Table of Content

05 April 2017, Volume 32 Issue 4

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Effective interpretation of clinical laboratory reports to improve the level of clinical diagnosis and treatment

Zhao Jianhong1， Wen Hainan2

2017, 32(4):  277-280.  doi:10.3969/j.issn.1004-583X.2017.04.001

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In recent years， clinical testing gradually has developed into medical laboratories. Clinical workers need to keep up with the trend of the development and to  understand the endless stream of test items in depth and comprehensively. Interpreting the clinical value of common test items accurately and effectively would be undoubtedly important for improving the clinical diagnosis and treatment.  Many clinical test items and factors  will affect the interpretation of the test results. The interpretation of the test reports must understand the limitations of the testing methods and instruments， and fully evaluate the errors and uncertainties of the test methods. The reports  should be analyzed from the processes of preexamination， examination and postexamination. Also different methods might exert effect  in reference interval， medical decision and clinical significance. Interpretation of test results can not be separated from clinical circumstances， and final interpretation must be combined with clinical judgment.

Reinspection on fungal serum diagnosis in practice

Yu Jin

2017, 32(4):  281-283.  doi:10.3969/j.issn.1004-583X.2017.04.002

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Fungal serum diagnostic examinations for invasive fungal infections have been used for years and are continuously improving.In view of the knowledge increasing， herein to review， analyze and evaluate the most two valuable tests of galactomannan for aspergillosis and capsular polysaccharides antigen for cryptococcosis.

Determination of procalcitonin and clinical value

Shi Dongyan， Zhao Jianhong

2017, 32(4):  284-286,290.  doi:10.3969/j.issn.1004-583X.2017.04.003

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Procalcitonin（PCT）  is useful in the rapid detection and monitoring of bacterial infection. Serial evaluations of this protein seem to be more accurate in the diagnostic phase. PCT can provide information not only about the course of bacterial infection but also useful to predict outcome and response to antibacterial treatment. On the other hand， some issues have yet to be solved and PCT is preferably in combination with other clinical or laboratory tests， and this might be of help in finding early bacterial infections.

Status in clinical application of brain natriuretic peptide

Feng Zhongjun1， Zhang Shulan2

2017, 32(4):  287-290.  doi:10.3969/j.issn.1004-583X.2017.04.004

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Brain natriuretic peptide(BNP) is a biological marker for diagnosis of heart failure(HF)， it further shows a wide range of potential applications in prognosis and treatment in other diseases. Due to differences in various countries， a  large prospective clinical research work should be done to further elucidate. BNP  will play a more important role in the diagnosis and treatment of diseases， especially in HF.

Rapidly advance standardization process of glycosylated hemoglobin tests， promote diabetes clinical diagnosis and consistency

Gao Shejun， Li Hong

2017, 32(4):  291-296.  doi:10.3969/j.issn.1004-583X.2017.04.005

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Glycohemoglobin(HbA1c) is important for assessing longterm glycemic levels and diabetic complications of blood vessels in diabetic patients. However，there are significantly differences in bias because of various test methods and technological capabilities in different laboratories. In 2010， HbA1c was included in new guidelines from ADA for diagnosing diabetes， and recommended by WHO in 2011. All those promoted the standardization process of HbA1c tests. Significant achievements of HbA1c standardization have been made in some parts of the world，but there is some gap in our country and other countries， further effort is needed in the standardization of HbA1c measurement.

