Pro-adrenomedullin to predict severity and outcome in community-acquired pneumonia [ISRCTN04176397]

Introduction  

Pro-adrenomedullin (proADM) is helpful for individual risk assessment and outcome prediction in sepsis. A major cause of sepsis is community-acquired pneumonia (CAP). The aim of this study was to investigate the value of proADM levels for severity assessment and outcome prediction in CAP.     

Hospital mortality prognostication in sepsis using the new biomarkers suPAR and proADM in a single determination on ICU admission

Purpose

The soluble form of the urokinase-type plasminogen activator receptor (suPAR) and proadrenomedullin (proADM) are two new and promising sepsis biomarkers. We assessed the prognostic value of a single determination of proADM and suPAR, comparing them with C-reactive protein (CRP) and procalcitonin (PCT), and evaluating whether their addition to severity scores (APACHE II and SOFA) could improve their prognostic accuracy.

Methods

A single-centre prospective observational study conducted in an adult intensive care department at Marques de Valdecilla University Hospital in Spain. APACHE II and SOFA scores, CRP, PCT, suPAR and proADM levels on the day of ICU admission were collected.

Results

A total of 137 consecutive septic patients were studied. The best area under the curve (AUC) for the prediction of in-hospital mortality was for APACHE II (0.82) and SOFA (0.75) scores. The ROC curve for suPAR yielded an AUC of 0.67, higher than proADM (0.62), CRP (0.50) and PCT (0.44). Significant dose-response trends were found between hospital mortality and suPAR (OR Q4 = 4.83, 95 % CI 1.60–14.62) and pro-ADM (OR Q4 = 3.00, 95 % CI 1.06–8.46) quartiles. Non-significant associations were found for PCT and CRP. The combination of severity scores and each biomarker did not provide superior AUCs.

Conclusions

SuPAR and, to a lesser extent, proADM levels on ICU admission were better tools in prognosticating in-hospital mortality than CRP or PCT. However, neither of the two new biomarkers has been demonstrated to be excessively useful in the current setting. The prognostic accuracy was better for severity scores than for any of the biomarkers.     

早期诊断严重脓毒症脓毒性休克研究进展

脓毒症(sepsis)可发展成严重脓毒症(severe sepsis)甚至脓毒性休克(septic shock),其发展转归有众多复杂的机制参与,包括宿主对感染的反应以及氧的传输和利用障碍等。早期诊断和积极干预脓毒症,有利于改善脓毒症的预后。早期诊断的生物学指标包括降钙素原(procal-citonin,PCT)、前肾上腺髓质素(proadrenom edullin,proADM)及前心房尿钠肽(pro-atrial natriuretic peptide,proANP)等。     

肾上腺髓质素N端20肽对血管紧张素Ⅱ刺激心肌成纤维细胞增殖、胶原合成的影响

目的:探讨肾上腺髓质素N端20肽(PAMP)对血管紧张素Ⅱ(angotesinⅡ,AngⅡ)刺激心肌成纤维细胞(CFs)增殖及胶原生成的影响。方法:采用胰酶消化、差速贴壁法培养新生SD大鼠CFs,以3H脯氨酸掺入法测定胶原合成、四氮唑盐(MTT)比色法测定细胞数目,分别观察不同浓度的PAMP、AngⅡ、及PAMP对ANGⅡ诱导CFs增生及胶原合成作用的影响。实验分组(1)空白对照组;(2)10-9、10-8、10-7、10-6mol/LAngⅡ组;(3)10-9、10-8、10-7、10-6mol/LPAMP组;(4)10-7mol/LAngⅡ+PAMP(10-9、10-8、10-7、10-6mol/L)组。结果:(1)随着PAMP浓度的增高,MTT比色值差异无显著性(F=10.21,P>0.05)。随着AngⅡ浓度的增高,MTT比色值也明显增高,各组间差异有显著性(P值均<0.01)。PAMP+AngⅡ组,随着PAMP浓度的增高,MTT比色值均显著降低(P<0.01)。(2)PAMP组的3H脯氨酸掺入率与对照组相比(F=16.92,P>0.05),各组之间差异无显著性。随着AngⅡ浓度的增高,CFs的3H脯...     

