2018年·第98卷第22期

The knowledge system of laboratory medicine includes two parts: laboratory technology and analysis and interpretation of laboratory results. In the process of medical development from empirical medicine to evidence-based medicine, the inspection technology has done a lot of work from the aspects of inspection methods, inspection means and inspection quality management, focusing on the accuracy, stability and timeliness of inspection results, and has been greatly improved, which has achieved the first leap of laboratory medicine. With the development of evidence-based medicine to individualized medicine and precision medicine, the clinical requirements for the interpretation of test results are becoming more and more urgent. Especially with the increasing number of test items, the pathological changes reflected in the test results are more and more deep and detailed. The test indexes not only cover the physiological state, pathophysiological condition, biochemical reaction, immune reaction and regulation of the body, but also directly related to the causes, pathogenesis, disease course evolution, drug sensitivity and drug resistance, therapeutic effect and prognosis of the disease. Therefore, there is a special need for a professional and systematic interpretation of complex test results in clinical practice, which will surely drive the second leap of development of laboratory medicine.

Cataract is the top blinding eye disease in the World Health Organization's "Vision 2020, the right to see for all" action goal. cataract surgical rate (CSR) (number of cataract surgeries per million person-years) is one of the three major monitoring indicators of the World Health Organization's Universal Eye Health: Global Action Plan (2014-2019)^[1]。 After entering the 21st century, our government has taken many measures simultaneously to eliminate cataract blindness in our country, and achieved obvious results. CSR has been continuously improved, but there are still deficiencies. This paper reviews the measures and achievements of eliminating cataract blindness in China, analyzes the shortcomings, and puts forward the direction of efforts.

Diabetes is a group of metabolic diseases characterized by chronic hyperglycemia caused by multiple etiologies, which are caused by defects in insulin secretion and/or action. The test results are an important basis for the diagnosis, treatment and condition monitoring of diabetes mellitus. Correct analysis of test results is very important for the diagnosis, differential diagnosis, judgment of pathological process and evaluation of treatment effect. According to the etiology of diabetes, it is divided into: type 1 diabetes, type 2 diabetes, special types of diabetes and gestational diabetes. In order to better analyze the pathological significance contained in the data of the test report, save the time of consulting the test report, and improve the application effect of the test report, this consensus is specially formulated.

Dyslipidemia usually refers to elevated levels of cholesterol and/or triacylglycerol in the serum, commonly known as hyperlipidemia. In fact, dyslipidemia also generally refers to various dyslipidemia including low high density lipoprotein cholesterolemia.

Platelet activation (activation, adhesion and aggregation) is the key to the pathogenesis of acute coronary syndrome (ACS), and antiplatelet therapy is the cornerstone of prevention and treatment of acute vascular events throughout the treatment of ACS^[1,2]。 Dual antiplatelet therapy of aspirin combined with clopidogrel (or ticagrelor) is the most widely used in clinic^[3]。 However, anti-platelet drug therapy exhibit diversity differences between individuals, which are significantly associated with the occurrence of adverse events such as recurrent thrombosis or bleeding^[4,5]。 However, the relevant professional authorities have never formed a unified consensus. The reasons for this phenomenon may be as follows: (1) There are multiple signal-mediated pathways for platelet activation. Blocking a certain pathway by related drugs cannot completely inhibit platelet activation^[6]。 (2) Platelets have the functions of adhesion, aggregation, release, promoting coagulation and blood clot contraction, and the individual's response to antiplatelet drugs is also affected by metabolic genes, liver and kidney function, drugs, etc. So far, no single platelet function test (PFT) has captured the endpoint events triggered by these different pathways, that is, it can comprehensively assess the complexity of platelet physiology and function^[7]。 (3) Low degree of standardization, irregular operation and inadequate attention to details are also one of the reasons why PFT cannot be widely accepted in clinical practice^[8,9]。 (4) There are many methods and standards for platelet function testing. At present, there are no special guidelines (consensus) or recommendations to standardize platelet function testing in China, and clinicians and laboratory personnel have uneven understanding of platelet function testing.

Venous blood and peripheral blood are commonly used in clinical blood testing specimens. With the continuous development and improvement of the modernization, micro-quantity and convenience of laboratory medicine technology, the application of peripheral blood is becoming more and more extensive. Due to the poor compliance of voluntary cooperation and thin blood vessels, the success rate of venous blood sampling is lower and the incidence of complications is higher than that of adults^[1]Therefore, peripheral blood collection occupies an indispensable position in pediatric clinical work. Compared with venous blood, peripheral blood has many influential factors, such as irregular collection process operation, which can easily lead to variation or inaccuracy of test results. Therefore, it is very important to standardize peripheral blood collection operation. At present, there is a lack of unified standards and norms for peripheral blood collection operation in China, and the relevant guidelines abroad are difficult to meet the actual needs of China. In order to standardize the operation process of peripheral blood collection in China, the Expert Committee of Laboratory Medicine for Pediatric Diseases of Laboratory Physicians Branch of Chinese Medical Doctors Association and the World Chinese Laboratory and Pathologists Association jointly formulated this consensus, aiming at providing a reference basis for standardized collection operation of peripheral blood samples in China and improving the quality of peripheral blood sample inspection.

