前言：

       作為制藥行業(yè)的GMP實(shí)驗(yàn)室，每天都會(huì)有大量的數(shù)據(jù)產(chǎn)生，按照數(shù)據(jù)承載的載體可以分為電子的數(shù)據(jù)、紙質(zhì)的數(shù)據(jù)或者混合的數(shù)據(jù)（Hybrid system），按照數(shù)據(jù)的類型可大致分為檢測放行的數(shù)據(jù)、驗(yàn)證相關(guān)數(shù)據(jù)或外圍輔助系統(tǒng)產(chǎn)生數(shù)據(jù)等，如此多的數(shù)據(jù)和記錄中，有哪些需要第二人的復(fù)核？

       1.目的：實(shí)驗(yàn)室數(shù)據(jù)的第二人復(fù)核指分析員完成檢測后，第二人對(duì)于檢測結(jié)果的準(zhǔn)確性的復(fù)核，本文結(jié)合國內(nèi)外GMP法規(guī)、指南及數(shù)據(jù)完整性對(duì)于數(shù)據(jù)復(fù)核的相關(guān)要求，探討實(shí)驗(yàn)室那些數(shù)據(jù)需要第二人的復(fù)核。

       2.術(shù)語：在展開討論前，我們先了解下法規(guī)指南中關(guān)于審核和復(fù)核的相關(guān)術(shù)語：

       Review 審核

       Double check 再次確認(rèn)

       Four-eyes principle (a contemporaneous reading by a second analyst) 四眼原則

       Independent verification 獨(dú)立復(fù)核

       A contemporaneous enumeration 同步計(jì)數(shù)

       A contemporaneous verification 同步復(fù)核

       Review need to be performed in real-time 實(shí)時(shí)審核

       3.法規(guī)和指南規(guī)定（第二人復(fù)核）

       3.1Medicines & Healthcare products Regulatory Agency (MHRA) ‘GXP’ Data Integrity Guidance and Definitions

       Where the data obtained requires manual observation to record (for example results of a manual titration, visual interpretation of environmental monitoring plates) the process should be risk assessed and depending on the criticality, justify if a second contemporaneous verification check is required or investigate if the result could be captured by an alternate means.

       對(duì)于人工觀察并記錄的數(shù)據(jù)，例如手工滴定，環(huán)境監(jiān)測平皿計(jì)數(shù)，應(yīng)基于風(fēng)險(xiǎn)及數(shù)據(jù)的關(guān)鍵程度，論述第二人的同步確認(rèn)是否需要或者檢測的結(jié)果用其他可替代的途徑獲取。

       3.2PICS Good Practices for Data Management and Integrity in Regulated GMP-GDP Environments 202107

       Additional controls should be considered when critical test interpretations are made by a single individual (e.g. recording of microbial colonies on agar plates). A secondary review may be required in accordance with risk management principles. In some cases this review may need to be performed in real-time. Suitable electronic means of verifying critical data may be an acceptable alternative, e.g. taking photograph images of the data for retention.

       當(dāng)關(guān)鍵檢測是由單人進(jìn)行解讀時(shí)（例如，記錄瓊脂平皿上的微生物菌落），應(yīng)考慮額外的控制。根據(jù)風(fēng)險(xiǎn)管理原則，可能需要進(jìn)行二次審核。在某些情況下，這種審核可能需要實(shí)時(shí)進(jìn)行?？梢越邮懿捎煤线m的電子手段核實(shí)關(guān)鍵數(shù)據(jù)作為替代方法，例如：對(duì)數(shù)據(jù)拍照留存。

       3.3USP 1117 MICROBIOLOGICAL BEST LABORATORY PRACTICES

       An important data integrity threat with microbiological testing resides with falsification of data and intentional omission of testing results. To control this risk, the company culture and ethical standards are essential as well as the application of a rigorous quality management system.