Measurement of calcaneus bone mineral density and relationship analysis in Uygur residents in Tianshan community of Urumqi

Qi Wenxue1， Sun Yan2， Zhang Hong3， Jiang Yujie1， Jiang Sheng1

2017, 32(4):  297-300.  doi:10.3969/j.issn.1004-583X.2017.04.006

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ObjectiveTo explore the bone mineral density and the relevant factors in Uighur residents  in Urumqi Tianshan district and to provide basic information and basis for osteoporosis prevention and intervention in this community.MethodsCalcaneal bone mineral density was measured for 773 uighurs in Urumqi Tianshan. The osteoporosis incidence of different genders was compared， meanwhile， visceral fat area， body fat percentage， waist hip ratio， body fat mass， muscle weight， calculating rate of muscle， questionnaire investigation， fasting blood glucose， blood sugar 2 hours after meal， triglycerides (TG)， highdensity lipoprotein cholesterol (HDL-C)， low density lipoprotein cholesterol(LDL-C)， total cholesterol(TC)，body mass index (BMI) and waist hip ratio were detected. ResultsThe incidence of osteoporosis increased significantly with the age  in male and female(P<0.01)，osteoporosis incidence was higher in female than in male， at the age 50 and 70 years， the osteoporosis incidence increased obviously .Regression analysis showed that the increased age and visceral fat area in male may be risk factors for bone abnormality and the increased BMI in male may be protection factor for bone abnormality; the increased age， menopause and waisttohip ratio in female may be risk factors for bone abnormality， increased BMI and rate of muscle may be protection factors. ConclusionIn Tianshan of Urumqi area， in male， low fat diet， proper exercise and lowing visceral fat area should be performed in order to prevent the occurrence and development of bone abnormalities. Female should try to avoid artificial menopause and abdominal obesity， enhance movement，increase muscle mass， reduce abdominal fat to prevent the occurrence and development of abnormal bone， so as to prevent the occurrence of osteoporosis and osteoporotic fracture.

Comparison of two methods of nutritional assessment in elderly patients with diabetic nephropathy

Kong Jianhua， Zhang Jie， Cui Yunjing， Hua Yingying

2017, 32(4):  301-304.  doi:10.3969/j.issn.1004-583X.2017.04.007

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ObjectiveNutrition Risk Screening 2002 (NRS2002) and MiniNutritional Assessment (MNA) were applied in nutritional assessment for elderly diabetic nephropathy(DN) of hospitalized patients， and appropriate nutritional assessment methods， as well as the implementation of nutrition interventions for the population were explored. MethodsA total of 210 elderly hospitalized DN patients were evaluated with NRS2002 and MNA for nutritional screening. Simultaneously assessment was made in the prevalence of malnutrition by measuring body mass index(BMI)，arm muscle circumference(AMC)， calf circumference (CC) and total protein (TP)， albumin(ALB)，prealbumin (PA). Kappa value of the two nutritional measurements，i.e. NRS2002 and MNA were compared to analyze the accuracy of the two methods，and correlation analysis was conducted for the two methods and traditional indicators. ResultsFor 210 cases of elderly patients with DN， two evaluation methods gave different nutrient malnutrition incidence results (17.1%40.5%)， NRS2002 was 37.1%， MNA 40.5%， anthropometric indexes evaluation was 17.1%， laboratory parameters evaluated method was 20.5%. MNA and NRS2002 scores were TP， ALB， PA， BMI， AMC and CC relevant. NRS2002 nutrition risk screening and MNA consistency test showed significant difference(Kappa=0.612，P<0.01). ConclusionCompared with the traditional nutritional evaluations， MNA and NRS2002 as comprehensive nutritional assessment methods， are more comprehensive and accurate.

