《全国医疗服务价格项目规范》与地方标准的对接 ——以B型钠尿肽实验室检查的定价为例

2012年,国家发展改革委、原卫生部、国家中医药管理局联合颁布了《全国医疗服务价格项目规范(2012年版)》,其中对实验室检查项目的定价规定,不得区分试剂或方法,并要充分考虑当地医疗机构主流检验方法和社会承受能力等因素。为了探讨将上海地区现行实验室检查的项目与2012年版《规范》对接的方法,以B型钠尿肽的试验室检测为例,通过对国内外指南、专家共识及其他相关文献的回顾,以及上海地区BNP检测开展情况的分析,确定将化学发光法作为BNP检测的适宜技术及定价标准,同时提出了关于实验室检查项目地方与国家标准对接实践的建议。     

转基因检测标准的方法验证工作研究

转基因检测标准为转基因食品的有效标识、科学监管、推广应用提供重要的技术支撑。方法验证工作是指实验室通过一定的科学方法,验证上述转基因检测标准在实验室现有的人员、设备、场地环境等条件下是否可得到令人满意的结果。方法验证工作直接影响到标准的实施和应用,但现有的转基因检测标准的验证方法,大部分只提供了方法验证的定义,缺乏具体的操作方案。从验证工作的仪器设备、试剂及标准物质、技术验证参数、环境要求等关键要素进行讨论,提出相应的验证工作建议,旨在为农业转基因实验室开展方法验证提供详细的技术指导,并为我国转基因标准体系的应用推广提供参考。     

核酸定量检测方法研究进展

核酸相关的研究和应用广泛存在于各个学科领域,与之相关的核酸定量检测技术越来越受到研究人员的重视。本文对目前实验室广泛采用的和近几年进展迅速的核酸定量方法(包括紫外分光光度法、荧光染料法、实时荧光定量PCR法、数字PCR法等)进行介绍,着重阐述其检测原理和优缺点,为研究人员今后进行相关研究提供参考。     

新型冠状病毒实验室检测方法研究进展

世界范围内流行的SARS-CoV-2已造成大批新型冠状病毒肺炎(COVID-19)患者,严重威胁着全人类生命健康.新型冠状病毒肺炎尚没有特效药,也没有疫苗,实验室确诊新型冠状病毒肺炎,隔离传染源,尽早治愈患者对整个疫情防控起着非常重要的作用.目前实验室检测方法有病毒分离培养、实时荧光定量PCR、环介导等温扩增技术、CRISPR/Cas技术、测序技术、基因芯片和抗原抗体检测.本文就上述几种方法做一综述,为确诊COVID-19提供参考.     

HIV的实验室检测技术进展

对目前实验室常用的艾滋病毒检测技术的前沿研究进展进行了综述,介绍了本实验室一种新的结合胶体金的H IV检测方法。     

EB病毒检测技术研究进展

EB病毒属于人类疱疹病毒Ⅳ型,是一种普遍存在的病原体,可以导致多种疾病。有效的EBV诊断对治疗选择和治疗监测有指导意义。目前实验室用于检测EB病毒的方法主要是血清学方法和核酸检测方法,血清学方法对于EB病毒感染相关疾病的诊断有着重要意义,但是不能监测疾病的发展与转归。核酸检测方法可以直观地反映病毒的存在,灵敏度高。不同的检测方法和标本类型都有着不同的临床意义和适用范围,因此对这些方法进行正确的选择非常重要。这篇综述介绍了目前常见的EB病毒检测方法的进展,详述了各种技术的优缺点,为临床选择适合的检测方法提供参考。     

3种检测艰难梭菌方法的临床应用评估

本研究旨在对3种检测粪便样本中艰难梭菌的方法进行临床应用评估,为艰难梭菌的实验室检测提供参考。采用艰难梭菌毒素A/B(Clostridium difficile toxins A and B,CDAB)酶联免疫荧光检测法、环丝氨酸-头孢西丁-果糖琼脂(cycloserin-cefoxitin-fructose agar,CCFA)常规培养法和显色培养法(chromID~(TM))同步检测粪便样本中的艰难梭菌,并对培养所得菌株进行tcdB基因扩增以验证其产毒性。以艰难梭菌培养联合tcdB基因扩增为参考方法,分别计算上述3种方法的灵敏度、特异度、阳性预测值和阴性预测值等参数,分析其与参考方法的一致性。研究共收集临床粪便样本164份,参考方法检测结果为58份阳性,106份阴性。经统计分析,艰难梭菌毒素A/B法的灵敏度、特异度、阳性预测值和阴性预测值分别为51.7%、95.3%、85.7%和78.3%,CCFA常规培养法分别为72.4%、98.1%、95.5%和86.7%,而艰难梭菌显色培养法分别为94.8%、92.5%、87.3%和97.0%。3种方法中,艰难梭菌显色培养法与参考方法的一致性最高(Kappa=0.856)。采用该方法检测粪便样本中的艰难梭菌操作简便,成本经济,结果判断直观、准确,具有较好的临床应用价值。     

