).There were no significances of positive rate and positive cells score in AML-M2,AML-M3,AML-M4,AML-M5 subtypes between POX and cMPO (P＞0.05).Conclusions There are not major differences between positive rate of POX and cMPO,as well as the positive cells scores in acute leukemia,especially acute myelocytic leukemia.We can choose the better method according to the actual situation and the sensitivity requirements.The two methods should be replenished by each other and used alternately.

Objective To evaluate the value of Sysmex XT-4000i hematology analyzer in its body-fluid mode in cell count and cell differential count of pleural effusion,ascites and cerebrospinal fluid samples.Methods A total of 95 pleural effusion,ascites and cerebrospinal fluid samples were collected from patients hospitalized between May and September 2015.The samples were tested by Sysmex XT-4000i hematology analyzer (instrument method) and modified Neubauer hemocytometer (manual method) for cell count,and the results of them were compared and analyzed.Results The instrument method and the manual method had a good consistency in nuclear cell count and erythrocyte count (kappa=0.965,P＜ 0.001;kappa=0.988,P＜0.001).There was no significant difference in the count ofmononuclear cells (P＞0.05).However,there was a significant difference in the count of multiple nuclear cells (P＜0.05).Conclusions Hematology analyzer in its body-fluid mode may replace manual method in cell count of pleural effusion,ascites and cerebrospinal fluids for its high precision,high efficiency and easy operation.However,cell differential count of this method needs microscopic examination assistance.

Rationale: Coexisting systemic lupus erythematosus (SLE) and human immunodeficiency virus (HIV) infection cases are rare worldwide. Great challenges are posed on the diagnosis and treatment of such concurrent cases. Patient concern: We report the case of a 44-year-old Chinese man with edema, hematuria, and fever who presented at West China Hospital, Sichuan University, Chengdu, Sichuan, China, in 2013. Diagnoses: An initial diagnosis of SLE was made from the clinical manifestations and laboratory findings based on the Systemic Lupus International Collaborating Clinics classification criteria. Immunosuppressant therapy relieved him of the edema and hematuria, but he regained the symptoms after a cold. Workup, including electrochemiluminescence immunoassay, western blot, and polymerase chain reaction analysis, revealed that he was concurrently infected with HIV after hospitalization. Interventions: The treatment plan included methylprednisolone and cyclophosphamide, with gastroprotective and hepatoprotective agents, simultaneously aiming to reduce urinary protein. After HIV infection confirmed, cyclophosphamide was stopped. He was referred to the local Centers for Disease Control and Prevention for combination antiretroviral therapy (ART). He was suggested to continue monitoring CD4 T-cell count for an appropriate dose of immunosuppressive drugs. Outcomes: In the last follow-up in May 2017, he had been stable in terms of both SLE and HIV infection. Lessons: The case highlights the presence of concurrent SLE and HIV infection. Laboratory technicians and clinicians should be cautious on diagnosis, especially in eliminating the false-positive results. Attention should be paid to the dose of immunosuppressants and the ART procedure.

The SCARB1 gene encodes human scavenger receptor class B type I (SR-BI), the primary receptor for high-density lipoprotein (HDL)- cholesteryl ester uptake, and polymorphisms in this gene may influence SR-BI protein expression and serum lipid levels, modulating susceptibility to coronary heart disease (CHD) and cerebral infarction (CI). Therefore, we investigated the association between singlenucleotide polymorphisms (SNPs) in the SCARB1 gene and serum lipid levels as well as risk of CHD and CI in the Chinese Han population. Genotypes in 295 CHD patients, 302 CI patients and 312 healthy controls matched for age and gender were determined by high-resolution melting (HRM). Among the 5 SNPs investigated in this study, rs10846744 and rs2278986 were significantly associated with CHD risk. The frequency of the C allele for rs10846744 and that of the T allele for rs2278986 appeared to be significantly increased in the CHD group (OR: 1.416, 95%CI: 1.128–1.778, P=0.0058 and OR: 1.681, 95%CI: 1.327–2.130, P<0.0001, respectively). CHD patients with genotypes CC and CG for rs10846744 had a higher HDL-c level than those with genotype GG, and CHD patients with genotypes CC and CT for the rs2278986 SNP had a higher HDL-c level compared to those with the TT allele. The other 3 SNPs, rs5888, rs10744182 and rs838893, showed no significant association with serum lipid levels and CHD or CI risk in the Chinese population. The CCCTT and CCTTC haplotypes of rs5888, rs10846744, rs10744182, rs2278986 and rs838893 appear to significantly increase CHD risk, whereas the CGTTC, CCTCT and TGCTC haplotypes appear to significantly reduce risk. Overall, the CCTTC and TGTTC haplotypes acted as a significant risk for CI, with the CGCTC and CCCCT haplotypes conferring significantly reduced risk. These results suggest that SCARB1 gene polymorphisms may contribute to genetic susceptibility to CHD; in particular, the C allele of rs10846744 and the C allele of rs2278986 may serve as risk and protective factors for CHD, respectively.

