2013-2020年四川大学华西医院寄生虫形态学室间质量评价结果分析

Analysis of external quality assessment of parasite morphology from 2013 to 2020 in West China Hospital of Sichuan University

目的通过对寄生虫形态学室间质量评价(EQA)结果进行回顾分析,进一步提高临床检验人员发现和识别寄生虫的能力。方法回顾分析2013—2020年四川大学华西医院寄生虫形态学EQA的200份样本回报结果,其中80份来自美国病理家协会(CAP),120份来自中国国家卫生健康委临床检验中心(简称临检中心)。统计回报结果正确率,分析寄生虫(卵)辨认错误的原因,并总结少见和相似寄生虫的形态特征、鉴别要点。结果200份样本中,195份(97.5%)识别结果正确;80份CAP样本中,77份(96.3%)识别正确,3份识别错误,12份未评分;120份临检中心样本中,118份(98.3%)识别正确,2份识别错误。200份样本共涉及30种寄生虫的47种不同生活史形态。相似寄生虫(卵)鉴别包括:阔节裂头绦虫卵、肺吸虫卵、肝片形吸虫卵与姜片虫卵,脱蛋白质膜受精蛔虫卵与退变钩虫卵,钩虫卵与东方毛圆线虫卵,马来微丝蚴与班氏微丝蚴。少见寄生虫卵鉴别包括:微小膜壳绦虫卵与缩小膜壳绦虫卵;粪便中食物残渣与寄生虫卵的鉴别及各种包囊的鉴别。结论通过回顾分析寄生虫形态学EQA资料,并定期进行混合虫卵样本的镜下复习和寄生虫图谱复习,以及少见、相似寄生虫(卵)的形态复习,可提高寄生虫检测质量,提升检验人员寄生虫形态学检测的能力。

Objective To improve the ability of clinical laboratory examiners to detect and identify parasites through reviewing and analyzing the results of the external quality assessment of parasite morphology.Methods A retrospective analysis of 200 samples from the external quality assessment of parasite morphology from 2013 to 2020 was conducted,of which 120 samples were from the National Center for Clinical Laboratories and the other 80 samples from the College of American Pathologists(CAP).The accuracy of external quality assessment was calculated,the reasons for misidentification of parasites(eggs)were analyzed,and the morphological characteristics and identification points of rare and similar parasites were summarized.Results Of the 200 samples,195 samples were identified correctly(an accuracy rate of 97.5%).Of the 80 CAP samples,77 samples were identified correctly,3 samples were identified incorrectly(an accuracy rate of 96.3%),and 12 samples were not graded.Of the 120 samples from the National Center for Clinical Laboratories,118 samples were identified correctly,with only 2 identification errors(an accuracy rate of 98.3%).Totally,30 parasites in 47 different life-history forms were involved in the external quality assessment of parasite morphology.The morphologically similar parasite eggs in identification included Diphyllobothrium latum eggs,Paragonimus westermani eggs,Hepatella hepatica/Fasciolopsis buski eggs,Ascaris lumbricoides eggs and hookworm eggs,hookworm eggs and Trichostrongylus orienatalis eggs,microfilaria-Brugia malayi and microfilaria-Wuchereria bancrofti.The rare parasite eggs identified were Hymenolepis nana eggs and Hymenolepis diminuta eggs.Food residue and parasite eggs in stool,as well as different kinds of cysts,were also identified.Conclusions Periodically retrospective analysis of the laboratory external quality assessment data of parasites,regular review of mixed egg samples under a microscope,review of parasite archives,and morphology review of rare and similar parasites(eggs)can improve the quality of parasite laboratory and improve the capabilities of clinical laboratory examiners.