安徽省常规生化项目室内不精密度现状分析

Internal imprecision status of routine chemical determination items in Anhui laboratories

目的分析安徽省常规生化项目不精密度水平,为全省临床实际工作提供大数据支持。方法收集159家临床实验室常规生化室间比对计划中值水平室内质控的相关数据,分析21项常规生化项目[白蛋白(Alb)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)、淀粉酶(Amy)、天门冬氨酸氨基转移酶(AST)、总钙(Ca)、肌酸激酶(CK)、氯(Cl)、肌酐(Cr)、γ-谷氨酰基转移酶(GGT)、葡萄糖(Glu)、钾(K)、乳酸脱氢酶(LDH)、钠(Na)、无机磷(P)、总胆红素(TB)、总胆固醇(TC)、甘油三酯(TG)、总蛋白(TP)、尿酸(UA)、尿素]的总体变异系数,根据我国卫生行业标准WS/T 403—2012评估各项目的符合情况。结果除Cl、Ca项目外,其他项目的不精密度(中位数)均低于WS/T 403—2012的标准。Cl、Ca、TP、尿素4个项目的总体符合率<60%,医疗机构分组统计,各组均可见较多极值数据,其中Ca项目的符合率三级医疗机构与二级医疗机构之间差异有统计学意义(χ2=5.12,P<0.05),其他项目的符合率差异均无统计学意义(P>0.05)。结论安徽省常规生化项目不精密度水平基本可以满足临床需求,个别项目的检测能力需加强。

Objective To provide scientific data for supporting clinical practice by analyzing the internal imprecision status of clinical routine chemical determination items in laboratories.Methods The data of median level from the Internal Quality Control Program from 159 hospitals were collected and evaluated,and the total coefficients of variation for 21 clinical routine chemical determination items [albumin（Alb）,alkaline phosphatase（ALP）,alanine aminotransferase（ALT）,amylase（Amy）,aspartate aminotransferase（AST）,total calcium（Ca）,creatine kinase（CK）,chlorine（Cl）,creatinine（Cr）,gamma glutamyltransferase（GGT）,glucose（Glu）,potassium（K）,lactate dehydrogenase（LDH）,sodium（Na）,inorganic phosphate（P）,total bilirubin（TB）,total cholesterol（TC）,triglyceride（TG）,total protein（TP）,uric acid（UA） and urea] were analyzed. The consistency of 21 clinical routine chemical determination items was analyzed according to WS/T 403—2012 as standard.Results Except Cl and Ca,the imprecisions（medians） of other determination items were lower than the WS/T 403—2012 standard. The overall consistency rates of Cl,Ca,TP and urea were 〈60%. Grouped statistics for medical institutions showed more extreme data,among which the consistency rate of Ca had statistical significance between the tertiary and the secondary medical institutions（χ2=5.12,P〈0.05）. There was no statistical significance for the consistency rates of the other determination items（P〉0.05）.Conclusions The imprecision status of routine chemical determination items in Anhui meets clinical basic demand,and some determination items need to be improved.