A 99-year-old male was admitted to the hospital on February 20, 2017 due to "dyspnea for 7 days and unsteady standing for 3 days". 7 days ago, the patient had dyspnea without obvious trigger, accompanied by cough and white phlegm, and phlegm sounds could be heard, denying fever and chest pain. Three days ago, the patient had unstable standing, tilted to the left side, difficulty in walking, accompanied by urinary incontinence, unclear speech, choking, denial of fall and disturbance of consciousness. The patient came to the emergency department of Peking Union Medical College Hospital on February 20, 2017, with a heart rate of 120 beats/min, blood pressure of 126/63 mmHg (1 mmHg =0.133 kPa), finger oxygen saturation of 82% (natural state), and blood test routine: white blood cell count 9.4×10⁹/L, neutrophil percentage 88.3%↑, hemoglobin 111 g/L↓, platelet count 159×10⁹/L↓; Liver and kidney function: alanine aminotransferase 30 U/L, total bilirubin 12.3 μ mol/L, creatinine 199 μ mol/L↑, urea nitrogen 22.54 mmol/L↑, serum potassium 4.7 mmol/L, serum calcium 2.09 mmol/L↓ (2.13~2.70 mmol/L), hypersensitive C-reactive protein (hsCRP) 332 mg/L↑; Coagulation index was normal; Arterial blood gas analysis: pH 7.43, partial pressure of carbon dioxide 38 mmHg, partial pressure of oxygen 54 mmHg↓, bicarbonate 25.2 mmol/L. In the emergency department, the diagnosis of "acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and cerebrovascular disease is not excluded" is considered and admitted to the ward. Since the onset of the disease, the patient's spirit and appetite are poor, and wheezing is obvious, which affects sleep. Stools as usual, urine is difficult to control, and urine color and urine volume are still normal. Past history: hypertension, atrial fibrillation for 20 years, regular use of clobiglor, metoprolol tartrate, normal blood pressure, heart rate control is acceptable; He was diagnosed with chronic obstructive pulmonary disease (COPD) for 13 years, and was regularly controlled by salmeterol and ticasone aerosol. Acute exacerbations often occurred in winter, and he was hospitalized many times for this. Regular physical examination revealed liver cysts, gallbladder stones, renal cysts, prostatic nodules, and atherosclerosis. Relevant departments were followed up regularly, and there was no special treatment yet. The last physical examination was in September 2016, when serum creatinine was 80 μ mol/L, and no interstitial lesions were found on lung CT (FIG. 1A)。 Deny history of diabetes, deny history of viral hepatitis, no history of blood transfusion, deny history of food and drug allergies. Long-term history of heavy smoking, quitting smoking at age 69; Not alcoholic. The history of marriage and childbirth and family history are no different.

The patient, a 17-year-old male, was admitted to hospital on June 14, 2017 due to "thickened skin of the head and face and acrohypertrophy of the limbs for more than 2 years". Two years ago, the patient developed thick skin and increased wrinkles on the head and face, accompanied by greasy facial skin and hair, and the symptoms progressively aggravated; At the same time, acral hypertrophy of the limbs occurred, mainly thickening of the ends of fingers and toes. The parents were not intimate married, and there were no similar cases and other familial genetic history in the family. Physical examination: Height 182 cm, weight 71.0 kg, BMI 21.4 kg/m²Blood pressure 134/79 mmHg (1 mmHg =0.133 kPa). The skin of the head and face is thick and greasy, with enlarged pores, acne can be seen on the facial skin, and the skin of the head forms deep folds, which are cerebral gyrus-shaped; The ends of the fingers are thickened, showing pestle-shaped fingers, and both ankle joints are thick (Figure 1)。 No other positive signs were seen.

The pathogenesis of bronchial asthma (asthma for short) is very complex and has not been fully elucidated so far. At present, scholars from all walks of life generally accept that the pathogenesis of asthma is generalized as airway immune-inflammatory mechanism, neuromodulatory mechanism and their interaction, among which airway immune-inflammatory mechanism includes airway inflammation, airway hyperresponsiveness and airway remodeling.

Gallbladder cancer refers to a malignant tumor that occurs in the gallbladder (including the bottom, body, neck and cystic duct of the gallbladder), and is the most common malignant tumor of the bile duct system. The incidence of gallbladder cancer in China accounted for 0.4% ~3.8% of bile duct diseases in the same period, ranking sixth in the incidence of digestive tract tumors in China. The prognosis of gallbladder cancer is poor, and the 5-year survival rate of patients is only 5%^[1]。 There are significant differences in the geographical, ethnic and ethnic distribution of the incidence of gallbladder cancer worldwide, which suggests that genetic and environmental factors play an important role in the occurrence and development of gallbladder cancer^[2]。 With the rapid development of high-throughput technology in recent years, the research of molecular biology on tumors is increasingly in depth, and gallbladder cancer is one of them. At present, there is no breakthrough in the diagnosis and treatment of gallbladder cancer. It is generally recognized that in order to really improve the diagnosis and treatment of gallbladder cancer, it is necessary to fully study its molecular biological characteristics. The present situation and prospect of molecular biology research in gallbladder cancer are summarized as follows.