Abstract:
An object of the present invention is to automatically investigate factors in complicated uncertainty, particularly from the view point of reagents and samples which are subject to quality change and prone to affect the measurement quality. To accomplish the above object, quality control samples having a plurality of concentration levels are measured to calculate the average, coefficient of variation, standard deviation, and other numerical values. When quality control samples having n (n&gt;=2) different concentration levels are measured, the present invention provides the method to presume the factors in uncertainty, the factors being specific to each of 3 n  different combinations of variation patterns.

Description:
BACKGROUND OF THE INVENTION 
       [0001]    1. Field of the Invention 
         [0002]    The present invention relates to an automatic analyzer which performs qualitative and quantitative analyses of a biological sample, such as blood, urine, etc. More particularly, the invention relates to an automatic analyzer which is provided with the quality control function. 
         [0003]    2. Description of the Related Art 
         [0004]    The automatic analyzer performing qualitative and quantitative analyses of a biological sample, such as blood, urine, etc. mixes a reagent which reacts with a component under measurement in the sample, and measures reagent color variations and the luminescence of a labeled substance contained in the reagent in order to perform analysis. In this case, measurement values may vary by aging of the reagent, aging of the optical system including a photometer, photoelectron multiplier, etc., and variations in the dispensing quality of dispensing and stirring mechanisms, and the like. Therefore, today&#39;s automatic analyzers periodically create a calibration curve by using a known amount of standard sample (calibrator) and check the validity of a measured concentration by using a quality control sample (control substance), thus controlling the measurement quality. These quality control procedures are periodically performed in order to ensure that measurement results of the sample are correct. In routine tests, quality control for clinical testing equipment such as a biochemistry automatic analyzer, etc. is indispensable for stably acquiring exact data without being affected by reagent properties, machine troubles, and the like. Approaches for quality control include internal quality control and external quality control. With internal quality control, measurement value variations are observed for each individual apparatus on a daily basis (individual variation) and in unit of several days to several months (day-to-day variation). With external quality control, in order to obtain the same measurement results in every hospital, measurements are performed by using the same standard samples in different inspection institutions for correcting measurement variations among the different inspection institutions. 
         [0005]    One quality control method is to evaluate the accuracy of measurements by using standard substances. Specifically, this method performs the steps of: repetitively performing measurement with a target measuring instrument by using standard substances (quality control samples such as standard liquids, control substances, etc.) having a known or constant concentration; and determining the average, variation range, etc. of measurement values to supervise whether or not the measurement process is stable. 
         [0006]    The above-mentioned controlled data is generally represented as a control chart which is a statistical method for setting a quality control limit range statistically obtained and checking whether the measurement process is stable or maintained in a stable state. 
         [0007]    When a measurement value controlled in this way exceeds the quality control limit range, it is necessary to investigate the cause and restore the measurement process to the stable state. The above-mentioned measurement value deviation is possibly caused by various factors such as the standard liquids, control substances, or reagents used for measurement, as well as experimental environment (temperature, humidity, etc.) and facilities or measuring instruments (abnormal temperature of constant-temperature bath, degraded lamp, etc. in the case of biochemistry analyzers). 
         [0008]    Conventional automatic analyzers, on the contrary, performs quality control through the steps of: plotting a control chart; recording information such as the replacement date of reagent, lamp, etc. in a recording section; and displaying the information in the control chart together with quality control values. In this case, the user visually determines the cause of control value deviation based on user&#39;s experiences. Recent years have seen an international trend of numerical value calibration and certainty check based not on the former quality control techniques but on the uncertainty (parameters accompanying measurement results for characterizing value variation which can rationally be associated with measured quantities). The definition and calculation method of the uncertainty used for quality control have come to be widely known by the establishment of ISO15189 (Medical laboratories—Particular requirements for quality and competence) and the promotion activities of the Japanese Standards Association, and the like. The above-mentioned former techniques are disclosed in JP-A-6-281656, Japanese Patent No. 3420791, JP-A-2000-266756, JP-A-2000-187037, and Non-patent References 1 and 2. 
         [0009]    Non-patent Reference 1: Academic Journal of Japanese Association of Clinical Laboratory Automation (JSCLA), Vol. 32, No. 1, pp. 19-25: A Study for Measurement Uncertainty in Routine Test using Automatic Analyzer 
         [0010]    Non-patent Reference 2: Clinical Chemistry, Vol. 36, Supplementary No. 1, pp. 151-153, 2007: Uncertainty of Routine Test Values Transmitted from Standard System 
       SUMMARY OF THE INVENTION 