       微生物檢測的一個(gè)重要的數(shù)據(jù)完整性威脅在于偽造數(shù)據(jù)和故意遺漏檢測結(jié)果。為了控制這種風(fēng)險(xiǎn)，公司文化和道德標(biāo)準(zhǔn)以及嚴(yán)格的質(zhì)量管理體系的應(yīng)用是必不可少的。

       For the compendia sterility test that combines criticality of the test and higher risk of misinterpretation of results, it is now a standard practice to have a second analyst perform a contemporaneous evaluation of the sample (in test media) for microbial growth. Nonetheless, applying uncritically a contemporaneous reading by a second analyst (four-eyes principle) for all samples and microbiological tests is not recommended. Precision in counts may vary from one analyst to another (even if they are trained and qualified) as colonies may overlap, swarm over media, etc., allowing for misinterpretation. Microbiology is a “l(fā)ogarithmic science”; sample size is statistically weak and testing procedures have inherent variability. By tolerating no differences in counts, a high number of non-critical deviations will be generated, thus consuming resources unreasonably. As an alternative to a contemporaneous enumeration, a contemporaneous verification by a second person that the testing activity is performed correctly may be executed for higher risk tests. A second person could verify, for instance, if the reading of results is correctly executed according to the procedure, if the result on the Petri plate is correctly transcribed onto the GMP recording sheet (i.e. if growth is observed this is captured in the GMP sheet), and if the description of the sample corresponds to the description on the GMP recording sheet. An assessment of the risk due to a misinterpreted result and its impact on patient safety is performed to determine the high risk test outlined above.

       考慮到檢測項(xiàng)目的關(guān)鍵性和結(jié)果易出現(xiàn)差錯(cuò)的無菌檢測，現(xiàn)在的通用的做法是讓第二名分析人員對(duì)樣品(培養(yǎng)基中)進(jìn)行微生物生長的同時(shí)觀察。盡管如此，不建議對(duì)所有樣品和微生物測試不加批判地應(yīng)用由第二個(gè)分析人員(四眼原則)同時(shí)進(jìn)行讀數(shù)。計(jì)數(shù)的精度可能因分析人員而異(即使他們受過訓(xùn)練并有資格)，因?yàn)榫淇赡苤丿B，聚集在培養(yǎng)基上，等等，允許誤解。微生物學(xué)是一門“對(duì)數(shù)科學(xué)”；樣本大小在統(tǒng)計(jì)上是微弱的，測試程序具有內(nèi)在的可變性。如果不允許計(jì)數(shù)上的差異，就會(huì)產(chǎn)生大量的非關(guān)鍵偏差，從而不合理地消耗資源。作為同時(shí)枚舉的一種替代方法，由第二個(gè)人同時(shí)驗(yàn)證測試活動(dòng)是否正確執(zhí)行，可以用于更高風(fēng)險(xiǎn)的測試執(zhí)行驗(yàn)證。第二個(gè)人可以確認(rèn)，例如，結(jié)果的讀取是否按照程序正確執(zhí)行，培養(yǎng)皿上的結(jié)果是否正確轉(zhuǎn)錄到GMP記錄頁上(即，如果觀察到生長，則在GMP記錄頁上記錄)，并且樣品的描述是否與GMP記錄頁上的描述相對(duì)應(yīng)。對(duì)錯(cuò)誤解釋結(jié)果的風(fēng)險(xiǎn)及其對(duì)患者安全的影響進(jìn)行評(píng)估，以確定上述高風(fēng)險(xiǎn)測試。

       3.4WHO ECSPP TRS 1033 Annex 4 Guideline on data integrity 202103

       Example 3: Data entry

       Data entry includes for example sample receiving registration, sample analysis result recording, logbook entries, registers, batch manufacturing record entries and information in case report forms. The recording of source data on paper records should be done using indelible ink, in a way that is complete, accurate, traceable, attributable and free from errors. Direct entry into electronic records should be done by responsible and appropriately trained individuals. Entries should be traceable to an individual (in electronic records, thus having an individual user access) and traceable to the date (and time, where relevant). Where appropriate, the entry should be verified by a second person or entered through technical means such as the scanning of bar-codes, where possible, for the intended use of these data. Additional controls may include the locking of critical data entries after the data are verified and a review of audit trails for critical data to detect if they have been altered. The manual entry of data from a paper record into a computerized system should be traceable to the paper records used which are kept as original data.