Changes and significance of immunoglobulin light chain in diabetic nephropathy

Cui Xue， Yang Lin， Li Juan， Ma Lixia

2017, 32(4):  305-309.  doi:10.3969/j.issn.1004-583X.2017.04.008

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ObjectiveTo investigate the relationships among serum free light chains (FLCs) and clinical indicators and renal pathological changes of  diabetic nephropathy (DN). MethodsForty DN patients and 40 nonDN patients were enrolled. The participants were divided into experiment and control group，but chronic inflammatory disease was exclued. Serum creatinine， urinary protein， hsCRP and Hcy were observed. The λFLC  and  κFLC were detected by indirect immunofluorescence. Furthermore， we observed the renal pathological changes by light microscope. The λFLC  and κFLC were determined through ELISA. Univariate analysis was used to examine the relationships between FLCs and clinical indicators and renal pathological changes of DN. ResultsThe experiment group had higher hsCPR and Hcy level than the control group (P<0.05). The levels of cFLC (The sum of λFLC  and κFLC)  in the experiment group were higher compared with the control group (P<0.05). The Hcy and hsCRP were positively correlated with combined free light chain(cFLC) (P<0.05). The scores of tubulointerstitial lesions showed positive correlations (P<0.05) with cFLC， but negatively correlated with eGFR (P<0.05). ConclusionThe level of cFLC could be a predictor of the risk of mortality (especially cardiovascular disease caused) of DN patients and the progression of  DN.

Incidence and risk factors of  type 1 cardiorenal syndrome in patients with acute coronary syndrome

Wang Yanbo，Gu Xinshun，Hao Guozhen，Jiang Yunfa，Fan Weize，Fu Xianghua

2017, 32(4):  310-313.  doi:10.3969/j.issn.1004-583X.2017.04.009

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ObjectiveTo analyze the incidence and risk factors of  type 1  cardiorenal  syndrome (CRS) in patients with acute coronary syndrome (ACS).MethodsConsecutive patients with ACS who were admitted to our department were enrolled in this study from January 2015 to April 2015. All the eligible cases were divided to CRS group and control group according to the incidence of type 1 CRS. The baseline clinical characteristics and the procedure of coronary interventions were recorded and compared. The incidence of major adverse events (MACE) were followed up. Logistic regression analysis was used for the predictor of type 1 CRS in ACS patients.ResultsA total of 109 patients with ACS were enrolled，the average age was 59.3±9.0 years old， and 84 cases were male. The incidence of type 1 CRS was 10.1%. STEMI patients were more common (72.7% vs 23.5%，P=0.002)， GRACE and CRUSADE scores were higher in  CRS group compared with those of control group (both P<0.01). The incidence of sudden death before admission was higher (36.4% vs 2.0%，P<0.01)  and HCT was lower (P=0.049)  in CRS group compared to the control group. The peak levels of CK and cTnI were higher in CRS group than those in the control group， while LVEF and E/e’ were lower. No significance of interventional characteristics were found except ratio of multivessel diseases. During the hospitalization， the incidences of MACE (45.5% vs 16.3%，P=0.020) and heart failure were higher in CRS group than those in the control group (18.2% vs 0%，P=0.009). Logistic regression analysis showed that the baseline level of serum creatinin(SCr) and peak value of cTnI were independent risks of type 1 CRS in patients with ACS during the hospitalization (both P<0.05).ConclusionACS combined with type 1 CRS patients in poor prognosis， high cTnI peak and increased SCr level at admission were risks for type 1 ACS in patients with CRS.

Lipid characteristics in different glucose levels of patients with type 2 diabetes mellitus

Li Xiaoqun1， Luo Fang2， Luo Yi2， Tao Junquan3

2017, 32(4):  314-316,322.  doi:10.3969/j.issn.1004-583X.2017.04.010

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ObjectiveTo analyze the lipid at different levels of glycemic control in order to guide lipidlowering therapy and to investigate the correlation between the overall level of glycemic control and the various lipid in patients with type 2 diabetes mellitus(T2DM). MethodsAll 194 patients with  T2DM  were divided into two groups by HbA1c， including the satisfactory glucose patients for group A and the nonsatisfactory glucose patients for group B， then cholesterol (TC)，triglyceride (TG)， highdensity lipoproteincholesterol (HDLC) and lowdensity lipoprotein (LDLC)， apolipoprotein A1 (ApoA1) and lipoprotein B (ApoB) were measured in all patients. The lipid and apolipoprotein between two groups were assessed and compared， also the association between HbA1c and various lipid was assessed.ResultsThe levels of lipid（TG， TC， LDLC and ApoB） in group B were significantly higher than those of group A（P<0.05）， while the levels of lipid (HDLC and ApoA1) in group B were significantly lower than those of group A（P<0.05）， the correlation analysis indicated positive correlation between overall HbA1c and TC， LDLC， ApoB， TC and LDLC， ApoA1 and HDLC， ApoB and TG，TC，LDLC. ConclusionThe patients with T2DM at different glycemic control levels should have standardized hypoglycemic and lipidlowering therapy according to the actual situation to prevent longterm complications.