       [0011]    Both in the former quality control techniques based centering on the reproducibility and accuracy and in the recently regarded quality control technique based on the uncertainty, it was possible to detect a problem on quality control when a numerical value abnormally varies. However, although the uncertainty serves as an index for representing the technical reliability, there is no unified view for in-depth investigation of the cause when the uncertainty exceeds a clinical permissible value, i.e., whether the problem is caused by equipment or reagent. Since measurement of the uncertainty involves many factors such as equipment state including its maintenance control, reagent, and quality control sample, time-consuming and labor is required for an ordinary medical technologist to investigate the factor in uncertainty. In particular, it is commonly not easy for the technologist to determine the factor during a routine clinical test. Therefore, in order to remove the cause, the test must be once stopped. This may cause test results to be significantly delayed or force the medical technologist to proceed with the test without sufficiently maintaining the quality. As mentioned earlier as related art, techniques for maintaining a constant quality and systems for warning degraded quality have been studied and improved. However, while the investigation of the factor in uncertainty relies on the judgment of the medical technologist, the importance of a unified view or unified judgment system increases when unifying of the quality and measurement values with respect to the outside facilities is required as well as internal quantity. 
         [0012]    In particular, among the factors in uncertainty, reagents are subject to quality change by storage conditions of lots. Therefore, it is difficult to investigate the factor in uncertainty, whether the problem is caused by quality control sample or measurement reagent. Nevertheless, there has been no choice but to rely on medical technologist&#39;s experiences to determine the factor in uncertainty. 
         [0013]    Non-patent Reference 1 describes data uncertainty measurement conducted in recent years, wherein quality control samples having different concentrations are used. According to the measurement, measurement values of medium- and high-concentration quality control samples are stable but data variation of measurement values of low-concentration quality control samples increase. This means that the measurement value of a sample with low existential quantity of a target measurement item may not be accurate during measurement of an actual patient body even if results of measurement with quality control samples having a single concentration fall within a permissible variation range. 
         [0014]    An object of the present invention is to provide an automatic analyzer provided with a function for automatically determining the factor in such complicated uncertainty without relying on medical technologist&#39;s judgment, and provide a related analysis method. 
         [0015]    In order to attain the above-mentioned object, the automatic analyzer according to the present invention includes a detection unit  101 , a storage unit  102 , a calculation unit  103 , a display unit  104 , an operation unit  105 , and a determination unit  106 , as shown in  FIG. 1 . The storage unit  102  such as a hard disk stores measurement data output from the detection unit  101  of the automatic analyzer, and stores and updates concentrations and types of standard liquids and control substances at a plurality of levels. The calculation unit  103  calculates the concentration, standard deviation, coefficient of variation, date, time, etc. for each measurement from the output measurement data. The display unit  104 , including the storage unit  102  for storing and updating calculated data, displays control charts and numerical values. The operation unit  105 , including a keyboard, CRT, etc., sets a judgment value (boundary value for determining whether or not measured values are abnormal) and types and concentrations of samples. The determination unit including a logic having a plurality of branch points to compare a calculated numerical value with a judgment value, determines whether or not an abnormal condition occurs and the cause thereof. The result of judgment output from the determination unit  106  is displayed on the display unit  104  and an alarm is generated. 
         [0016]    The automatic analyzer uses quality control samples having a plurality of concentration levels for quality control to calculate the average, coefficient of variation, standard deviation, etc. of measurement values. Numerical value variations can be classified into three different variation patterns: falling, stable, and rising patterns. Therefore, when quality control samples having n (n&gt;=2) different concentration levels are measured, the automatic analyzer presumes the factor in uncertainty specific to each of 3 n  different combinations of variation patterns. 
         [0017]    When a measurement value deviates from a quality control range, the automatic analyzer according to the present invention investigates the cause of deviation thus remarkably saving labor and time consumed to recover a state where normal values can be measured. This makes it possible to reduce the load to and artificial judgment mistakes by the medical technologist, thus avoiding a judgment error due to individual difference. Further, since the automatic analyzer accumulates data in the storage unit and analyzes how an interval or what cause tends to make a measurement value deviate from the quality control limit range occur, it is expected that quality deviation be prevented previously. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0018]      FIG. 1  is a block diagram showing the overview configuration of an automatic analyzer according to the present invention. 
           [0019]      FIG. 2  is a flow chart of processing from measurement of a quality control sample to judgment of cause of variation. 
           [0020]      FIG. 3  is an exemplary method for calculating SD values used for routine quality control. 
           [0021]      FIG. 4  is an example of quality control chart. 
           [0022]      FIGS. 5A to 5G  show variation patterns of quality control samples shown in the control chart,  FIG. 5A . showing SD value when only H abnormally increases,  FIG. 5B  showing SD value when only M abnormally increases,  FIG. 5C  showing SD value when only L abnormally increases,  FIG. 5D  showing SD values when H and M abnormally increase,  FIG. 5E  showing SD values when M and L abnormally increase,  FIG. 5F  showing SD values when H and L abnormally increase,  FIG. 5G  showing SD values when H, M, and L abnormally increase. 
       
