基于上转化发光免疫层析技术建立发热伴血小板减少综合征病毒总抗体快速检测方法

目的基于上转化发光(UPT)免疫层析技术,建立发热伴血小板减少综合征病毒(SFTSV)总抗体的现场快速检测方法。方法将SFTSV重组NP蛋白与上转化发光颗粒(UCP)偶联,制备UCP-NP免疫层析试纸条,评价该试纸条检测SFTSV总抗体的灵敏性、特异性和稳定性,并检测SFTSV血清254份,与酶联免疫法(ELISA)比较。结果该方法可在15min内完成SFTSV总抗体检测,可检测1∶500稀释度的SFTSV阳性血清,与其他出血热病毒无交叉反应,加样14d内稳定性较高。UPT免疫层析法与ELISA法检测临床血清样品一致性极高(Kappa=0.967),约登指数为0.973。结论建立了基于UPT免疫层析技术的SFTSV总抗体快速检测方法,该方法灵敏、特异,且操作简便、快速,结果稳定,适合在基层门诊和体检现场推广。     

HPV E6/E7 mRNA检测用于ASCUS患者诊断分流的临床研究

目的:探讨人乳头瘤病毒(HPV)E6/E7mRNA检测用于未明确诊断意义的不典型鳞状上皮细胞(ASCUS)诊断结果的判定价值。方法:对160例薄层液基细胞学检查诊断为ASCUS者进行HPV E6/E7mRNA和高危型HPV(HR-HPV)DNA检测,结合病理学诊断资料进行统计学分析。结果:160例中病理结果为宫颈上皮内瘤变Ⅱ级(CINⅡ)及以上级别者的HPV E6/E7mRNA阳性率明显高于CINⅡ以下级别者,差异有统计学意义(P0.05),但与HR-HPV DNA检测结果无统计学差异。HPV E6/E7 mRNA检测CINII及以上级别的灵敏度(69.2%)与HR-HPV DNA检测相比无统计学差异(P0.05);特异度(73.9%)高于HR-HPV DNA检测(61.9%),差异有统计学意义(P0.05)。结论:HPV E6/E7 mRNA检测可作为ASCUS者是否需要进行阴道镜检查的一项指标依据。     

The Assessment of a Rapid Noninvasive Immunochromatographic Assay Test for Fecal Lactoferrin in Patients with Suspected Inflammation of the Ileal Pouch

Purpose

Pouchitis is a common complication after ileal pouch-anal anastomosis. Diagnosis is based on the Pouch Disease Activity Index, which comprises clinical symptoms, endoscopic appearance, and histologic confirmation. A Pouch Disease Activity Index ≥ 7 confirms pouchitis. Fecal lactoferrin is a marker of intestinal inflammation, which can aid in the diagnosis of pouchitis. The IBD EZ VUE? test is a simple, rapid, noninvasive test for fecal lactoferrin. Our goal was to study the sensitivity and specificity of this test in the diagnosis of pouchitis.

Methods

Consecutive patients with pouch dysfunction were recruited from October 2005 to July 2006. A fecal sample was collected before calculation of the Pouch Disease Activity Index. An IBD EZ VUE? test was performed on each fecal sample and the results correlated with the diagnosis of pouchitis to calculate sensitivity and specificity of the IBD EZ VUE? test.

Results

There were 32 patients (21 healthy and 11 inflammed pouches). The IBD EZ VUE? test was positive in 14 patients. It had a sensitivity of 100 percent and a specificity of 86 percent in diagnosing pouchitis. The positive predictive value was 76 percent. There were three false-positive results.

Conclusions

The IBD EZ VUE? test is a sensitive method that may remove the need for invasive pouch investigations and lead to greater confidence when antibiotic therapy is commenced. Further investigations may be reserved for those patients who have a positive lactoferrin test and fail to respond to antibiotic treatment.     