Status and influencing factors of selfmonitoring blood glucose in patients with type 2 diabetes mellitus

Guo Tingting， Zhang Jianshuang， Li Yupeng， Li Jin， Xie Yun

2017, 32(4):  317-322.  doi:10.3969/j.issn.1004-583X.2017.04.011

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ObjectiveTo investigate the status and related factors of selfmonitoring blood glucose(SMBG) in patients with type 2 diabetes mellitus (T2DM)， and to explore the relationship between SMBG frequency and glycemic control. MethodsA total of 289 T2DM patients who hospitalized in Tianjin Metabolic Disease Hospital were enrolled in the study. A questionnaire survey was conducted on SMBG frequency， gender， age， duration， education， diabetes comprehensive management， blood glucose level， and related complications. ResultsAmong 289 eligible patients， the average SMBG frequency was 10.03 times per month， with 55.1% patients monitored no less than 4 times per month. Logistic regression analysis showed that dietary control， exercise therapy and HbA1c level were the main factors affecting regular SMBG (P<0.05). In addition， age， FBG， P2BG， whether received diabetes education， whether insulin treatment and whether presented hypoglycemia were independent effect for SMBG frequency(P<0.05)， there was no clear association between SMBG and diabetic complications（P＞0.05）. SMBG  frequency was negatively correlated with FBG， P2BG and HbA1c levels（r=-0.276，-0.360，-0.361，respectively；P＜0.05）；Oral hypoglycemic agents treated patients and insulin treated patients， when the SMBG frequency was at least 7.5 times per month (2 times / week)， 10.5 times per month (3 times / week)， respectively，the glycemic control can basically reach  the standard. ConclusionThe level of knowledge and monitoring quality of SMBG in  T2DM  patients were relatively low. In order to improve this situation， endocrinologists and nurses can develop individualized SMBG programs for patients， and strengthen the education on diabetesrelated diet， exercise therapy and blood glucose monitoring knowledge. SMBG can improve glycemic control， while glucose levels can also affect SMBG. The relationship between SMBG and diabetic complications still needs further proof.

Ultrasound imaging analysis of diffuse malignant peritoneal mesothelioma

Sun Xinyia，Zheng Guoqia，Liu Chendia，Zhang Guozuna，Yang Deruib，Li Aihuab

2017, 32(4):  323-326.  doi:10.3969/j.issn.1004-583X.2017.04.012

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ObjectiveTo retrospectively analyze the ultrasonographic performance of 112 cases of diffuse malignant peritoneal mesothelioma， and the characteristics of ultrasound imaging. MethodsUltrasound imaging and clinical data of 112 cases of diffuse malignant peritoneal mesothelioma confirmed by pathology in our hospital were analyzed. ResultsIn 112 patients，including 45 males and 67 females， the proportion of male and female was 1∶1.5. The age of onset was 42-83 years old，mean age  （57.0±6.8)  years old. A total of 105 cases(93.8%) had asbestos exposure history. The success rate of puncture biopsy was 94.6%. Ultrasonic manifestations of diffuse malignant peritoneal mesothelioma showed diffuse thickening of the omentum in 112 cases(100%)， thickening of parietal peritoneum in 96 cases(85.7%)  and thickening of mesentery in 61 cases(54.5%)， and the thickness of uneven， irregular border. Blood flow spectrum of thickening omentum showed the resistance index increased. Abdominal lymph adenopathy was seen in 29  cases(25.9%)， bowel involvement in 57  cases(51.0%). Peritoneal biopsy puncture feeling was hard. The strips were full， bright appearance， transparent or gelatinous. There was medium to large ascites in abdominal cavity. ConclusionUltrasound examination and puncture biopsy guided by ultrasound for peritoneal thickening area  make the disease get a clear pathological diagnosis.