       數(shù)據(jù)錄入包括如下示例，例如樣品接收登記、樣品分析結(jié)果記錄、日志錄入、登記、批生產(chǎn)記錄錄入以及病例報(bào)告表中的信息。在紙質(zhì)記錄上記錄源數(shù)據(jù)時(shí)，應(yīng)使用不可擦除的墨水，且以完整、準(zhǔn)確、可追溯、可歸屬且沒有錯(cuò)誤的方式記錄。應(yīng)由負(fù)責(zé)任的，經(jīng)過適當(dāng)培訓(xùn)的人員直接錄入電子記錄。錄入應(yīng)可追溯到個(gè)人（在電子記錄中，單個(gè)用戶訪問），并且可追溯到日期（和時(shí)間，如相關(guān)）。在適用情況下，錄入應(yīng)由第二人核實(shí)，或盡可能針對(duì)這些數(shù)據(jù)預(yù)期用途通過技術(shù)手段錄入，例如條形碼掃描。其他控制可能包括：在數(shù)據(jù)核對(duì)后鎖定關(guān)鍵數(shù)據(jù)錄入，以及審查關(guān)鍵數(shù)據(jù)的審計(jì)追蹤以檢測數(shù)據(jù)是否被更改過。經(jīng)數(shù)據(jù)從紙質(zhì)記錄手動(dòng)錄入到計(jì)算機(jī)化系統(tǒng)應(yīng)該可以追溯到所使用的作為原始數(shù)據(jù)保存的紙質(zhì)記錄。

       3.5 EU gmp Annex 11: Computerized Systems

       6. Accuracy Checks

       For critical data entered manually, there should be an additional check on the accuracy of the data. This check may be done by a second operator or by validated electronic means. The criticality and the potential consequences

       關(guān)鍵數(shù)據(jù)的手動(dòng)輸入應(yīng)由第二個(gè)操作員或經(jīng)驗(yàn)證的計(jì)算機(jī)化方法復(fù)核。

       3.6 PICS Good Practices for Data Management and Integrity in Regulated GMP-GDP Environments 202107

       9.7 Data capture/entry for computerized systems.

       - All manual data entries of critical data should be verified, either by a second operator, or by a validated computerized means.

       - 所有關(guān)鍵數(shù)據(jù)的手動(dòng)輸入應(yīng)由第二個(gè)操作員或經(jīng)驗(yàn)證的計(jì)算機(jī)化方法復(fù)核。

       3.7 對(duì)比分析：

       ● 對(duì)于人工觀察并記錄的實(shí)驗(yàn)室檢測數(shù)據(jù)（例如手動(dòng)滴定、平皿計(jì)數(shù)等），MHRA和PICS數(shù)據(jù)完整性指南中均要求要基于風(fēng)險(xiǎn)和數(shù)據(jù)的關(guān)鍵程度，必要時(shí)第二人同步復(fù)核或采取可替代的數(shù)據(jù)獲取方式，

       ● USP 1117中規(guī)定，微生物檢測的一個(gè)重要的數(shù)據(jù)完整性威脅在于偽造數(shù)據(jù)和故意遺漏檢測結(jié)果，考慮到檢測項(xiàng)目的關(guān)鍵性和結(jié)果易出現(xiàn)差錯(cuò)的無菌檢測，現(xiàn)在的通用的做法是讓第二名分析人員對(duì)樣品(培養(yǎng)基中)進(jìn)行微生物生長的同時(shí)觀察。盡管如此，考慮到微生物檢測項(xiàng)目的特殊性不建議對(duì)所有樣品和微生物測試不加批判地應(yīng)用由第二個(gè)分析人員(四眼原則)同時(shí)進(jìn)行讀數(shù)。

       ● 對(duì)于人工錄入的關(guān)鍵數(shù)據(jù)需要第二個(gè)操作員或經(jīng)驗(yàn)證的計(jì)算機(jī)化方法復(fù)核，EU GMP Annex 11 和PICS及WHO數(shù)據(jù)完整性指南中均有相關(guān)規(guī)定。

       思考：綜合上述分析，應(yīng)基于風(fēng)險(xiǎn)和數(shù)據(jù)的關(guān)鍵程度來決定是否需要第二人復(fù)核，如何進(jìn)行數(shù)據(jù)關(guān)鍵程度的風(fēng)險(xiǎn)評(píng)估。

       4. 實(shí)驗(yàn)室關(guān)鍵數(shù)據(jù)的評(píng)估

       4.1 WHO Guidance on good data and record management practices

       Critical GXP：data with a direct impact on patient safety or product quality

       關(guān)鍵數(shù)據(jù)：數(shù)據(jù)直接影響到病人的安全或最終產(chǎn)品的質(zhì)量。

       4.2 Medicines & Healthcare products Regulatory Agency (MHRA)

       ‘GXP’ Data Integrity Guidance and Definitions

       4. Establishing data criticality and inherent integrity risk

       4.1 Data has varying importance to quality, safety and efficacy decisions. Data criticality may be determined by considering how the data is used to influence the decisions made.