鼠疫耶尔森菌抗原检测试剂用国家参考品的研制

目的研制鼠疫耶尔森菌(Yersinia pestis)抗原检测试剂用国家参考品。方法通过对5株鼠疫耶尔森菌和10株非鼠疫耶尔森菌的菌种检定、培养及灭活、抗原检测,组建鼠疫耶尔森菌抗原检测试剂用国家参考品。对参考品进行样品均匀性以及稳定性评估,组织5家实验室协作标定。结果参考品由5份阳性、10份阴性、1份最低检出量以及1份重复性样品组成,均匀性和稳定性良好。协作标定结果显示:①5份阳性参考品阳性率100%;②10份阴性参考品阴性率100%;③最低检出量参考品的检出量不高于1.0×10~6个菌/mL;④重复性参考品检测反应结果应一致(酶联免疫法、上转发光免疫层析法等CV<5%)。结论建立的鼠疫耶尔森菌抗原检测试剂用国家参考品填补了相关领域的空白,可用于相关试剂的质量控制。     

病毒性出血热实验室检测

病毒性出血热是一组临床症状主要表现为发热和出血的急性传染病,病死率高,主要由四个科的RNA病毒引起,包括布尼亚病毒科、黄病毒科、丝状病毒科和沙粒病毒科病毒。该类疾病发病初期的临床症状相似,因此,建立快速、简易的实验室检测方法对及时进行临床诊断救治、开展流行病学调查并最终控制其传播流行具有重要意义。本综述对病毒性出血热的实验室检测方面进行描述,主要内容包括病原学分类及病毒分离、核酸、抗原和抗体检测的相关技术,并结合新型检测方法提出展望。     

梅毒实验室检测方法的研究进展

梅毒是由梅毒螺旋体引起的一种严重危害人类健康的性传播疾病,选择敏感性高、特异性强的检测方法对于梅毒的确证和临床指导应用均具有很重要的意义。当前,有多种梅毒实验室检测方法,其中直接检测法在近十年的临床诊断中仍被经常使用,血清学检测法仍然是目前梅毒实验室诊断的主要方法,以各类PCR技术为代表的梅毒分子生物学检测方法因其具有高度的特异性和敏感性已被广泛应用于临床检验。对梅毒实验室检测技术中直接法、血清学检测法及PCR检测法三类方法的研究进展进行了综述。     

On the origin of the Hirudinea and the demise of the Oligochaeta

The phylogenetic relationships of the Clitellata were investigated with a data set of published and new complete 18S rRNA gene sequences of 51 species representing 41 families. Sequences were aligned on the basis of a secondary structure model and analysed with maximum parsimony and maximum likelihood. In contrast to the latter method, parsimony did not recover the monophyly of Clitellata. However, a close scrutiny of the data suggested a spurious attraction between some polychaetes and clitellates. As a rule, molecular trees are closely aligned with morphology-based phylogenies. Acanthobdellida and Euhirudinea were reconciled in their traditional Hirudinea clade and were included in the Oligochaeta with the Branchiobdellida via the Lumbriculidae as a possible link between the two assemblages. While the 18S gene yielded a meaningful historical signal for determining relationships within clitellates, the exact position of Hirudinea and Branchiobdellida within oligochaetes remained unresolved. The lack of phylogenetic signal is interpreted as evidence for a rapid radiation of these taxa. The placement of Clitellata within the Polychaeta remained unresolved. The biological reality of polytomies within annelids is suggested and supports the hypothesis of an extremely ancient radiation of polychaetes and emergence of clitellates.     