    
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS 
       [0023]    Embodiments of the present invention will be explained below with reference to the accompanying drawings. 
       First Embodiment 
       [0024]      FIG. 1  is the best mode of the automatic analyzer according to the present invention. 
         [0025]    In order to perform quality control, the automatic analyzer inputs directly or through a barcode reader the information on a plurality of quality control samples and information on measurement items, and then starts measurement. This measurement can be implemented in various ways: before or after starting a test every day, at intervals of a predetermined number of samples during tests, and at predetermined time. Measurement data output from the detection unit  101  is once stored in computer memory, and then read by the calculation unit  103  to calculate the average, measurement range, standard deviation, coefficient of variation, and the like. The calculated numerical values can be accumulated in the storage unit and then integrated with previously measured data to create a control chart. Then, the determination unit  106  compares numerical values calculated by the calculation unit with a judgment value input from the operation unit to determine whether or not numerical value variations occur as well as the cause of variations. The determination unit is provided with the information required for judgment. The factor obtained by the judgment can be displayed on the display unit or notified as an alarm. 
         [0026]      FIG. 2  is a flow chart showing a logic from quality control measurement to judgment. 
         [0027]    In Step  301 , names and types of reagents to be used, measurement items, user-defined judgment value, etc. are set and stored by the operation from the operation unit such as the keyboard, CRT, etc. connected to the computer. In Step  302 , the automatic analyzer measures the registered quality control samples. The automatic analyzer, after calibration is completed every day, measures the quality control samples before, during, or after measurement of a patient body or a plurality of times. In Step  303 , the detection unit outputs the obtained measurement data to the computer. In Step  304 , the computer calculates the average, standard deviation, etc. based on the received data. In Step  305 , the determination unit compares values obtained by calculation with the judgment value previously input or a default judgment value. As a result of comparison, the determination unit determines a sample with which the calculated value exceeds the judgment value for each item. When the calculated value does not exceed the judgment value, the determination unit determines that the certainty is maintained and stores the data in the storage unit in Step  310 . When the calculated value exceeds the judgment value, the determination unit determines variation patterns, i.e., types and number of variations for each item in Step  307 , and then selects the factor in uncertainty presumed from the judged variation patterns in Step  308 . In Step  309 , the judged factor and control chart are displayed on the display unit together with items and other data. When this measurement is performed during tests, the display screen may not be selected and therefore it is desirable to generate an alarm. Then, in Step  310 , the obtained data is accumulated in the storage unit such as a database. Accuracy control is performed according to the above-mentioned flow. 
       1. Quality Control Samples 
       [0028]    Although any types of standard serums, pool serums, and control substances containing more than a certain quantity of substances of measurement items can be used for uncertainty measurement, quality control samples having a plurality of concentration levels are prepared for each measurement item. It is necessary that the concentration levels be within the measurement range of the reagents and equipment used. Samples having three different concentration levels are used in the present embodiment. It is particularly preferable to use three levels with certain intervals, for example, the low level (hereinafter referred to as L), middle level (hereinafter referred to as M), and high level (hereinafter referred to as H). L denotes the vicinity of a lower limit of the reference range of the normal measurement value; M denotes the vicinity of an upper limit of the reference range thereof; and H denotes a level which is at least twice the normal measurement value. 
       2. Measurement Items 
