目的 探讨新型冠状病毒感染(COVID-19)患者凝血功能的变化情况,为病情转归预测提供依据.方法 收集2021年1月15日至3月15日收治于通化市中心医院的322例COVID-19确诊患者,通过电子病历回顾性分析临床资料及实验室指标检测结果,根据病情分为普通型组(292例)、重型组(30例),以疫情初期该院收治的其他病原体感染患者(351例)作为对照组,分析各组患者凝血相关参数变化,包括血小板计数(PLT)、活化部分凝血活酶时间(APTT)、D-二聚体(DD)、纤维蛋白(原)降解产物(FDP)、凝血酶原时间(PT)、纤维蛋白原(Fib)、凝血酶时间(TT)、抗凝血酶(AT),采用单因素和多因素Logistic回归分析各项参数在重型组的危险因素,绘制ROC曲线,连续监测重症患者住院期间凝血指标变化规律.结果 与普通型组和对照组相比,重型组DD、FDP显著升高,APTT、PT、TT轻度延长(P＜0.05);与对照组比较,重型组Fib、PLT升高,但低于普通型组(P＜0.05);重型组AT明显降低(P＜0.05).单因素和多因素Logistic回归分析显示,DD、APTT、PT、TT是预测COVID-19病情严重程度的危险因素,出现重型的风险比(OR)及其95％CI分别为1.238(1.091～1.546)、1.655(1.449～1.955)、11.133(1.558～79.527)、3.846(1.068～13.852).绘制重型组 COVID-19 患者 DD、APTT、PT、TT 的 ROC 曲线,DD 的AUCROC 最大,AUCROC及其95％CI为0.814(0.732～0.896).结论 凝血指标DD、PT、TT是COVID-19患者病情进展的提示指标,可作为评估病情严重程度的预测依据.动态监测PT和DD水平对COVID-19疗效监测、预后判断具有重要作用.

Objective:To conduct periodic revalidation of the 15 items and 43 terms autoverification rules of blood analysis after 1 year of application, analyze the application suitability and make the rules improved.Methods:Track the results of 528 010 blood analysis samples of our hospital from August 1, 2019 to January 31, 2020, and analyze the pass rate and interception rate of autoverification; 600 specimens in total were selected randomly for microscope examination, including 300 specimens which touched autoverification rules (1 012 items of autoverification rules) and were intercepted by autoverification and 300 specimens which untouched autoverification rules and were released by autoverification. The abnormal characteristics and unacceptable Delta check of the specimens also need to be concerned at the same time.The false negative rate and false positive rate, true negative rate, true positive rate and pass correct rate of autoverification were verified and compared with the rate of the second phase verification when the autoverification rule was established. The false negative rate, false positive rate, true negative rate and true positive rate of the Delta check rule which 54 716 specimens touched were calculated and compared with the second phase verification rate when the autoverification rule was established.The results of microscopic examination were used as the gold standard for the calculation of the rates, and P<0.05 was considered as a significant difference. The false positive and true positive of 1 012 autoverification rules were analyzed item by item.The false positive and true positive of 108 specimens which touched blast cell autoverification rule were analyzed terms by terms. The mean TAT and median TAT of 528 010 specimens and 193 750 outpatient specimens were calculated respectively, and the report percentages of 528 010 samples that TAT<30, 30-60　and>60 min were calculated respectively. Analyze and evaluate the application suitability of autoverification rules to juge whether they meet the needs of doctors and laboratory. The design process and the rules and application process of autoverification were optimized and improved.Results:The autoverification pass rate was 63.06% (332 971/528 010), the interception rate was 36.94% (195 039/528 010). The false negative rate was 1.00% (1/600), the false positive rate was 12.67% (76/600), the true negative rate was 49% (294/600), the true positive rate was 37.33% (224/600), and the correct rate was 98% (294/300). The pass rate, true negative rate, true positive rate and correct rate of the periodic reverification group were higher than the second phase verification group, the false negative rate and false positive rate were lower than that the second phase verification group. The false negative rate and true positive rate of the Delta check of periodic verification group were lower than that the second phase verification group, the false positive rate and true negative rate were higher than the second phase verification group, there were significant differences in the comparition results. The mean TAT of 528 010 specimens was25 min, and the median TAT was 22 min. The mean TAT of 193 750 outpatient specimens was 23 min, and the median TAT was 20 min. The report percentages of 528 010 samples that TAT<30 min, 30 min-60 min and>60 min were 83.30% (439 819/528 010), 8.00% (42 250/528 010) and 8.70% (45 941/528 010), respectively.Conclusion:The results of periodic revalidation of autoverification after 1 years application show that the 15 items and 43 terms autoverification rules of blood analysis could meet requirements about the accuracy and efficiency of the laboratory, and have a good suitability for application.

<正>孤独症经常指自闭性疾病或幼儿自闭症,是一种在3岁以前发生的复杂的行为异常。孤独症患儿以缺乏社会交往及交流能力、有重复性模式化的行为为基本表现。很多孤独症患儿的症状是逐渐出现的,约30%有"退行性"表现。50%～70%的孤独症儿童通过非语言的IQ测验表现为智力低下。符合孤独症诊断标准的2～3岁儿童中约25%后来开始说话和

患者女，18岁，身高1．45m，体重37kg。因原发闭经就诊。查体：智力正常、手指细长，后发际不低、面部多痣，阴毛、腋毛缺如，外阴幼女型。超声：始基子宫，卵巢未探及。性激素：促卵泡生成激素增高，雌二醇降低、催乳素、孕酮、黄体生成素及睾酮均在正常范围。