On the ontogeny of the haptor and the evolution of the Monogenea

Data on the ontogeny of the posterior haptor of monogeneans were obtained from more than 150 publications and summarised. These data were plotted into diagrams showing evolutionary capacity levels based on the theory of a progressive evolution of marginal hooks, anchors and other attachment components of the posterior haptor in the Monogenea (Malmberg, 1986). 5 + 5 unhinged marginal hooks are assumed to be the most primitive monogenean haptoral condition. Thus the diagrams were founded on a 5 + 5 unhinged marginal hook evolutionary capacity level, and the evolutionary capacity levels of anchors and other haptoral attachement components were arranged according to haptoral ontogenetical sequences. In the final plotting diagram data on hosts, type of spermatozoa, oncomiracidial ciliation, sensilla pattern and protonephridial systems were also included. In this way a number of correlations were revealed. Thus, for example, the number of 5 + 5 marginal hooks correlates with the most primitive monogenean type of spermatozoon and with few sensillae, many ciliated cells and a simple protonephridial system in the oncomiracidium. On the basis of the reviewed data it is concluded that the ancient monogeneans with 5 + 5 unhinged marginal hooks were divided into two main lines, one retaining unhinged marginal hooks and the other evolving hinged marginal hooks. Both main lines have recent representatives at different marginal hook evolutionary capacity levels, i.e. monogeneans retaining a haptor with only marginal hooks. For the main line with hinged marginal hooks the name Articulon-choinea n. subclass is proposed. Members with 8 + 8 hinged marginal hooks only are here called Proanchorea n. superord. Monogeneans with unhinged marginal hooks only are here called Ananchorea n. superord. and three new families are erected for its recent members: Anonchohapteridae n. fam., Acolpentronidae n. fam. and Anacanthoridae n. fam. (with 7 + 7, 8 + 8 and 9 + 9 unhinged marginal hooks, respectively). Except for the families of Articulonchoinea (e.g. Acanthocotylidae, Gyrodactylidae, Tetraonchoididae) Bychowsky's (1957) division of the Monogenea into the Oligonchoinea and Polyonchoinea fits the proposed scheme, i.e. monogeneans with unhinged marginal hooks form one old group, the Oligonchoinea, which have 5 + 5 unhinged marginal hooks, and the other group form the Polyonchoinea, which (with the exception of the Hexabothriidae) has a greater number (7 + 7, 8 + 8 or 9 + 9) of unhinged marginal hooks. It is proposed that both these names, Oligonchoinea (sensu mihi) and Polyonchoinea (sensu mihi), will be retained on one side and Articulonchoinea placed on the other side, which reflects the early monogenean evolution. Except for the members of Ananchorea [Polyonchoinea], all members of the Oligonchoinea and Polyonchoinea have anchors, which imply that they are further evolved, i.e. have passed the 5 + 5 marginal hook evolutionary capacity level (Malmberg, 1986). There are two main types of anchors in the Monogenea: haptoral anchors, with anlages appearing in the haptor, and peduncular anchors, with anlages in the peduncle. There are two types of haptoral anchors: peripheral haptoral anchors, ontogenetically the oldest, and central haptoral anchors. Peduncular anchors, in turn, are ontogenetically younger than peripheral haptoral anchors. There may be two pairs of peduncular anchors: medial peduncular anchors, ontogentically the oldest, and lateral peduncular anchors. Only peduncular (not haptoral) anchors have anchor bars. Monogeneans with haptoral anchors are here called Mediohaptanchorea n. superord. and Laterohaptanchorea n. superord. or haptanchoreans. All oligonchoineans and the oldest polyonchoineans are haptanchoreans. Certain members of Calceostomatidae [Polyonchoinea] are the only monogeneans with both (peripheral) haptoral and peduncular anchors (one pair). These monogeneans are here called Mixanchorea n. superord. Polyonchoineans with peduncular anchors and unhinged marginal hooks are here called the Pedunculanchorea n. superord. The most primitive pedunculanchoreans have only one pair of peduncular anchors with an anchor bar, while the most advanced have both medial and lateral peduncular anchors; each pair having an anchor bar. Certain families of the Articulonchoinea, the Anchorea n. superord., also have peduncular anchors (parallel evolution): only one family, the Sundanonchidae n. fam., has both medial and lateral peduncular anchors, each anchor pair with an anchor bar. Evolutionary lines from different monogenean evolutionary capacity levels are discussed and a new system of classification for the Monogenea is proposed.In agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. EditorIn agreeing to publish this article, I recognise that its contents are controversial and contrary to generally accepted views on monogenean systematics and evolution. I have anticipated a reaction to the article by inviting senior workers in the field to comment upon it: their views will be reported in a future issue of this journal. Editor