       [0029]    Although any measurement items that can be measured with the automatic analyzer can be used, it is desirable that each item can be measured with both the enzyme method and immunization. More than about 300 measurement items are known. Main items include total protein (TP), albumin (ALB), lactate dehydrogenase (LD), aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), amylase (AMY), pancreatic amylase (P-AMY), leucine aminopeptidase (LAP), γ-glutamyl transpeptidase (γGT), cholinesterase (CHE), creatine kinase (CK), total cholesterol (T-Cho), neutral fat (TG), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), free fatty acid (FEA), urea nitrogen (UN), creatinine (CRE), uric acid (UA), glucose (Glu), hemoglobin A1C (HbA1c), lactic acid (LA), pyruvic acid (PA), total bilirubin (T-BIL), direct bilirubin (D-BIL), calcium (Ca), sodium (Na), inorganic phosphorus (IP), serum iron (Fe), unsaturated iron binding capacity (UIBC), creatine kinase MB (CK-MB), phospholipid (PL), C reactive protein (CRP), rheumatoid cause (RF), immunoglobulin G (IgG), immunoglobulin A (IgA), immunoglobulin M (IgM), complement 3 (C3), complement 4 (C4), antistreptolysin-O (ASO), etc. In particular, uric acid (UA), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine (CRE), γ-glutamyl transpeptidase (γGT), etc. are known for the dispersion tendency of low-concentration regions, and therefore it is more desirable to apply these measurement items to the present invention. 
       3. Measurement Data Calculation Procedures 
       [0030]    Data variation can be measured by measuring the same sample a plurality of times. Actually in measurement of simultaneous repeatability of reagents, independent data for 20 to 30 measurements are used. Also in individual or day-to-day quality control, although the availability of more data items for more number of measurements provides higher quality, measurement is possible with data for at least two measurements. Since at least 15 independent measurement values is recommended for presuming the uncertainty in ordinary quality control, measurement procedures using data of 15 times measurement will be described for the present embodiment. Average, standard deviation, etc. can be used for quality measurement. For example,  FIG. 3  shows quality control based on SD values by using data for 15 measurements as the parent population. The data for 15 days from the first day on which measurement is started is used to accumulate quality control data and calculate SD values used as a judgment value. For each quality control sample, the same sample is measured a plurality of times and then the average is used as the measurement value of the day. In order to equalize the reference values used for judgment and parent population of measurement values subjected to comparison, the data for the past 15 days including the measurement date is used. However, when any of these measurement values of three different concentration level samples exceeds a judgment value, the data for the relevant day is not used since it affects subsequent SD values. For example, when data obtained on the 17th day exceeds a judgment value, SD values of the next day (18th day) are calculated based on the data of 15 days excluding the 17th day, i.e., the third to 16th days and the 18th day. Likewise, on the 19th day of the month after the next month, SD values are calculated based on the data for 15 days, i.e., the fourth to 16th days and the 18th to 19th days. When quality control measurement is performed several times a day, it is desirable to calculate SD values based on the data for the past 15 measurements. 
       4. Judgment Value Setup Procedures 
       [0031]    It is very rare that the same measurement values and the same SD values are obtained every day. Since numerical values will vary even slightly, it is important to determine whether or not the variation is within an ordinary data spread range, not to determine whether or not SD value variation occurs. 
         [0032]    The most basic and most commonly used quality control limit range uses a value twice or three times the variation (standard deviation). (Hereinafter, this value is referred to as the a value.) When the distribution of variation is 1σ, 2σ, and 3σ of the normal distribution, 68%, 95%, and 99% of data fall within the quality control limit, respectively. In actual measurement, severer quality control limit increases the possibility that even a value variation not due to abnormal cause may be out of the quality control limit range, disturbing ordinary test procedures. Since quality requirements differ for each institution and measurement item, the medical technologist can arbitrarily set a judgment value. The judgment value can be input or changed before or after measurement of quality control samples. 