目的：教育部新“普通高等学校本科专业目录”中将原有授予医学学士学位的五年制医学检验专业改为授予理学学位的四年制医学检验技术专业，并将其划归入新单独设立的医学技术类。由此带来的培养目标和培养体系的改变，为我国高等医学检验专业教育提出了新的挑战。本文就四年制医学检验技术专业《临床基础检验学》教学过程中面临的一些问题进行探索，为该门课程进行教学改革以适应新的学科分类及学制奠定基础。

目的 通过研究急性髓系白血病(AML)患者白血病细胞表面趋化因子受体CXCR4的表达情况,探讨CXCR4在AML中表达的意义.方法 收集初诊未治疗的130例AML患者,根据FAB分型标准进行分类,以急性淋巴细胞白血病(ALL)患者和非血液系统疾病患者作为对照,检测3组之间及不同FAB亚型之间CXCR4表达情况,分析CXCR4在白血病尤其是AML中表达的意义.结果 AML实验组和ALL对照组细胞表面CXCR4相对荧光强度明显高于非血液系统疾病对照组,且ALL对照组荧光强度最高(P＜0.05).M3和M4/M5亚型组白血病细胞CXCR4表达明显高于其他亚组(P＜0.05).结论 CXCR4的高表达可能与白血病的发病、浸润及病情发展有关,可为预防白血病细胞迁移及髓外浸润,提高难治性AML疗效和减少AML复发等方面提供新的思路.

目的 探讨影响晚期非小细胞肺癌预后的相关因素.方法 回顾性分析118例晚期非小细胞肺癌患者的临床资料,分析影响其预后的相关因素.结果 ①单因素分析:患者年龄37～79岁,中位值为60岁,低年龄组(≤60岁)和高年龄组(＞60岁)中位生存期分别为641天和513天(P=0.015);纤维蛋白原为1.99～9.99 g/L,中位值为4.00 g/L,低纤维蛋白原组(≤4.00 g/L)和高纤维蛋白原组(＞4.00 g/L)中位生存期分别为692天和421天(P=0.005);病理类型:腺癌、鳞癌、腺鳞癌中位生存期依次递减(P=0.020);PS评分越高,中位生存期越短(P=0.018);性别、PLRNLR,T/N分期,CYFRA21-1,吸烟对晚期非小细胞肺癌患者生存时间的影响差异无统计学意义.②通过Cox回归分析进行多因素分析,仅纤维蛋白原为影响晚期非小细胞肺癌预后的独立因素.结论 单因素分析显示年龄、纤维蛋白原、PS评分和病理类型对于晚期非小细胞肺癌预后有影响,且年龄、纤维蛋白原、PS评分与预后生存期呈负相关,腺癌的生存时间较鳞癌和腺鳞癌长;多因素Cox分析提示纤维蛋白原是影响晚期非小细胞肺癌预后的独立危险因素,且纤维蛋白原越高,预后越差.

