[1]周朝琼,王华丽,孔丽蕊,等.基于患者数据的移动中位数法在实验室血清钙和磷检测质量控制中的应用[J].现代检验医学杂志,2023,38(06):185-190.[doi:10.3969/j.issn.1671-7414.2023.06.034]
　ZHOU Chaoqiong,WANG Huali,KONG Lirui,et al.Application of the Moving Median Method Based on Patient Data for the Quality Control of the Serum Calcium and Phosphorus Test in the Laboratory[J].Journal of Modern Laboratory Medicine,2023,38(06):185-190.[doi:10.3969/j.issn.1671-7414.2023.06.034]
点击复制

基于患者数据的移动中位数法在实验室血清钙和磷检测质量控制中的应用()
分享到：

《现代检验医学杂志》[ISSN:/CN:]

卷:
第38卷
期数:
2023年06期
页码:
185-190
栏目:
质量控制·实验室管理
出版日期:
2023-11-15

文章信息/Info

Title:
Application of the Moving Median Method Based on Patient Data for the Quality Control of the Serum Calcium and Phosphorus Test in the Laboratory
文章编号:
1671-7414（2023）06-185-06
作者:
周朝琼1; 2; 王华丽1; 2; 孔丽蕊1; 2; 何大海1; 2; 黄 英1; 2; 吴 风1; 2; 张 艳1; 2
（1. 成都市郫都区中医医院检验科，成都 611730；2. 成都中医药大学附属第三医院检验科，成都 610031）
Author(s):
ZHOU Chaoqiong1; 2;  WANG Huali1; 2;  KONG Lirui1; 2;  HE Dahai1; 2;  HUANG Ying1; 2;  WU Feng1; 2;  ZHANG Yan1; 2
（1.Department of Clinical Laboratory, Traditional Chinese Medicine Hospital of Chengdu Pidu District, Chengdu 611730，China; 2. Department of Clinical Laboratory, the Third Affiliated Hospital of Chengdu University of Chinese Medicine, Chengdu 610031, China）
关键词:
血清钙; 血清磷; 移动中位数法; 质量控制
分类号:
R446
DOI:
10.3969/j.issn.1671-7414.2023.06.034
文献标志码:
A
摘要:
目的 回顾性分析实验室血清钙(calcium，Ca) 和无机磷（phosphorus，P）结果，评价基于患者数据移动中位数(moving median，MM) 的方法在实验室血清Ca 和P 检测质量控制中的应用价值。方法 收集成都市郫都区中医医院2022 年2 月～ 2023 年1 月在自动生化分析仪（Hitachi Labospect 008AS）上检测的所有患者血清离子Ca 和P 数据，同时收集上述项目同期质控数据，按检测时间排序，剔除离群值后，将前半年数据（2022 年2 ～ 7 月）作为训练组，后半年数据（2022 年8 月～ 2023 年1 月）作为测试组。将训练组最大和最小的MM 值作为测试组的上下控制线，做MM质控图；将训练组日中位数（M）的中位数和标准差数设为测试组靶值及标准差，转换为Z 值后作Z 分数质控图，同时根据Westgard 中的22S 和13S 规则, 比较MM 及内部质量控制(internal quality control，IQC ) 的失控判断能力和及时性。结果 移动中位数法检测到Ca 的系统误差和随机误差分别33 次和17 次，P 的分别为23 次和13 次。IQC 检测到Ca 的系统误差和随机误差分别为7 次和8 次，P 的分别为2 次和4 次。MM 对随机误差识别时间晚于IQC。结论 MM 法对Ca 和P 的系统误差及随机误差检出次数均优于IQC，但对随机误差识别时间晚于IQC，故MM 对实验室工作人员监测测量状态来说是一种有效手段，对提高实验室质量管理较实用，可作为IQC 的一种有效补充。
Abstract:
Objective Laboratory serum calcium (calcium，Ca) and inorganic phosphorus (phosphorus，P) results were retrospectively analyzed to evaluate the value of the method based on patient data moving median (moving median，MM) in the quality control of laboratory serum Ca and P tests. Methods To collect the detection data of serum ions Ca and P of all patients on the automatic biochemical analyzer (Hitachi Labospect 008AS) from February 2022 to January 2023. At the same time, the quality control data of the above items were collected and sorted by the detection time. After excluding the outlier values, the data of the first half year (February 2022 to July 2022) were taken as the training group, and the data of the second half year (August 2022 to January 2023) were taken as the test group. The maximum and minimum moving median MM values of the training group were taken as the test group for the upper and lower control lines, and the median and standard deviation of the daily median (M)of the training group were set as the target value and standard deviation of the test group. After converting into the Z value，the quality control map of Z score was made. At the same time, according to the 22S and 13S rules, the ability and timeliness of MM and IQC are compared in Westgard. Results The moving median method detected 33 and 17 systematic and random errors for Ca，and 23 and 13 errors for P, respectively. The systematic and random errors detected by IQC for Ca were 7 and 8 times, and 2 and 4 times for P, respectively. But the MM identifies the random error later than the IQC. Conclusion The MM method is better than IQC for systematic errors and random errors for Ca and P, but identifies the random error later than IQC, so MM is an effective means for laboratory staff to monitor the monitoring and measurement status of laboratory error, practical for improving laboratory quality management, and can be used as an effective supplement to IQC.