Measurement of midregional proadrenomedullin in plasma with an immunoluminometric assay

BACKGROUND: Adrenomedullin (ADM) is a potent vasodilatory peptide, and circulating concentrations have been described for several disease states, including dysfunction of the cardiovascular system and sepsis. Reliable quantification has been hampered by the short half-life, the existence of a binding protein, and physical properties. Here we report the technical evaluation of an assay for midregional pro-ADM (MR-proADM) that does not have these problems. METHODS: MR-proADM was measured in a sandwich immunoluminometric assay using 2 polyclonal antibodies to amino acids 45-92 of proADM. The reference interval was defined in EDTA plasma of 264 healthy individuals (117 male, 147 female), and increased MR-proADM concentrations were found in 95 patients with sepsis and 54 patients with cardiovascular disease. RESULTS: The assay has an analytical detection limit of 0.08 nmol/L, and the interassay CV was <20% for values >0.12 nmol/L. The assay was linear on dilution with undisturbed recovery of the analyte. EDTA-, heparin-, and citrate-plasma samples were stable (<20% loss of analyte) for at least 3 days at room temperature, 14 days at 4 degrees C, and 1 year at -20 degrees C. MR-proADM values followed a gaussian distribution in healthy individuals with a mean (SD) of 0.33 (0.07) nmol/L (range, 0.10-0.64 nmol/L), without significant difference between males or females. The correlation coefficient for MR-proADM vs age was 0.50 (P < 0.001). MR-proADM was significantly (P < 0.001) increased in patients with cardiovascular disease [median (range), 0.56 (0.08-3.9) nmol/L] and patients with sepsis [3.7 (0.72-25.4) nmol/L]. CONCLUSIONS: MR-proADM is stable in plasma of healthy individuals and patients. MR-proADM measurements may be useful for evaluating patients with sepsis, systemic inflammation, or heart failure.     

大面积烧伤患者血栓弹力图检测的临床意义

目的探讨血栓弹力图(TEG)在评价大面积烧伤患者体内凝血状态中的作用。方法对63例大面积烧伤患者(治疗组)进行TEG的测定,了解其凝血功能情况,并与52例健康体检者(对照组)的TEG相比较。结果60例大面积烧伤患者(治疗组)TEG均表现为高凝图像,R值(4.01±0.79 min),K值(0.90±0.15 min),Angle值(77.58±2.75°),MA值(73.89±5.64 mm)及CI值(4.21±0.90),与对照组R值(4.66±0.92 min),K值(1.45±0.48 min)相比较,治疗组R,K明显缩短,差异具有统计学意义(P<0.05)。与对照组Angle值(68.63±5.74°),MA值(62.33±6.31 mm)及CI值(1.79±0.74)相比较,治疗组明显变大,差异具有统计学意义(P<0.05)。结论大面积烧伤患者体内存在病理性高凝状态,应用TEG动态观察大面积烧伤患者凝血状态,对病情评估及指导治疗有重要意义。     

磁共振NODDI技术对阿尔兹海默病和遗忘型轻度认知障碍海马体微观结构的研究

目的利用神经突方向离散度和密度成像(neurite direction dispersion and density imaging,NODDI)分析阿尔兹海默病(Alzheimer's disease,AD)和遗忘型轻度认知障碍(amnestic mild cognitive impairment,aMCI)患者双侧...     

