2017年 · 第97卷第18期

In 2016, the Chinese Medical Journal published a number of expert consensus and review articles on the testing and diagnosis reporting model^{[1,2,3,4,5,6,7,8,9,10]}That has aroused widespread attention in the industry. After a period of intense discussion, especially the development status of laboratory medicine, the vague understanding in the past gradually became clear, that is, how to strengthen effective communication with clinical practice and improve the knowledge service ability of laboratory medicine is the problem that must be solved in the development of laboratory industry. Through the establishment of the inspection and diagnosis report system, it is the key to improve the knowledge service connotation of the inspection industry and effectively improve the service level for clinical and patients. However, the leap from the data detection report to the inspection and diagnosis report to complete this inspection result needs to be based on the talent team capable of this job content.

The hormones produced by the thyroid gland regulate the body's metabolism and affect every cell, tissue and organ in the body^[1]。 Worldwide, thyroid disorders are very common and include abnormal thyroid function and morphological alterations. Functional abnormalities lead to hyperthyroidism and hypothyroidism, with morphological changes manifesting as goiter, nodules, and cancerous changes. The incidence of thyroid disease is increasing year by year, and the diagnosis, treatment and monitoring of thyroid disease are strongly dependent on laboratory tests. Therefore, it is very important to correctly select and understand the relevant laboratory tests for thyroid diseases^[2]。 Laboratory diagnosis report is a report issued by a qualified physician or authorized signatory that has guiding value for clinical diagnosis, differential diagnosis and treatment. Formulating a scientific laboratory diagnosis report model can improve the level of laboratory medicine and better serve clinical services^[3,4,5,6,7]。

Catheter-associated bloodstream infection (CRBSI) is a common clinical infection, which can develop into sepsis or even septic shock with poor prognosis. CRBSI is also the key object of hospital infection control. The incidence of CRBSI has returned to zero in medical institutions with the best infection control work in the world. Clinical microbiological diagnosis is the key to CRBSI diagnosis and the decisive basis for CRBSI diagnosis. It is an inevitable trend to improve the quality of laboratory medicine to formulate a scientific and complete laboratory diagnosis report model. In order to ensure the accuracy of CRBSI diagnosis and give full play to the role of laboratory medicine in the diagnosis, treatment and control of CRBSI, the Laboratory Physician Branch of Chinese Medical Physicians Association refers to the American CRBSI Guidelines^[1]American Society of Infectious Diseases (IDSA) /American Society of Microbiology (ASM) Clinical Microbiology Guidelines^[2]CDC Hospital Infection Diagnostic Criteria^[3]UK Health Protection Agency Guidelines (HPA)^[4]China Report Expert Consensus^[5,6]Combined with the latest progress of CRBSI at home and abroad and the current status of domestic clinical examination and diagnosis, the Expert Consensus on the Testing and Diagnosis Report Model of Catheter-related Bloodstream Infection was formulated.

Since November 2015, primary biliary cirrhosis has been officially renamed primary biliary cholangitis (PBC) internationally, and the abbreviated form remains unchanged. The reason for the name change is that the disease is a chronic intrahepatic cholestatic autoimmune liver disease mainly caused by inflammatory injury of small and medium-sized intrahepatic bile ducts. The progression of the disease is usually slow, and most patients do not develop liver cirrhosis. The old name may cause unnecessary mental burden on PBC patients. Therefore, renowned international experts in relevant fields jointly issued a statement to change the name of PBC^[1,2,3,4]。 The disease is more common in middle-aged and elderly women, usually with insidious onset, asymptomatic or non-specific symptoms such as fatigue and pruritus as the main clinical manifestations, and is easy to miss or misdiagnose. Serum anti-mitochondrial antibody (AMA) and alkaline phosphatase (ALP) and glutamyl transpeptidase (GGT) reflecting cholestasis are important for the diagnosis of PBC^[5]。 At present, the diagnostic criteria of PBC proposed at home and abroad are mainly based on the following three items: abnormal elevation of cholestatic enzyme; serum AMA or AMA-M2 antibody positive; Hepatic histology supports PBC. A diagnosis can be made if two of them are met. However, it should be noted in clinical practice that liver diseases caused by other common causes should be excluded before diagnosis of suspected PBC. Moreover, what may happen with laboratory test results is not all as simple as in the standards. Therefore, the test results need to be analyzed in detail.

Urinalysis is one of the commonly used clinical tests. Through routine urine test, special test, early renal injury test, renal function test and other tests, it is helpful for the screening, diagnosis and staging, differential diagnosis and curative effect observation of urinary system diseases, and it is of great significance for the screening or differential diagnosis of systemic diseases such as endocrine or metabolic abnormalities and jaundice. Routine urine examination includes physical examination, chemical examination and formable component examination. The combination of these three examinations has important guiding significance for screening, diagnosis and differential diagnosis of urinary system diseases.

Hepatitis B (hereinafter referred to as hepatitis B) is an infectious disease caused by hepatitis B virus (HBV). The susceptibility to hepatitis B virus varies greatly among different individuals, and the process of virus infection is complicated. Hepatitis B, especially chronic hepatitis B, has a variety of clinical manifestations. The laboratory diagnosis of hepatitis B is mainly clinical immunological detection, clinical molecular biological detection and clinical biochemical detection. Immunological detection includes colloidal gold immunochromatography, enzyme immunoassay and chemiluminescence immunoassay; Molecular biology methods include fluorescence quantitative PCR and gene sequencing; Clinical biochemical detection includes spectral analysis technology, electrochemical analysis, dry chemical analysis technology, electrophoresis technology, chromatography technology, etc.

Aplastic anemia (AA) is a bone marrow hematopoietic failure (BMF) caused by autoimmune destruction of hematopoietic stem/progenitor cells (HSPC). While immunosuppressive therapy (IST) and hematopoietic stem cell transplantation (HSCT) significantly improved the prognosis of AA, some patients progressed to clonal diseases, including paroxysmal nocturnal hemoglobinuria (PNH), myelodysplastic syndrome (MDS), and acute myeloid leukemia (AML)^[1,2]。 Recent studies using high-throughput sequencing technology have shown that some AA have clonal hematopoiesis, and the presence of these clones can be detected at the early stage of the disease even in pediatric patients and patients who do not eventually develop MDS/AML^[1,2]。 Clonal hematopoiesis does not necessarily mean the development of cancer or other disease, which can remain stable for a substantial period of time. Somatic mutations that occur in myeloid tumors also frequently occur in AA patients. Somatic mutations in AA patients may provide the basis for frequent clonal hematopoiesis, and then develop into MDS and AML. This part of AA with evidence of clonal hematopoiesis is completely different from AA without evidence of clonal hematopoiesis in both clonal indexes and treatment outcomes, and it is in line with the "clonal cytopenia (CCUS) of unknown significance" proposed by scholars in recent years. This article mainly reviews the recent progress of AA clonal hematopoiesis in recent years and the mechanism of its late development into clonal disease.