       數(shù)據(jù)關(guān)鍵性及數(shù)據(jù)完整性風(fēng)險(xiǎn)

       數(shù)據(jù)對(duì)于藥品質(zhì)量、安全及有效性的影響存在差異，數(shù)據(jù)的關(guān)鍵程度可以通過對(duì)于相關(guān)決策的影響程度來判定。

       4.3 PICS GOOD PRACTICES FOR DATA MANAGEMENT AND INTEGRITY IN REGULATED GMP/GDP ENVIRONMENTS/ EU GMP DT Q&As

       5.4 Data criticality

       5.4.1 The decision that data influences may differ in importance and the impact of the data to a decision may also vary. Points to consider regarding data criticality include:

       Which decision does the data influence?

       For example: when making a batch release decision, data which determines compliance with critical quality attributes isnormally of greater importance than warehouse cleaning records.

       What is the impact of the data to product quality or safety?

       For example: for an oral tablet, API assay data is of generally greater impact to product quality and safety than tablet friability data.

       數(shù)據(jù)的關(guān)鍵性

       數(shù)據(jù)對(duì)于決策的影響與數(shù)據(jù)的重要性有關(guān)，數(shù)據(jù)對(duì)于決策的影響也存在差異，數(shù)據(jù)關(guān)鍵性的考慮點(diǎn)如下：

       數(shù)據(jù)影響到什么決策？

       例如：放行決策，影響到關(guān)鍵質(zhì)量屬性的測試要比倉庫清潔記錄重要。

       對(duì)于產(chǎn)品質(zhì)量和安全性的影響

       例如：口服片劑，API含量檢測數(shù)據(jù)要比片劑的松脆度關(guān)鍵。

       Additional controls should be considered when critical test interpretations are made by a single individual (e.g. recording of microbial colonies on agar plates). A secondary review may be required in accordance with risk management principles. In some cases, this review may need to be performed in real-time.

       4.4 EMA guidance on good manufacturing practice and good distribution practice questions and answers

       How can data criticality be assessed?

       The decision that data influences may differ in importance and the impact of the data to a decision may also vary. Points to consider regarding data criticality include:

       Which decision does the data influence?

       For example: when making a batch release decision, data which determines compliance with critical quality attributes isnormally of greater importance than warehouse cleaning records.

       What is the impact of the data to product quality or safety?

       For example: for an oral tablet, API assay data is of generally greater impact to product quality and safety than tablet dimensions data.

       數(shù)據(jù)的關(guān)鍵性

       數(shù)據(jù)對(duì)于決策的影響與數(shù)據(jù)的重要性有關(guān)，數(shù)據(jù)對(duì)于決策的影響也存在差異，數(shù)據(jù)關(guān)鍵性的考慮點(diǎn)如下：

       數(shù)據(jù)影響到什么決策？

       例如：放行決策，影響到關(guān)鍵質(zhì)量屬性的測試要比倉庫清潔記錄重要。

       對(duì)于產(chǎn)品質(zhì)量和安全性的影響

       例如：口服片劑，API含量檢測數(shù)據(jù)要比片劑的尺寸關(guān)鍵。

       Additional controls should be considered when critical test interpretations are made by a single individual (e.g. recording of microbial colonies on agar plates). A secondary review may be required in accordance with risk management principles. In some cases, this review may need to be performed in real-time.

       4.5 APIC Practical risk-based guide for managing Data Integrity

       Data severity assessment: within CGxP data, different levels of severity can be defined as a function of its use. Typically, this is linked to the stage of manufacturing following the principle of increasing CGxP outlined in ICH Q7. Alternatively, other factors such as impact on final product quality can be taken into account to further differentiate between severity categories.

       數(shù)據(jù)關(guān)鍵程度的評(píng)估應(yīng)基于生產(chǎn)的步驟及對(duì)于最終產(chǎn)品質(zhì)量的影響

       4.6 PDA 80 Data integrity management system for pharmaceutical laboratories

       Data integrity controls should be based on quality risk management principles such as ICH Q9, that is, the level of controls, verification, and oversight should be commensurate with the criticality of the data to patient safety and with the risk to data accuracy, completeness, fabrication or falsification.