参考文献/References:

[1] DUAN Xincen, WANG Beili, ZHU Jing, et al. Assessment of patient-based real-time quality control algorithm performance on different types of analytical error[J]. Clinica Chimica Acta, 2020, 511: 329-335.
[2] 刘瑜, 张顺利, 岳育红, 等. 基于患者数据的质控与传统质控方法比对研究[J]. 首都医科大学学报,2021, 42(5)：706-714. LIU Yu, ZHANG Shunli, YUE Yuhong, et al. Comparative study of patient-based quality control (PBQC) and traditional quality control methods[J].Journal of Capital Medical University, 2021, 42(5):706-714.
[3] VAN ROSSUM H H. Moving average quality control:principles, practical application and future perspectives[J]. Clinical Chemistry and Laboratory Medicine, 2019, 57(6): 773-782.
[4] 史惪, 陈秀珍, 李传达, 等. 实验室可波动的误差参照标准的应用程序[J]. 现代检验医学杂志, 2004,19(3): 1-3. SHI De, CHEN Xiuzhen, LI Chuanda, et al. The applying procedure of the laboratory’s referred standard of the fluctuation of misnomer[J]. Journal of Modern Laboratory Medicine, 2004, 19(3): 1-3.
[5] WESTGARD S A.2017 Global QC practices survey rest of world results[EO]. https://www.westgard.com/downloads/metrics-and-data-downloads/80-2017-global-qc-practices-survey-rest-of-world-results.html. Accessed June, 2019.
[6] BULL B S, ELASHOFF R M, HEILBRON D C, et al. A study of various estimators for the derivation of quality control procedures from patient erythrocyte indices[J]. American Journal of Clinical Pathology,1974, 61(4): 473-481.
[7] Clinical and Laboratory Standards Institute. C24-ED4 C. Statistical quality control for quantitative measurement procedures:principles and definitions[S].4th ed. Wayne: PA, CLSI C24-Ed4, 2016.
[8] ROSSUM H H V, KEMPERMAN H. Implementation and application of moving average as continuous analytical quality control instrument demonstrated for 24 routine chemistry assays[J]. Clinical Chemistry and Laboratory Medicine, 2017, 55(8): 1142-1151.
[9] NG D, POLITO F A, CERVINSKI M A. Optimization of a moving averages program using a simulated annealing algorithm: the goal is to monitor the process not the patients[J]. Clinical Chemistry, 2016, 62(10):1361-1371.
[10] BADRICK T, BIETENBECK A, CERVINSKI M A, et al. Patient-based real-time quality control: review and recommendations[J]. Clinical Chemistry, 2019, 65(8):962-971.
[11] 夏骏, 孙汝林, 周俞, 等. 患者数据均值和百分位数在临床生化日常室内质量控制中的应用[J]. 中华检验医学杂志, 2019, 42(4)：270-276. XIA Jun, SUN Rulin, ZHOU Yu, et al. Patient data used in internal quality control[J]. Chinese Journal of Laboratory Medicine, 2019, 42(4): 270-276.
[12] 何书康, 王薇, 杜雨轩. 临床检验基于患者数据室内质量控制方法的研究与进展[J]. 国际检验医学杂志,2020, 41(11): 1390-1395. HE Shukang, WANG Wei, DU Yuxuan. Research and progress of clinical laboratory based on patient data for indoor quality control[J]. International Journal of Laboratory Medicine, 2020, 41(11): 1390-1395.
[13] 谢叶红, 张艳, 王华丽, 等. 基于患者血脂检测数据的实时质量控制[J]. 检验医学与临床, 2023, 20(12):1730-1735. XIE Yehong, ZHANG Yan, WANG Huali, et al. Real time quality control based on patients’ blood lipid testing data[J]. Laboratory Medicine and Clinic, 2023,20(12): 1730-1735.
[14] 张艳, 王华丽, 谢叶红, 等. 基于患者结果的移动均值法在血清钙实时质量控制中的运用[J]. 临床检验杂志, 2023, 41(4): 295-298. ZHANG Yan, WANG Huali, XIE Yehong, et al. Application of moving average method based on patient results in real-time quality control of serum calcium[J].Chinese Journal of Clinical Laboratory Science, 2023,41(4): 295-298.
[15] LIM C Y, BADRICK T, LOH T P. Patient-based quality control for glucometers: using the moving sum of positive patient results and moving average[J].Biochemia Medica, 2020, 30(2): 020709.
[16] WESTGARD J O. Internal quality control: planning and implementation strategies[J]. Annals of Clinical Biochemistry, 2003, 40(Pt 6): 593-611.
[17] KILGARIFF M, OWEN J A. An assessment of the “average of normals” quality control method[J]. Clinica Chimica Acta, 1968, 19(2): 175-179.
[18] BADRICK T, BIETENBECK A, KATAYEV A, et al. Implementation of patient-based real-time quality control[J]. Critical Reviews in Clinical Laboratory Sciences, 2020, 57(8): 532-547.

备注/Memo

备注/Memo:
基金项目： 成都市卫生健康委员会科研课题（2021178：基于患者数据实时质量控制方法的研究；2021192：基于生物学变异建立临床检测项目个性化参考区间模型研究及临床验证应用；2022376：运用大数据间接建立成都市郫都区人群参考区间及个性化参考区间的研究）；成都中医药大学“杏林学者”医院专项基金（YYZX2021142：总胆汁酸和甘胆酸的生物学变异及临床应用的研究；YYZX2021136：基于生物学变异建立郫都区医养中心老年人检测项目个性化参考区间的研究及应用）。
作者简介：周朝琼（1995-），女，大学本科，主管技师，主要从事临床检验及质量控制，E-mail: 1340709790@qq.com。
通讯作者：张艳，副主任技师，E-mail:114612396@qq.com。
更新日期/Last Update: 2023-11-15