         [0033]    In order to set a pertinent judgment value, collection of preliminary data is required. When the measurement process is in a stable state, different types of standard serums having a constant concentration are measured n times every day, and data is continuously accumulated for K days. It is desirable that the same quality control samples and reagents are used during this period. The average, standard deviation, coefficient of variation, etc. are calculated based on the accumulated data. These values are multiplied by X or Z% is added to or subtracted from them to derive a judgment value. The judgment value can be fixed or variable. It can be made variable by increasing the parent population each time quality measurement is performed. 
         [0034]    In the present embodiment, the same item is measured five times and an average is calculated in each of the first 15 days. Then, the standard deviation for the 15 days is calculated and the 2 σ (SD×2) value is set as a judgment value. 
       5. Display Method 
       [0035]    It is also possible to display measured or calculated data in numerical form. As the control chart method for quality control, it is possible to use known techniques, for example, X-R control chart method, X bar-R control chart method, X bar-Rs-R control chart method, twin plot method, plus-minus control chart method, multi-rule control chart method, cumulative sum control chart method, scatter chart method, and the like. For example, for facilitating the viewing of measurement value variations, it is more desirable to create a control chart having a horizontal axis assigned the measurement date and a vertical axis assigned the normalized value not affected by the concentration of quality control samples, such as CV value, SD value, etc.  FIG. 4  is a general control chart having a horizontal axis  201  assigned the measurement date and a vertical axis  202  assigned the SD value. Control charts can be displayed independently for each concentration and, more preferably, a plurality of control charts can be overlapped or arranged on the same screen. For example, in  FIG. 4 , control charts for a high-concentration level sample (H)  203 , a medium-concentration level sample (M)  204 , and a low-concentration level sample (L)  205  are vertically arranged. 
         [0036]    When control charts for each concentration are arranged or overlapped, although calculated numerical values such as average, SD value, etc. can be displayed according to the original Y-axis scale, it is more desirable to display the numerical values with a fixed scale regardless of numerical value for each concentration, for example, so as to fit into the span between specified upper- and lower-limit control values, thereby making it easier to compare variations for each concentration with each other. 
         [0037]    In  FIG. 4 , the horizontal axis is assigned the date for a fixed time period in unit of week, month, and year (for example, 30 days), and updated on a daily basis. Further, control charts for a plurality of items specified by the user can be displayed on the same screen. 
       6. Judgment Method 
       [0038]    In routine measurements, when each measurement value is compared with a target value, three different variation patterns are considered, that is, the value remains unchanged, decreases, and increases. Therefore, in the case where n different quality control samples are measured, 3 n  (n-th power of 3) different combinations of variation patterns are considered. Specifically, when quality control is performed by using three different quality control samples, the number of combinations of variation patterns is 27 (3 3 ) In calculation of the average, for example, these 27 different combinations must be examined. However, since the measurement range, SD value, CV value, etc., increase with increasing data variation, a decrease in these values means a decrease in variation. In quality control with biochemistry analyzers, therefore, a decrease in the SD value is not regarded as a problem but regarded as the same meaning as no variation, that is, maintained stability. Accordingly, an increase in the SD value means that the stability of the measurement process is not maintained, arising a problem which must be noticed. As for SD value variation, therefore, only two different variation patterns may be considered: whether the SD value increases or not. Thus, when n (n≧2) different quality control samples are used, 2 n  (n-th power of 2) different combinations of variation patterns may be considered. 