Effect of longterm antibiotics combined with inhalation therapy in treatment of benign tracheal stenosis after bronchoscopic interventional therapy

Xu Mingpeng1，Li Lihua1，Li Yu1，Liang Yilin2，Gan Luoman3，Liu Guangnan1

2017, 32(4):  327-330,335.  doi:10.3969/j.issn.1004-583X.2017.04.013

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ObjectiveTo evaluate the efficacy of longterm antibiotics combined with inhalation therapy in the treatment of patients with benign tracheal stenosis after bronchoscopic interventional therapy. MethodsRetrospective analysis was performed in the clinical data of 67 cases of benign tracheal stenosis treated with longterm antibiotics （more than 1 month）combined with inhalation of budesonide and amikacin for six months after bronchoscopic interventional therapy. The tracheal diameter and dyspnea index were evaluated before and after bronchoscopic interventional therapy. And initial cure rate and cure rate after six months and complications were evaluated. ResultsAfter bronchoscopic interventional therapy， the tracheal diameter significantly increased from (3.82±0.91) mm to （12.16±1.57) mm(P<0.05)， and the dyspnea index significantly decreased from (3.45±0.63) to (0.52±0.50)(P<0.05). After bronchoscopic interventional therapy， the initial cure rate was 100%. After intravenous antibiotic therapy for one month， combined with inhalation of amikacin and budesonide suspension for six months， the unblocked rate of tracheal was 94.02%. No complications such as double infection happened. ConclusionAfter the bronchoscopic interventional therapy， longterm intravenous antibiotic therapy combined with  inhalation therapy in benign tracheal stenosis can improve longterm  efficacy.

Creutzfeldt-Jacob disease--two cases and literature review

Qiao Qi， Wang Huijuan， Zhang Limiao， Yue Zan， Wang Binglei， Bian Xin

2017, 32(4):  331-335.  doi:10.3969/j.issn.1004-583X.2017.04.014

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ObjectiveTo explore the pathogenesis，etiological subtype，clinical manifestation，cerebrospinal fluid (CSF) characters，magnetic resonance imaging(MRI) findings，electroencephalogram （EEG)  changes and diagnosis criteria of CreutzfeldtJacob disease(CJD).MethodsAnalysis was made in the clinical data of two CJD patients from the hospital. ResultsCJD showed the clinical manifestation predominantly of progressive dementia，ataxia and myoclonus. Occurrence of periodic sharp wave complexes(PSWCs) in EEG， hyper intense signal changes in cortical regions (cortical ribboning)  in MRI， and protein 1433 in CFS substantiate all supported the diagnosis. ConclusionCJD has typical characters of EEG，MRI and CFS. Specially， diffusion weighted imaging may be a noninvasive screening tool with higher sensitivity and specificity.

Effect of yoga practice on blood glucose of type 2 diabetes mellitus: a metaanalysis

Liu Yongjin， Du Bo， Shao Jiangjian， Chen Chaoyun， Huang Suping

2017, 32(4):  339-343.  doi:10.3969/j.issn.1004-583X.2017.04.016

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ObjectiveTo investigate the effect of yoga practice on blood glucose of type 2 diabetes mellitus(T2DM). MethodsDatabases were electronically searched to collect randomized controlled trials (RCT) about yoga practice on blood glucose of  T2DM  published before November 2016. Two reviewers independently screened literatures， extracted data and assessed the risk of bias of included studies， and the metaanalysis was performed by using RevMan 5.3 software. ResultsA total of 9 RCTs involving 916 patients were included. The results of metaanalysis demonstrated that  yoga practice had positive effect on the levels of FBG， 2hPG， HbA1c  compared with the control group.ConclusionYoga practice is effective in lowing the level of blood glucose， and yoga practice is a form of recommendable exercise for prevention and treatment in population with high risk for T2DM and patients with T2DM.