四种实验室检测技术对利福平和异烟肼耐药性检测的临床价值

目的 探讨微孔板法、实时荧光PCR熔解曲线技术(简称“熔解曲线法”)、多色巢式实时荧光定量PCR技术(简称“Xpert 法”)和罗氏药物敏感性试验(L-J药敏试验,简称“比例法”)用于快速筛查耐多药结核病(MDR-TB)的临床价值。方法 从医院信息系统(hospital information system,HIS)连续收集2014年7月至2018年3月重庆市公共卫生医疗救治中心收治的确诊为结核病,且具有微孔板法、比例法、熔解曲线法、Xpert 法检测MTB对利福平、异烟肼耐药性诊断结果的2792例患者资料;其中微孔板法、比例法采用阳性分离菌株检测,熔解曲线法和Xpert 法采用患者标本直接检测。纳入同时具有微孔板法和比例法耐药性检测结果的1488例患者作为研究对象,其中341例行微孔板法+比例法+Xpert法检测利福平耐药性,87例行微孔板法+比例法+熔解曲线法检测利福平耐药性,66例行微孔板法+比例法+熔解曲线法检测异烟肼耐药性。以比例法为标准,采用SPSS 13.0软件分别计算微孔板法、熔解曲线法、Xpert法检测利福平和(或)异烟肼耐药性的敏感度、特异度、符合率、Kappa值等。结果 以比例法为标准,微孔板法、Xpert法、熔解曲线法检测利福平耐药性的敏感度、特异度、阳性预测值、阴性预测值、符合率、Kappa值分别为97.2%(731/752)、96.9%(713/736)、96.9%(731/754)、97.1%(713/734)、97.0%(1444/1488)、0.94,97.2%(140/144)、94.9%(187/197)、93.3%(140/150)、97.9%(187/191)、95.9%(327/341)、0.92,97.1%(33/34)、84.9%(45/53)、80.5%(33/41)、97.8%(45/46)、89.7%(78/87)、0.79;微孔板法和熔解曲线法检测异烟肼耐药性的敏感度、特异度、阳性预测值、阴性预测值、符合率、Kappa值分别为94.8%(751/792)、95.7%(667/697)、96.3%(751/780)、94.2%(667/708)、97.9%(1418/1448)、0.91, 97.3%(36/37)、86.2%(25/29)、90.0%(36/40)、96.2%(25/26)、92.4%(61/66)、0.84。结论 微孔板法、熔解曲线法、Xpert 法检测利福平和(或)异烟肼耐药性均具有较高的敏感度和特异度,适合快速筛查耐多药结核病;微孔板法还能获得各药物最低药物浓度,为临床用药剂量的选择提供参考依据。     

Alcohol Acceptance, Preference, and Sensitivity in Mice. II. Quantitative Trait Loci Mapping Analysis Using BXD Recombinant Inbred Strains

Quantitative trait loci (QTL) mapping of complex phenotypes has emerged as an important feature of the recombinant inbred (Rl) strain methodology. In this second study of our series on alcohol-related behaviors in mice, we examine alcohol acceptance, preference, and hypnotic dose sensitivity (HDS) to a standard dose of alcohol measured in BXD RI strains to identify candidate QTL regions responsible for their heritability. We detected highly significant marker associations for acceptance on chromosome 12 (Eif4e) , for preference on chromosome 1 (D1Rti2) and chromosome 7 (D7Mit7) , and for HDS on chromosome 7 (Mpmv1). These are the strongest QTL associations that we detected, but several other candidate QTL regions are reported. Given the limited number of BXD RI strains available, the large number of markers used herein, and the consequent chance of identifying false marker associations, these RI QTL mapping results must be seen as tentative, but an important first step toward identifying QTL for alcohol-related behaviors.     

