尿路感染的实验室诊断进展

尿路感染是临床常见病和多发病,同时也是最常见的医院获得性感染.尿路感染的临床表现多样,症状不典型,白细胞尿和菌尿的检出是其筛检和确诊的重要指标.本文结合尿路感染的发病机制、诊断标准,对尿中白细胞和细菌检验项目和技术的临床意义及应用评价做了简要概述.     

骨髓增生异常综合征继发椭圆形红细胞增多症的诊断分析

正常人血液中可有少数椭圆形红细胞 ,但最多不超过15 %。在多种贫血患者中 ,如地中海贫血、镰状细胞贫血、红细胞酶缺乏引起的贫血等 ,椭圆形红细胞也可以增多 ,但一般不超过 2 5 %。在某些病理情况下椭圆形红细胞超过 2 5 %以上时 ,称为椭圆形红细胞增多症。椭圆形红细胞增多症分为遗传性和继发性两类 ,继发性椭圆形细胞增多症可见于多种疾病 ,国外有骨髓增生异常综合征 (MDS)继发椭圆形红细胞增多症的报道[1 3 ] 。我院也于近年诊断了 3例骨髓增生异常综合征继发椭圆形红细胞增多症病人。病例 1,男 ,2 4岁。因头晕、乏力、活动后心悸气…     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.     

64层CTA结合血清MMP-9、sCD40L评价冠脉临界病变斑块成分及稳定性

目的:通过64层计算机体层摄影冠状动脉血管造影识别冠状动脉临界病变患者的冠脉斑块成分,并检测血清基质金属蛋白酶-9（MMP-9）、可溶性CD40配体（sCD40L）水平,探讨其斑块稳定性及临床意义。方法: 选择经64层计算机体层摄影冠状动脉血管造影证实至少有1支冠脉某一阶段狭窄30%～70%的患者65例,其中稳定型心绞痛36例,不稳定型心绞痛29例,通过斑块CT值及冠脉管腔碘造影剂CT值确定其斑块类型:非钙化斑块,钙化斑块和混合斑块;并用ELISA方法测定患者及37例无心血管疾病对照组血清MMP-9、sCD40L水平,比较其差异性并探讨其相互关系。结果: 冠脉临界病变患者混合斑块最多,其次为非钙化斑块,钙化斑块最少,“混合斑块+非钙化斑块”显著多于钙化斑块数目;患者血清MMP-9、sCD40L水平显著高于无心血管疾病对照组。结论: 冠心病冠脉临界病变斑块多为易损斑块。     

乳腺癌和癌旁组织雌激素受体β亚型构成比分析

目的 探讨乳腺癌和癌旁组织中雌激素受体（ER）β亚型构成比变化.方法 收集87例乳腺癌患者癌和癌旁组织,采用实时荧光定量聚合酶链反应定量测定成对组织中ERβ亚型（ERβ 1、ERβ2和ERβ5）相对表达水平,最终获得各亚型在癌变中的比例.结果 癌组织中ERβ 1、ERβ2和ERβ5的表达水平均较癌旁组织低（P=0.00）.在癌组织和癌旁组织,ERβ5在3种主要亚型中所占阳性比例均最高（54.02％和75.84％）,尤以癌旁组织为甚,而ERβ 1阳性比例均最低（6.77％和9.74％）.ERβ 1和ERβ2在癌旁组织中阳性比例低于癌组织（Z=-2.24,P=0.025和Z=-4.85,P＜0.01）,而ERβ5在癌旁组织中阳性比例明显高于癌组织（Z=-5.32,P＜0.01）.结论 乳腺癌变过程中ERβ各亚型表达水平均明显下调,但下调幅度差异显著,亚型构成比变化明显,提示ERβ各亚型在癌变过程中表达调控的差异性机制将成为乳腺癌发病机制研究新的突破口.     

