串联质谱分析干血滤纸片中酰基肉碱质控

目的：串联质谱技术是近几年应用于临床检验的新技术，具有特异性强、灵敏度高，一次试验可检测数十种物质的优点。本文通过对近4年的质控结果进行分析，探讨影响检测结果的因素及应对措施。方法：美国CDC每年提供4批酰基肉碱质控干血滤纸片，酰基肉碱检测方法为取直径为3mm的质控干血滤纸片放入96孔聚丙烯板，经含酰基肉碱内标的甲醇萃取，盐酸正丁醇衍生后，进行串联质谱检测。分析本实验室质控结果与美国CDC检测结果的偏差及其他实验室质控结果（169个实验室的均值）与美国CDC检测结果的偏差之间的差异。结果：本实验室每次质控结果所有酰基肉碱均在美国CDC检测结果95％可信区间内，且每一批结果的临床评价与美国CDC质控临床评价完全一致。本实验室质控结果与美国CDC检测结果的偏差与其他实验室质控结果与美国CDC检测结果的偏差比较，无显著差异，丙酰基肉碱差异显著（Z=-2．638，P〈0．005），戊二酰基肉碱差异亦显著（Z=-2．482，P〈0．005）。结论：本实验室酰基肉碱质控结果，达到美国CDC的质控要求，丙酰基肉碱检测值偏高，其阳性判断切割值设定也相应增高，而戊二酰基肉碱检测值偏低，其阳性判断切割值设定也相应降低。

Quality Control of Tandem Mass Spectrometry with Testing Acylcarntines in Dry Blood Spots

Objective Tandem mass spectrometry is a new technology for clinical testing available only recently.This technology can detect dozens of biochemical substances in one setting rapidly.To investigate the factors that affect the results,we study the quality control testing results of our lab in last four years.Methods The standard dried blood filter paper specimens were provided by CDC of United States.The levels of several acylcarntines in the specimens were tested with tandem mass spectrometry in various laboratories including ours(169 world wide).The deviations of the acylcarntines levels of the laboratories form the standard value of CDC of United States were studied.Results All the reported acylcarntines levels in our laboratory were within 95% confidence interval and the clinical evaluation of the results from our laboratory and CDC of United States were consistent.The results with Butyrylcarnitine(C4),Isovalerylcarnitine(C5),Hexanoylcarnitine(C6),Octanoylcarnitine(C8),Myristoylcarnitine(C14)and Palmitoylcarnitine(C16) were all not significantly different,from the standard,however,the levels of Propionylcarnitine(C3) and Glutarylcarnitine(C5DC) were significantly different(Z=-2.638,P<0.005),(Z=-2.482,P<0.005).Conclusion The results of acylcarntines quality control test of our laboratory fulfilled the requirements of CDC of United States.Propionylcarnitine detection value was high in our laboratory,and its cut-off value should be increased accordingly,Glutarylcarnitine detection value was lower in our laboratory,and its cut-off value should be decreased accordingly.