Development of a Questionnaire Method to Discriminate Between Typical and Atypical Genotypes of Low Km Aldehyde Dehydrogenase in a Japanese Population

Nearly half of all Orientals exhibit aversive symptoms, such as "Oriental flushing" or palpitation, during alcohol consumption. This high alcohol sensitivity among Orientals has been attributed to a highly prevalent polymorphism in low K_m aldehyde dehydrogenase (ALDH2). In the present study, we attempted to develop a reliable questionnaire method to probe the frequency of alcohol drinking-related symptoms to estimate the ALDH2 genotype. Four-hundred twenty-four male and 100 female workers provided blood samples for polymerase chain reaction analysis and completed the questionnaire. We performed a stepwise logistic regression analysis to discriminate between the typical homozygote ( ALDH2*1/*1 ) and the atypical heterozygote ( ALDH2*1/*2 ) in male subjects. Because of the limitation in the sample size for ALDH2*2/*2 , this genotype was not included in the analysis. Results revealed that only three symptoms (facial flushing, flushing elsewhere, and palpitation) were enough to correctly predict the ALDH2 genotypes in ∼89% of all subjects. The present questionnaire method ( AL cohol Sensitivity screening Test; ALST) takes a little time and effort for the genotype determination, and may be especially useful in epidemiological studies with a large sample size or with subjects from whom DNA samples are not available.     

Revised Japanese criteria for Sjögren's syndrome (1999): availability and validity

The Japanese criteria for diagnosing Sjögren's syndrome (SS) were revised in 1999, and consist of four major areas: histopathology, oral examination, ocular examination, and serological examination. A diagnosis of SS can be made when the patient meets at least two of these four criteria. This report describes how the revised Japanese criteria were established. After the publication of the revised Japanese criteria (1999), a research study which focused on evaluating its availability and validity was carried out in 2001 using funds from Grant-in-Aids for Scientific Research supported by the Japan Society for the Promotion of Science. The availability of the revised criteria was investigated by a questionnaire study through the Japanese Medical Society for Sjögren's Syndrome, and the use of the revised criteria for diagnosing SS in these medical facilities was found to be 76%. To evaluate the validity of the revised criteria, the records of 900 patients, including SS patients and non-SS controls, from 54 clinical centers were registered and analyzed to calculate the accuracy of the criteria. The revised Japanese criteria were found to have 96.0% sensitivity, 90.5% specificity, and 94.5% accuracy for diagnosing SS.     

Diagnostic accuracy of rapid nucleic acid tests for group A streptococcal pharyngitis: systematic review and meta-analysis

BackgroundAcute pharyngitis is one of the most common conditions in outpatient settings and an important source of inappropriate antibiotic prescribing. Rapid antigen detection tests (RADTs) offer diagnosis of group A streptococcus at the point of care but have limited sensitivity. Rapid nucleic acid tests (RNATs) are now available; a systematic review of their accuracy is lacking.ObjectivesTo evaluate the accuracy of RNATs in patients with pharyngitis; to explore test-level and study-level factors that could explain variability in accuracy; and to compare the accuracy of RNATs with that of RADTs.Data sourcesMEDLINE, Embase, Web of Science (1990–2020).Study eligibility criteriaCross-sectional studies and randomized trials.ParticipantsPatients with pharyngitis.Index test/s and reference standardsRNAT commercial kits compared with throat culture.MethodsWe assessed risk of bias and applicability using QUADAS-2. We performed meta-analysis of sensitivity and specificity using the bivariate random-effects model. Variability was explored by subgroup analyses and meta-regression.ResultsWe included 38 studies (46 test evaluations; 17 411 test results). RNATs were most often performed in a laboratory. The overall methodological quality of primary studies was uncertain because of incomplete reporting. RNATs had a summary sensitivity of 97.5% (95% CI 96.2%–98.3%) and a summary specificity of 95.1% (95% CI 93.6%–96.3%). There was low variability in estimates across studies. Variability in sensitivity and specificity was partially explained by test type (p < 0.05 for both). Sensitivity analyses limited to studies with low risk of bias showed robust accuracy estimates. RNATs were more sensitive than RADTs (13 studies; 96.8% versus 82.3%, p 0.004); there was no difference in specificity (p 0.92).ConclusionsThe high diagnostic accuracy of RNATs may allow their use as stand-alone tests to diagnose group A streptococcus pharyngitis. Based on direct comparisons, RNATs have greater sensitivity than RADTs and equal specificity. Further studies should evaluate RNATs in point-of-care settings.     

