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.     

外周血淋巴细胞升高及血清蛋白减低

病历摘要 患者男,79岁.2007年10月13日主因"咯血3 d"入院.患者10月10日受凉后咯血,暗红色,有血块,约10 ml,伴乏力、胸部不适,无发热、盗汗、胸痛等症状.诊断为左下叶支气管扩张,肺炎;给予止血、抗炎药物对症治疗后,患者病情好转.但血常规示白细胞增高、淋巴细胞增高、血小板减少、贫血,疑为慢性淋巴细胞白血病,为明确诊断行骨髓细胞学、骨髓病理学、外周血免疫分型检查.     

应促进和拓展人工智能辅助血细胞形态学检查的临床应用

血细胞形态学检查是血细胞分析的重要复检手段, 也是以细胞病变为病理改变的血液病诊断的基础。人工智能辅助血细胞形态学检查可有效弥补人工显微镜检查方法的不足, 极大提高细胞形态学检验的工作效率, 很大程度上解决人力不足和劳动强度的问题, 明显提高检验结果的重复性, 便于检验结果的审核及复检, 可以实现远程在线血细胞形态学检验和诊断等。但我国目前血细胞形态学检查方法仍是以人工显微镜检查为主要方法, 为促进和拓展人工智能辅助血细胞形态学检查的临床应用, 自动化血细胞形态分析仪研发生产商及临床检验专家应共同致力于推动自动化血细胞形态学分析的标准化, 加强其性能评价及验证, 不断提高其分析性能, 拓展其临床应用范围, 推进我国血细胞形态学数据库的建设。     

筛选细胞剂量效应造成抗-M抗体漏检引起的思考

目的:通过对1例M抗原杂合子筛选细胞造成不规则抗体筛查假阴性病例的思考,指导不规则抗体筛选细胞、交叉配血方法的选择和手术备血流程的注意事项。方法:分别选择筛选细胞A、B用微柱凝胶法对同一样本进行不规则抗体筛查;分别用微柱凝胶法和聚凝胺法对同一组样本进行交叉配血。结果:应用筛选细胞A的不规则抗体筛查结果为阴性,筛选细胞B的不规则抗体筛查为阳性,北京市红十字血液中心抗体鉴定结果为抗-M抗体,说明筛选细胞A检测结果为假阴性。微柱凝胶法交叉配血不合,聚凝胺法交叉配血相合。结论:筛选细胞中存在杂合子会造成不规则抗体筛查假阴性,因此在选择筛选细胞时尽量选择抗原多且纯合子的筛选细胞;在抗体效价较低时聚凝胺法检测结果可能出现假阴性,所以有妊娠史和输血史的患者配血时应尽量选择敏感性较好的微柱凝胶法来检测。     

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.     

多步法抗菌药物诱导性肠球菌耐药的实验研究

目的深入研究肠球菌耐药性的产生机制,指导临床及防疫合理用药. 方法采用多步诱导法,对9株粪肠球菌、1株屎肠球菌和7株粪肠球菌、2株屎肠球菌进行氨苄西林和庆大霉素诱导性耐药试验;对诱导出的菌株用琼脂稀释法测定药物敏感性;用PCR法检测庆大霉素耐药基因,用PCR法扩增青霉素结合蛋白基因(pbp5)后测定DNA序列. 结果 3株粪肠球菌和1株屎肠球菌诱导出稳定的高耐庆大霉素菌株;与原株比较,耐药株的MIC分别增加了2～32倍;4株粪肠球菌诱导出稳定的氨苄西林耐药菌株;与原株比较,诱导耐药株的MIC分别增加了8～64倍;进行了测序分析的3株诱导耐药菌中的2株,其所编码的PBP5氨基酸序列中的第453～560位间有部分氨基酸被替代. 结论多步法抗菌药物诱导性耐药试验的结果表明,在低浓度抗菌药物的长期压力下,可诱导肠球菌产生获得性耐药.     

外源凝血因子活性测定时凝血活酶试剂的选择

使用不同国际敏感度指数 (ISI)的凝血活酶 ,测定同一外源凝血因子活性减低的标本 ,PT结果以时间和活动度报告时 ,不同试剂间有差异。以Quick一期法[1 2 ] 为原理的外源凝血因子活性定量测定时 ,ISI值对测定结果是否有影响 ,以及应该使用何种规格的试剂尚未见详细报道 ,本文对此     

红细胞生成相关长链非编码RNA的研究进展

长链非编码RNA（lncRNA）是一类转录本长度>200nt的非蛋白质编码RNA。lncRNA是一种功能性RNA分子,参与了细胞分裂、分化、生存等重要过程的调控。近年来红细胞生成相关长链非编码RNA的功能也相继被揭示,本文就相关研究进展进行综述。     

外周血嗜酸性粒细胞计数与中老年人冠状动脉钙化的关系

目的 探讨外周血嗜酸性粒细胞计数与中老年人冠状动脉钙化的关系.方法 选取2021年2-5月就诊于本院、年龄>40岁并行CT冠状动脉造影的患者118例为研究对象,评估冠状动脉钙化评分(CACS)与外周血嗜酸粒细胞计数及主要心血管危险因素(包括年龄、吸烟状况、高血压、血脂异常、糖尿病)的关系.结果 女性外周血嗜酸性粒细胞计...     

参加美国病理学家协会能力验证计划的意义和体会

美国病理学家协会（CAP）是世界上最大的专业病理学家组成的联合会。它依据美国临床检验标准化委员会（CLSI）的业务标准和操作指南,以及1988年美国临床实验室改进规范（CLIA’88）对临床实验室各个学科所有方面均制定了详细的检查单,通过严格要求来确保实验室符合质量标准,从而改进实验室的实际工作[1-2]。通过CAP认可有诸多益处,如能强化和完善质量控制和质量保证体系,促进检验结果被国际认可,