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中华临床实验室管理电子杂志 ›› 2017, Vol. 05 ›› Issue (02) : 93 -97. doi: 10.3877/cma.j.issn.2095-5820.2017.02.007

所属专题: 文献

质量控制

运用西格玛度量监测乙型肝炎病毒DNA定量检测质量变化
李婷婷1, 王治国1,()   
  1. 1. 100730 北京医院 国家老年医学中心 卫生部临床检验中心 北京市临床检验工程技术研究中心
  • 收稿日期:2017-01-10 出版日期:2017-05-28
  • 通信作者: 王治国

Using Sigma metrics to monitor the quality change in Hepatitis B virus DNA qualitative assay

Tingting Li1, Zhiguo Wang1,()   

  1. 1. National Center for Clinical Laboratories/Beijing Engineering Research Center of Laboratory Medicine, Beijing Hospital, National Center of Gerontology, Beijing 100730, China
  • Received:2017-01-10 Published:2017-05-28
  • Corresponding author: Zhiguo Wang
  • About author:
    Corresponding author: Wang Zhiguo, Email:
引用本文:

李婷婷, 王治国. 运用西格玛度量监测乙型肝炎病毒DNA定量检测质量变化[J]. 中华临床实验室管理电子杂志, 2017, 05(02): 93-97.

Tingting Li, Zhiguo Wang. Using Sigma metrics to monitor the quality change in Hepatitis B virus DNA qualitative assay[J]. Chinese Journal of Clinical Laboratory Management(Electronic Edition), 2017, 05(02): 93-97.

乙型肝炎病毒(hepatitis B virus,HBV)DNA定量检测对慢性HBV感染者的诊断和管理有重要意义。慢性乙型病毒性肝炎的临床治疗决策是根据HBV DNA的绝对或相对水平改变确定的。为获得高质量和可比较的HBV DNA结果,必须验证分析性能特征,并设计统计质量控制方法。本研究中我们确定了血浆HBV DNA检测的随机误差和系统误差,并通过标准化的操作过程规范(operational process specifications,OPSpecs)图验证检验方法性能。结果显示低和高控制物水平的系统误差分别为0.33和0.22 log(IU/ml),而其检测标准差(s)均为0.17 log(IU/ml)。另外,将具有2个质控结果的单规则12.5s作为候选的质量控制方法。研究结果显示,HBV DNA检测方法性能良好,且临床应用是可接受的,并可通过自动化提纯法进一步改善。我们将完善的统计质量控制学用于实时定量聚合酶链反应检测研究,结果表明通过长期采用西格玛度量统计质量控制法,可发现检测系统中的关键变化。西格玛度量和OPSpecs图可为实验室确定所用方法性能及质量控制设计,同时这些技术为实验室选择正确的方法和选择正确的质量控制提供了一种实用方法。

Hepatitis B virus (HBV) DNA measurement plays an important role in the diagnosis and management of patients with chronic HBV infection, because the treatment strategy is formulated based on either the absolute HBV DNA level, or the relative change in HBV DNA level. To obtain the results with high quality, assay, performance characteristics must be verified and statistical quality control methods must be planned. In this study, systematic and random error values of plasma HBV DNA were determined. Performance of the method was examined by employing a normalized operational process specifications (OPSpecs) chart. The systematic error at low and high control levels were 0.33 and 0.22 log (IU/ml) respectively. At both levels, the standard deviations (SD) of the assay were 0.17 log (IU/ml). In addition, a single rule of 12.5s with 2 control measurements was selected as a candidate quality control method. Results showed that the assay performed well and was acceptable for clinical use. Further improvement might be attained by switching to automated purification methods. The well-established discipline of statistical quality control was applied to a real-time quantitative polymerase chain reaction (PCR). It was concluded that by employing sigma-metrics statistical quality control (QC) methods which utilized long-term controls, critical changes in the measurement system could be detected. Sigma metrics and OPSpecs chart could examine the performance of the method and whether the quality control scheme planed was appropriate. Therefore, these methods were practical for assisting laboratory choose the proper measurement method and select correct quality control scheme.

图1 90%分析质量保证的标准化OPSpecs图
图2 PCR检测HBV DNA高低水平各20份样品结果的随机变异散点图
表1 批间、PCR和纯化阶段的质量控制参数
图3 标准化的西格玛度量方法评价QIAGEN Artus HBV PCR试验性能决策图
图4 90%分析质量保证(TEa为100.0%)的标准化OPSpecs图
1
Gish RG, Locarnini SA. Chronic hepatitis B: current testing strategies[J]. Clin Gastroenterol Hepatol, 2006,4(6):666-676.
2
Lai CL, Yuen MF. The natural history and treatment of chronic hepatitis B: a critical evaluation of standard treatment criteria and end points[J]. Ann Intern Med, 2007,147(1):58-61.
3
Chu CJ, Lok AS. Clinical utility in quantifying serum HBV DNA levels using PCR assays[J]. J Hepatol, 2002,36(4):549-551.
4
Espy MJ, Uhl JR, Sloan LM, et al. Real-time PCR in clinical microbiology: applications for routine laboratory testing[J]. Clin Microbiol Rev, 2006,19(3):165-256.
5
Linnet K, Boyd J. Selection and analytical evaluation of methods with statistical techniques//Saunders. Teitz Textbook of Clinical Chemistry and Molecular Diagnostics. St. Louis: Saunders, 2006:353-407.
6
Westgard JO. Assuring analytical quality through process planning and quality control[J]. Arch Pathol Lab Med, 1992,116(7):765-769.
7
Westgard JO. Charts of operational process specifications (″OPSpecs charts″) for assessing the precision, accuracy, and quality control needed to satisfy proficiency testing performance criteria[J]. Clin Chem, 1992,38(7):1226-1233.
8
肖亚玲,王薇,赵海建, 等. 西格玛性能验证图在常规化学检测项目性能评价中的应用[J]. 现代检验医学杂志, 2016,31(4):159-162.
9
王治国. 临床检验6σ质量设计与控制[M]. 北京:人民卫生出版社, 2012.
10
张诗诗,王薇,赵海建, 等. 临床检验定量测定项目性能规范制定新进展[J]. 临床检验杂志, 2016,34(3):208-210.
11
张路,王薇,王治国. 临床检验质量管理中西格玛度量的评估[J]. 临床检验杂志, 2015,33(10):724-728.
12
张路,王治国. 六西格玛度量在实验室性能评价和质量控制设计中的应用[J]. 国际检验医学杂志, 2015,36(17):2613-2614.
13
Yen-Lieberman B, Brambilla D, Jackson B, et al. Evaluation of a quality assurance program for quantitation of human immunodeficiency virus type 1 RNA in plasma by the AIDS Clinical Trials Group virology laboratories[J]. J Clin Microbiol, 1996,34(11): 2695-2701.
14
McPherson RA, Pincus MR. Henry′s clinical diagnosis and management by laboratory methods[M]. Saunders, 2011:234-256.
15
Ismail AM, Sivakumar J, Anantharam R, et al. Performance characteristics and comparison of Abbott and Artus real-time systems for hepatitis B virus DNA quantification[J]. J Clin Microbiol, 2011,49(9):3215-3221.
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