         [0039]    In the present embodiment, since quality control samples having three different concentration levels are measured, the number of combination of variation patterns of the SD values is (2 3 ). However, since a state where the SD value remains unchanged (or changes very slightly) in three different-level concentration samples means that normal measurement can be achieved, seven (8−1) different combinations of variation patterns of the SD value are used to indicate the factor in uncertainty. These seven different combinations of variation patterns are shown in  FIGS. 5A to 5G . When data variation on the date enclosed by a frame (June 16) is noticed in  FIGS. 5A to 5G , there are three different combinations of variation patterns in which one of three values abnormally increases: increase only in H ( FIG. 5A ), increase only in M ( FIG. 5B ), and increase only in L ( FIG. 5C ). There are three different combinations of variation patterns in which two out of three values abnormally increase: increase in H and M ( FIG. 5D ), increase in M and L ( FIG. 5E ), and increase in H and L ( FIG. 5F ). Then, there is a case where, in all of H, M, and L, SD values abnormally increase ( FIG. 5G ). 
         [0040]    The factors of these seven different combinations of variation patterns will be considered below. In the case where an abnormal increase in one of three values ( FIGS. 5A ,  5 B, and  5 C), when the peculiarity is specific not to a measurement item but to a quality control sample having the relevant concentration, there is a high possibility that the quality control sample may have been degraded or defective. 
         [0041]    In the case where, in H and M out of three concentration level sample, SD values abnormally increase ( FIG. 5D ), while the quality of values in low-concentration sample which is liable to cause data spread is maintained, the values in medium-concentration sample and high-concentration sample are abnormal. In this case, degradation of the measurement reagent is estimated since absence of linearity in the reagent is considered. 
         [0042]    In the case where, in M and L out of three concentration level sample, SD values abnormally increase ( FIG. 5E ), since values in high-concentration sample are not affectable but incorrect measurement values arise with use of medium- and low-concentration samples, there is a high possibility that the quality control sample may have been degraded. Depending on the measurement item, the effect caused by the concentration arises. For example, in the case of uric acid (UN), when ammonia in air is captured into the quality control sample, the concentration of ammonia in the sample is likely to change. Further, since a standard liquid having a lower concentration generally provides more unstable quality, it is presumed that a quality control sample having a lower concentration provides a shorter usable life even if three different quality control samples are opened on the same date. 
         [0043]    In the case where, in H and L out of three concentration level samples, SD values abnormally increase ( FIG. 5F ), since the measurement values of medium-concentration sample are stable, the inclination of the calibration curve measured before the test is assumed to be fluctuating centering on medium-concentration values. Therefore, it is presumed that the calibration curve of relevant date may not to have been correctly drawn. 
         [0044]    In the case where, in all of the three concentration level samples, SD values abnormally increase ( FIG. 5G ), when the increase is specific to a measurement item, the cause is degraded reagent for the measurement item. When values in all measurement items abnormally increase, the cause may not be the reagent but be the lamp, the temperature of the constant-temperature bath, and other mechanical factors. 
         [0045]    From these considerations, the cause of variation can be determined by classifying variation patterns into the above-mentioned seven different combinations of variation patterns for quality control samples having three different concentrations. 
         [0000]    Sample judgment (1) 
         [0046]    Calculation-based presumption of the cause of day-to-day variation by noticing the SD value will be explained below. A judgment value is set for each quality control sample. The medical technologist can optimally set the value with the setup screen. For example, when the SD value calculated on the 15th day from the start of measurement is used as a reference value, a numerical value (2SD) twice the SD value is set as the judgment value. In routine measurement, when the data is stable as shown in Table 1, the SD values of H, M, and L do not exceed the judgment value. 
         [0000]    
       