18F-FDG PET/CT对宫颈癌术后临床怀疑复发和转移病人中的应用价值

目的观察¹⁸F-氟代脱氧葡萄糖(¹⁸F-FDG)正电子发射断层显像技术/计算机体层扫描(PET/CT)对宫颈癌术后临床怀疑复发与转移患者的诊断价值。方法前瞻性纳入喀什地区第一人民医院2018年7月至2020年11月期间收治的118例宫颈癌术后怀疑复发与转移患者为研究对象,采用随机数字表法其分为观察组(n=59)与对照组(n=59)。对照组予给予以常规血清癌抗原19-9(CA19-9)检测,观察组行¹⁸F-FDG PET/CT检查。2组均以组织病理学结果为金标准,评估2组对宫颈癌怀疑复发与转移的诊断价值并对比组间差异。结果¹⁸F-FDG PET/CT检查诊断对宫颈癌复发及转移的特异度(76.92%)、灵敏度(93.48%)以及准确率(89.83%)均显著高于CA19-9检测(38.46%、60.87%、55.93%),2组比较差异有统计学意义(P<0.05),同时观察组诊断结果与组织病理学结果吻合度较高(Kappa=0.766,P<0.05)。结论¹⁸F-FDG PET/CT检查应用于宫颈癌术后临床怀疑复发与转移的诊断,可清晰显示其状况,灵敏度、准确率等均明显高于血清CA19-9检测。     

影响局部进展期直肠癌新辅助放化疗疗效的临床因素分析

目的探讨影响局部进展期直肠癌(locally advanced rectal cancer,LARC)患者新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)的疗效及预后的临床因素。方法回顾性分析辽宁省肿瘤医院335例接受nCRT后并进行根治性手术的LARC患者的临床资料。通过单因素及多因素分析,找出可能影响LARC患者nCRT的疗效及预后的临床因素。结果多因素Logistic回归分析表明,影响LARC患者nCRT疗效的独立临床因素有nCRT前肿瘤侵犯肠管周径(OR=2.350,95%CI:1.438~3.842,P=0.01)、cT分期(OR=2.101,95%CI:1.024~4.314,P=0.043)及cN分期(OR=5.836,95%CI:3.305~10.306,P<0.01)。竞争风险模型分析表明,影响LARC患者预后的独立因素有肿瘤退缩分级(tumor regression grading,TRG)的评级(HR=3.236,95%CI:1.714~6.110,P<0.01)、cT分期(HR=1.852,95%CI:1.061~3.230,P=0.030)、cN分期(HR=2.008,95%CI:1.083~0.372,P=0.027)、nCRT前癌胚抗原(carcinoembryonic antigen,CEA)水平(HR=7.038,95%CI:3.894~12.720,P<0.01)及血清糖类抗原199(Carbohydrate antigen 199,CA199)水平(HR=3.849,95%CI:2.016~7.350,P<0.01)。结论nCRT前肿瘤侵犯肠管周径、cT分期及cN分期是影响LARC患者nCRT疗效的独立临床因素,nCRT之前肿瘤侵犯肠管周径越大,cT分期及cN分期越高,LARC患者的nCRT疗效越差。TRG分级、cT分期、cN分期、nCRT前CEA和CA199水平是影响LARC患者预后的独立因素,接受nCRT的LARC患者TRG分级越高,cT分期及cN分期越高,nCRT前CEA及CA199水平越高,其预后可能越差。