肾上腺功能实验室检测的临床应用

肾上腺由皮质和髓质组成,可分泌皮质醇、醛固酮和儿茶酚胺等多种激素,具有丰富的血供和神经分布。神经和内分泌两者相互调控,构成一个复杂而精密的网络,即下丘脑-垂体-肾上腺轴(hypothalamic-pituitary-adrenal,HPA)和肾素-血管紧张素-醛     

PDCA循环法在ISO15189医学实验室质量管理体系建立中的应用

在医学实验室质量管理中,可以形成若干个PDCA循环.一个管理评审周期可以构成一个大的PDCA循环,小的PDCA循环可以是一个不符合项的纠正过程,或是一个新的检测方法的应用过程.每一循环都有新的目标和内容,上一级的循环是下一级循环的依据,下一级的循环是上一级循环的落实和具体化. 1 PDCA循环贯穿于医学实验室的质量管理中 PDCA循环又叫戴明环,是美国质量管理专家戴明博士提出的,PDCA即P(Plan)-思考、计划、策划;D(Do)-执行;C(Check)-检查、验证;A(Action)-行动、改进,它是全面质量管理所应遵循的科学程序,是质量计划的制订和组织实现的过程.ISO15189<医学实验室质量和能力的专用要求>,是专门针对医学实验室的管理标准,强调医学实验室的质量和技术,核心是全面的质量管理,宗旨是持续改进.质量是实验室的生命,是实验室的根本,实验室以质量求生存、求信誉、求发展[1].两者联合应用使先进、科学规范化的管理理念在我院检验科实际管理工作中得到具体的落实.     

依托网络技术的医学检验信息递送服务及安全管理

结合医院某科LIS系统探讨网络技术在医学检验信息递送服务体系中的应用。网络的应用在各行各业,可以满足发展中国家及世界各地偏远地区不断增长的获得医疗健康服务的需求。近年来中国的电信行业发展迅速,利用这一行业的优势能否建立面向患者的检验结果主动递送服务体系是值得我们探讨的话题。这些远程医疗的广泛应用要求技术专家和临床医生进一步加强协作,保证在实际环境中实现承诺,能让更多的数以百万计的民众获得医疗服务,为患者带来实实在在的好处。但不论是局域网、广域网、手机短信方式所提供的服务,信息安全性都是不容忽视的问题。     

尿流式有形成分及干化学分析在尿路感染诊断中的应用评价

Objective To evaluate the clinical application of automated urine formed elements analyzer and/or urine dipstick analyzer for examination of urinary formed elements in screening urinary tract infection (UTI). Methods 148 fresh midstream clear-catch urine samples from the UTI patients and 284 fresh midstream clear-catch urine samples from non-UTI subjects were selected. Bacteria culture was performed for bacterial colony counting and identification. Bacteria counts ( BACT), yeast-like fungus and WBC were performed by UF-looOi automated urine formed elements analyzer. Leukocyte esterase test (LEU) and nitrite test (NIT) were performed by URISYS 2400 urine dipstick analyzer. We evaluated data obtained from urine dipstick analyzer, UF-1000i and combination of UF-1000i with urine dipstick analyzer and the results was compared with those obtained from quantitative bacterial culture. Then we evaluated the sensibility, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results Among the 148 patients with UTI, the positive rate of the quantitative bacterial culture was 73.6% (109/148), the positive rate of LEU and NIT detected by dipstick test 26. 4% (39/148).There was significantly statistical difference between bacterial culture and strip test(χ2 = 55.68 ,P < 0. 05 ). The positive rate of urine flow cytometry by UF-1000i with either positive of BACT and WBC was 91.2%(135/148), which was higher than the positive rate of the quantitative bacterial culture. There was significant difference between two methods (χ2 = 14. 70, P < 0. 05 ). The positive rate of anyone positive among BACT, WBC, LEU and NIT was 94. 6% (140/148) when detected with combination of dipstick test and UF-1000i, which was higher than the positive rate of the quantitative bacterial culture. And there was significant difference between two methods (χ2 = 20. 45, P < 0. 05 ). The sensitivity of dipstick test was low (26. 4% ,39/148 ), and specificity was high ( 99. 3%, 282/284 ) . The sensitivity, specificity, positive predictive value, negative predictive value of BACT detected by UF-1000i in diagnosing urinary tract infection were 92. 6% ( 137/148 ), 39. 8% ( 113/284 ). 44. 5% ( 137/308 ) and 91.1% ( 113/124 ), respectively. If the dipstick test was combined with UF-1000i, the sensitivity, negative predictive value, specificity, positive predictive value and accuracy were 98.0% ( 145/148 ), 97.1% ( 100/103 ). 35.2% (100/284) ,44. 1% (145/329) and 56. 7% (245/432), respectively. Conclusions The combination of urine dipstick test and automated urine formed elements analyzer UF-1000i plays an important role in early diagnosis of UTI. And it has significant value in diagnosis of UTI, especially for the patients with negative bacterial cultures of urine sample.