Predictive Value of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Swab PCR Assay for MRSA Pneumonia

Pneumonia due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with poor outcomes and frequently merits empirical antibiotic consideration despite its relatively low incidence. Nasal colonization with MRSA is associated with clinical MRSA infection and can be reliably detected using the nasal swab PCR assay. In this study, we evaluated the performance of the nasal swab MRSA PCR in predicting MRSA pneumonia. A retrospective cohort study was performed in a tertiary care center from January 2009 to July 2011. All patients with confirmed pneumonia who had both a nasal swab MRSA PCR test and a bacterial culture within predefined time intervals were included in the study. These data were used to calculate sensitivity, specificity, positive predictive value, and negative predictive value for clinically confirmed MRSA pneumonia. Four hundred thirty-five patients met inclusion criteria. The majority of cases were classified as either health care-associated (HCAP) (54.7%) or community-acquired (CAP) (34%) pneumonia. MRSA nasal PCR was positive in 62 (14.3%) cases. MRSA pneumonia was confirmed by culture in 25 (5.7%) cases. The MRSA PCR assay demonstrated 88.0% sensitivity and 90.1% specificity, with a positive predictive value of 35.4% and a negative predictive value of 99.2%. In patients with pneumonia, the MRSA PCR nasal swab has a poor positive predictive value but an excellent negative predictive value for MRSA pneumonia in populations with low MRSA pneumonia incidence. In cases of culture-negative pneumonia where initial empirical antibiotics include an MRSA-active agent, a negative MRSA PCR swab can be reasonably used to guide antibiotic de-escalation.     

血栓弹力图R值在重型颅脑损伤并发MODS中的作用

目的分析血栓弹力图各参数与重型颅脑损伤并发多器官功能障碍综合征（MODS）进展之间是否存在相关性，并探讨其临床应用价值。 方法选择2020年3月至2021年7月收治到广西医科大学附属武鸣医院重症医学科的重型颅脑损伤并发MODS共126例。以患者进入ICU时的SOFA评分值作为基线SOFA评分，将入院1周内SOFA评分值较基线SOFA是否增加≥2分设为MODS加重组（n=38）和MODS未加重组（n=88），比较2组TEG各参数差异是否对重型颅脑损伤并发MODS加重风险存在预警价值。 结果单因素分析显示不同MODS组间的性别差异无统计学意义（P＞0.05），R值、α角在不同MODS组间的差异有统计学意义（P＜0.05）；多因素Logistic回归分析显示R值降低是MODS加重的主要关联因素OR=0.371，95%CI（0.243~0.568），R值每降低1分钟，患者MODS加重的风险增加0.629倍；利用ROC曲线分析R值对MODS的预测价值，R值的cut-off值为1.900，AUC为0.121（P＜0.001），提示R值可以一定程度上预测MODS的发生。 结论R值降低对于重型颅脑损伤并发MODS病情加重的风险存在预警价值，并且具有更便利、更快捷的优势，可尽早提示临床进行积极有效的干预。     