         
               
             
               
               
               
             
               
               
               
               
               
               
               
               
               
               
             
           
               
                 TABLE 1 
               
             
             
               
                   
               
               
                 Relation between variation patterns of quality 
               
               
                 control samples and transition of SD values 
               
             
          
           
               
                   
                 Judg- 
                   
               
               
                   
                 ment 
               
               
                   
                 value 
               
               
                   
                 (ex- 
                 Variation patterns of quality control samples 
               
               
                 SD 
                 am- 
                 having three different concentrations 
               
             
          
           
               
                 value 
                 ple) 
                 Stable 
                 a 
                 b 
                 c 
                 d 
                 e 
                 f 
                 g 
               
               
                   
               
               
                 H 
                 &lt;2SD 
                 (Within 
                 over 
                   
                   
                 over 
                   
                 over 
                 over 
               
               
                   
                 (H) 
                 limit) 
               
               
                 M 
                 &lt;2SD 
                 (Within 
                   
                 over 
                   
                 over 
                 over 
                   
                 over 
               
               
                   
                 (M) 
                 limit) 
               
               
                 L 
                 &lt;2SD 
                 (Within 
                   
                   
                 over 
                   
                 over 
                 over 
                 over 
               
               
                   
                 (L) 
                 limit) 
               
               
                   
               
             
          
         
       
     
         [0047]    In pattern a, the SD value of H exceeds the judgment value. In pattern b, the SD value of M exceeds the judgment value. In pattern c, the SD value of L exceeds the judgment value. In pattern d, the SD values of H and M exceed the reference range. In pattern e, the SD values of M and L exceed the reference range. In pattern f, the SD values of H and L exceed the reference range. Further, in pattern g, the SD values of H, M, and L exceed the reference range. As mentioned above, the types and number of quality control samples exceeding the judgment value differ for each variation pattern. Pattern recognition when the SD value is exceeded is performed using the judgment value. Calculations for this pattern recognition are automatically performed each time a quality control sample is measured, and a judged cause is displayed on the screen showing the quality control together with the control chart. 
         [0048]    If pattern recognition can be automatically performed, it is possible to display the judged cause, together with an alarm, with reference to the judgment list shown in Table 2. 
         [0000]                                      TABLE 2                   Judgment list of possible causes                State of control   Detailed           Pattern   chart   Description   Possible cause               a   One of three SD   Only H (high   Degraded quality           values   concentration)   control substance H       b   increases.   Only M (medium   Degraded quality               concentration)   control substance M       c       Only L (low   Degraded quality               concentration)   control substance L       d   Two out of three   H and M   Degraded measurement           SD values       reagent       e   increase.   M and L   Degraded quality                   control substance       f       H and L   Incorrect calibration                   curve       g   Three SD values   Specific to item   Degraded measurement           increase.       reagent               All items   Mechanical factor                   (lamp, temperature,                   etc.)                    
Sample judgment (2)
 
         [0049]    Results of sample measurement are displayed as a control chart. The control chart provides a line of the judgment value for each of H, M, and L, Facilitating the visual recognition of a case where the three different quality control samples have variations correlating each other. The pattern of the control chart shown in  FIG. 5  is overlapped with the obtained control chart on the same screen, and the medical technologist visually judges pattern matching. The medical technologist clicks or checks the control chart having the same pattern on the screen to indicate the result of judgment based on a correspondence table like Table 2. Checking completes the registration of judgment results.