甲状腺激素项目的全球室间质量评估分析

Analytical Performance of Thyroid Hormone Using Global External Quality Assurance System

目的回顾分析本实验室甲状腺激素项目在伯乐全球室间质量评估系统(EQAS)中的表现,持续改进甲状腺激素项目的检验质量。方法通过参加伯乐全球EQAS,分析第9循环1~12号样本结果报告及循环末报告,观察各样本的三碘甲状原氨酸(TT3)、甲状腺素(TT4)、游离T3(FT3)、游离T3(FT4)、促甲状腺激素(TSH)5个指标在不同浓度水平或相同方法学组的z-score(Z分数)结果和L-J分布图的情况,分析失控原因。结果 FT3的6号样本、FT4的6号样本、TT4的3号样本Z分数在2~3之间,被警告;FT3的5号样本Z分数大于3,结果不可接受;其余项目标本的Z分数均在2以内;尽管所有项目第9循环的平均Z分数都小于2,但FT3的表现低于97%实验室。持续改进后的第10循环实验室检测性能明显好于第9循环。结论甲状腺激素项目在检验质量上还存在一定的问题,需从人员、环境、仪器检测系统、标本处理等方面进行改进和纠正,通过持续改进,使实验室检验质量不断提高。

Objective To analyze retrospectively the performance of thyroid hormone tests in the Bio-Rad external quality assurance system（EQAS） so as for continuous improvements of laboratory performance. Methods Data of total triiodothyronine（TT3）,total thyroxine（TT4）,free T3（FT3）,Free T4（FT4） and thyroid stimulating hormone（TSH） from 12 samples in the ninth cycle were analyzed by Bio-Rad EQAS. And Z-score,mean Z-score and L-J distribution histogram at different concentration levels in the peer and method groups were evaluated with Beckman Coulter DXI 800 analytical system. Continual improvements were made for reliable performance. Results Samples No.6 of FT3,No.6 of FT4 and No. 3 of TT4 were warned due to their Z-scores between 2 and 3. And performance of sample No.5 of FT3 could not be accepted because its Z-scores were above 3. The average Z scores of TT3,TT4,FT3,FT4 and TSH in the 9 th cycle were below 2 although that of FT3 was inferior to 97% of participants. Our laboratory performance was better in the 10 th cycle than in the 9 th cycle after continual improvements. Conclusion Further improvements would be necessary for the quality assurance of thyroid hormone analysis in personnel,environment,instrument detection system and sample processing.