Background: Acute myeloid leukemia (AML) is a form of cancer characterized by infiltration of the bone marrow, blood, and other tissues by proliferative, clonal, abnormally differentiated cells of the hematopoietic system. Chemokine stromal cell-derived factor 1 (SDF-1) and its receptor CXC receptor 4 (CXCR4) play crucial roles in malignant cell invasion. Genetic polymorphisms may contribute to the differences in the expression level and activities associated with the SDF-1/CXCR4 pathway. This study aimed to determine the associations between the polymorphisms located on the SDF-1 (rs1801157, G>A) and CXCR4 (rs2228014, C>T) encoding genes and susceptibility and leukemia cell dissemination in AMLMethods: A total of 926 individuals, including 466 de novo AML patients and 460 healthy controls were genotyped for rs1801157 and rs2228014 using DNA Sanger sequencing.Results: Genotype distributions of CT and CT + TT for rs2228014 were significantly increased in AML patients compared with healthy controls [OR: 1.36, p = 0.04; OR: 1.34, p = 0.04; respectively]. However, rs1801157 demonstrated no significant differences in genotype distributions and allele frequency between AML patients and healthy controls. For the two combined SNPs, there was no significant proportional difference between the wild type GG-CC genotypes and non-GG-CC genotypes in AML patients and healthy controls. Additionally, peripheral blood leukemia-cell (PBLC) count was not statistically influenced by the genotypes of either rs1801157 or rs2228014.Conclusion: Genotype CT of rs2228014 appeared to correlate with AML risk, but played no role in leukemia cells invading the bloodstream, while rs1801157 and the two combined SNPs were not associated with either increased AML risk or extramedullary leukemia-cell dissemination. (C) 2016 Elsevier B.V. All rights reserved.

Objective To estimate the critical value notification of emergency specimens in general laboratory whether a-chieved the desired goals,and to apply quality improvement measures to achieve quality improvement purposes.Methods Critical values of emergency specimens in general laboratory were monitored and collected in 2014.Statistical analysis was done for non-notification rates and sources of the critical values,and quality improvement began in July,2014 by training, continuing education and amonthly bulletin of notification data of critical values.Results Total number of Critical values of emergency specimens in general laboratory in 2014 was 2 648 and 1 950 of them had been reported by telephone.Total notifi-cation rate was 61.4% in the first 6 months,and was 81.4% from July to December.At last,Critical value notification rates increased to 97.72% in December.Conclusion Strengthening the management of critical value notification can help impro-ving the quality of laboratory service,as well as enhancing stuff responsibility and awareness of service for clinic.

通过教师言行培养学生医德医风；以课堂教学为中心，辅以实习见习、校外参观学习、读书报告、学术报告、病案讨论，培养学生临床思维和技能；通过“导师制”的科研创新小组指导学生进行科研探索，以多元化教学模式的综合应用，提高医学检验系学生的人文素质、临床思维和技能、科研素质、信息素质等体现医学检验学生综合素质的基本要素，以适应21世纪医学检验专业人才培养目标的需要。

Objective To analyze the changes of Blood Cell Count and D-dimer concentration in lung cancer patients with thrombosis.Methods ①554 cases of patients with lung cancer were included between January 2012 and November 2013,75 patients with other diseases which lead to high coagulation state were excluded,blood cell count and D-dimer concentration were compared between 64 lung cancer patients were the cases with thrombosis with 415 lung cancer patients were the con-trol group without thrombosis.②Color doppler ultrasonography was taken as the golden standard,receiver operating charac-teristic curves (ROC)were drawn for indexes which had significance in method.Results ①Compared with lung cancer pa-tients without thrombosis,lung cancer patients without thrombosis had decreased red blood cell count (RBC),increased white blood cell count (WBC)and D-dimer.And there were no significant change in platelet (PLT).②The area under curve (AUC)of ROC in RBC,WBC and D-dimer were 0.662,0.637 and 0.896,respectively.By thecut-off values of RBC>4.06× 1012 L,WBC<5.37×109/L and D-dimer<4.02 mg/L,the negative predictive values of RBC,WBC and D-dimer for diagno-sis of lung cancer patient with thrombosis were 93%,93% and 96%,respectively.By the cut-off value of D-dimer>4.02 mg/L,the positive predictive value of D-dimer for diagnosis of lung cancer patient with thrombosis was 6 6%.Conclusion RBC,WBC and D-dimer were related with the progress of thrombosis in lung cancer patients.RBC,WBC and D-dimer have good negative prediction effect on lung cancer patients with thrombosis.D-dimer had positive effect for diagnosis of lung cancer with thrombosis.