       數(shù)據(jù)完整性控制應(yīng)基于質(zhì)量風(fēng)險(xiǎn)管理原則，如ICH Q9，即控制、復(fù)核和監(jiān)督的水平應(yīng)與數(shù)據(jù)對(duì)患者安全的重要性以及數(shù)據(jù)準(zhǔn)確性、完整性、偽造或偽造的風(fēng)險(xiǎn)相一致。

       A risk matrix can be established using criticality of the test and maturity of the quality system and use of risk reducing technology. Data criticality can be established based on whether the test is for a critical quality attribute (CQA), such as a sterility test; a critical process control (CPC), such as an environmental monitoring test; or an in process control or other test, such as environmental monitoring for nonsterile products. Figure 7.21 shows a risk matrix applied to data integrity. In this example, the matrix is used to establish which microbiological tests require second person verification prior to approving test results.

       結(jié)合檢驗(yàn)的關(guān)鍵性、質(zhì)量體系的成熟度和降低風(fēng)險(xiǎn)的技術(shù)，可以建立風(fēng)險(xiǎn)矩陣。可以根據(jù)測試是否為關(guān)鍵質(zhì)量屬性(CQA)(如無菌檢查)來確定數(shù)據(jù)的關(guān)鍵性，關(guān)鍵工藝控制(CPC)，如環(huán)境監(jiān)測試驗(yàn)；或者過程控制/其他測試，如非無菌產(chǎn)品的環(huán)境監(jiān)測。下圖顯示了應(yīng)用于數(shù)據(jù)完整性的風(fēng)險(xiǎn)矩陣。在本例中，矩陣用于確定在批準(zhǔn)測試結(jié)果之前，哪些微生物測試需要第二人復(fù)核。

       微生物實(shí)驗(yàn)室數(shù)據(jù)關(guān)鍵程度矩陣圖：

       4.7 對(duì)比分析：

       數(shù)據(jù)的關(guān)鍵程度應(yīng)基于數(shù)據(jù)對(duì)于產(chǎn)品放行決策的影響和數(shù)據(jù)對(duì)于產(chǎn)品質(zhì)量和病人用藥的風(fēng)險(xiǎn)。

       5.總結(jié)：

       5.1QC內(nèi)部需要人工觀察并記錄的相關(guān)數(shù)據(jù)不同于電子數(shù)據(jù)或打印輸出數(shù)據(jù)，此類數(shù)據(jù)的追溯性相對(duì)較弱，出現(xiàn)人為差錯(cuò)后的可檢測手段較電子數(shù)據(jù)或打印輸出數(shù)據(jù)相對(duì)較少，結(jié)合相關(guān)數(shù)據(jù)完整性指南的要求，對(duì)于QC內(nèi)部需要人工觀察并手動(dòng)記錄的數(shù)據(jù)，應(yīng)結(jié)合影響產(chǎn)品放行決策和對(duì)病人用藥的安全性的影響進(jìn)行數(shù)據(jù)關(guān)鍵性的評(píng)估，基于數(shù)據(jù)關(guān)鍵性及其風(fēng)險(xiǎn)，考慮進(jìn)行第二人復(fù)核來降低風(fēng)險(xiǎn)。

       5.2同時(shí)對(duì)于關(guān)鍵數(shù)據(jù)的第二人復(fù)核的“同步/實(shí)時(shí)”，是否有時(shí)間限要求？應(yīng)基于數(shù)據(jù)的可追溯性，選擇適當(dāng)?shù)牟呗赃M(jìn)行：

       ● 數(shù)據(jù)承載的載體后續(xù)不可得，例如手工滴定分析，應(yīng)做到同步并及時(shí)的結(jié)果復(fù)核；

       ● 數(shù)據(jù)承載的載體可得但隨時(shí)間的推移，檢測結(jié)果會(huì)發(fā)生變化，例如溶液顏色，應(yīng)做到同步并及時(shí)的結(jié)果復(fù)核；

       ● 數(shù)據(jù)承載的載體可得可追溯，例如無菌檢測，應(yīng)在數(shù)據(jù)承載的載體（培養(yǎng)基）銷毀前完成復(fù)核，可參考USP1117微生物樣品觀察時(shí)限的要求，觀察的上午或下午完成檢測結(jié)果的復(fù)核；需要注意的是微生物的平皿計(jì)數(shù)測試，雖載體可得可追溯，但平皿觀察環(huán)境及培養(yǎng)時(shí)間可能對(duì)于后續(xù)的微生物生長產(chǎn)生影響，建議及時(shí)進(jìn)行復(fù)核。

       ● 對(duì)于關(guān)鍵數(shù)據(jù)的人工錄入的第二人復(fù)核，可采取上述的原則進(jìn)行。

       備注：文中法規(guī)和指南的英文部分為法規(guī)和指南原文，中文部分為作者解讀和翻譯，供參考。