基于磁共振扩散加权成像直肠癌ADC值与其分化程度及神经脉管侵犯相关性研究

目的探讨磁共振弥散加权成像中表观扩散系数(apparent diffusion coefficient,ADC)、指数化表观扩散系数(exponential apparent diffusion coefficient,e ADC)与直肠癌分化程度及神经脉管侵犯的相关性。材料与方法 32例直肠癌患者进行术前常规序列及b值为50、500、1000 s/mm~2的MR扩散加权序列检查,测定不同b值下瘤体、正常肠壁的ADC、e ADC值并比较其差异。同时比较同一分化程度肿瘤不同b值间ADC、e ADC值的差异以及同一b值不同分化程度、神经脉管侵犯是否阳性的肿瘤间ADC、e ADC值的差异及相关性。结果直肠癌在不同b值的弥散加权成像(diffusion weighted imaging,DWI)图像上,均表现为稍高或高信号,b值为50、500、1000 s/mm~2的瘤体平均ADC值分别为(2.732±0.805)×10~(-3) mm~2/s、(1.226±0.195)×10~(-3) mm~2/s、(1.042±0.228)×10~(-3) mm~2/s,瘤体e ADC值分别为(0.097±0.058)mm~2/s、(0.304±0.055)mm~2/s、(0.363±0.070)mm~2/s,随着b值升高,组织ADC值降低,e ADC值则升高。不同b值条件下,瘤体ADC值随着肿瘤分化程度增高而增高,e ADC值则相反,b值为500、1000 s/mm~2的序列中,差异有统计学意义(b=500 s/mm~2时,P=0.03,F=4.123;b=1000 s/mm~2时,P=0.001,F=10.797);除b=1000 s/mm~2中神经侵犯阳性组平均ADC值较阴性平均ADC值高外,其余组神经脉管侵犯阳性结果组平均ADC值均较阴性组ADC值低。进行不同b值下瘤区ADC值与其分化程度Spear_son相关性分析,当b值为1000 s/mm~2时,病变ADC值与分化程度呈正相关(r_s=0.742,P0.05),而与e ADC值呈负相关(r_s=-0.630,P0.05);b值为1000 s/mm~2的病灶的ADC值诊断直肠腺癌效能较佳。结论磁共振弥散加权成像ADC值及e ADC值在一定程度上能够反映肿瘤的分化程度及脉管癌栓受侵情况,ADC值可作为早期检测、直肠癌放化疗疗效及预后评价的重要影像学指标。     

非酒精性脂肪性肝病的瞬时弹性成像技术和声辐射力脉冲成像技术的定量评价

目的 探讨非酒精性脂肪性肝病(NAFLD)的瞬时弹性成像技术(Fibro Scan)和声辐射力脉冲成像技术(ARFI)的定量评价价值.方法 回顾性分析2019年1月～2021年1月间医院收治的90例NAFLD患者的临床资料,根据肝组织病理穿刺活检分为单纯脂肪肝组(38例)、非酒精性脂肪性肝炎(NASH)组(33例)、肝...     

Prostate-specific antigen and prostate gland volume: correlation and clinical application.

We studied 103 patients seen in our Prostate Cancer Detection Clinic to determine whether a correlation exists between serum prostate-specific antigen (PSA) values and ultrasound-calculated prostate gland volume. Seventy men (68%) had a PSA value less than or equal to 4 ng/ml (our upper limit of normal). The men were subclassified by prostate gland volume at arbitrary break points. Twenty-five men (24%) had a prostate gland volume less than or equal to 25 cm3; in 96%, the PSA value was less than or equal to 4 mg/ml. Further analysis revealed that the percentage of men with a normal serum PSA value decreased as the prostate gland volume increased; 65.6% of the group with a gland volume between 25 and 50 cm3 (40 of 61) and 35.5% of the group whose prostate volume exceeded 50 cm3 (6 of 17) had PSA values less than or equal to 4 ng/ml. Four men had PSA values greater than 20 ng/ml; all had prostate cancer. Cancer was diagnosed in four additional patients, three with PSA values between 5 and 10 ng/ml and one with a PSA value less than 4 ng/ml. There appears to be a direct relationship between prostate gland volume and PSA value, as well as a cancer value threshold. The clinical implications of these findings are discussed.     

Comparison of myocardial performance index versus ratio of isovolumic contraction time/ejection time in left ventricular systolic dysfunction

Myocardial performance index (MPI) has been regarded as an important parameter in the evaluation of ventricular systolic function in congestive heart failure. This study was designed to investigate the relationship between the ratio of isovolumic contraction time/left ventricular ejection time (IVCT/LVET), MPI, and LV systolic function. A total of 43 patients (patient group) with LV ejection fractions (LVEFs) <55% were compared with 43 patients (control group) with LVEF values ≥55%. LVEF was measured in all cases by 2-dimensional echocardiography via the modified Simpson method. Isovolumic relaxation time (IVRT), IVCT, LVET, ratio of IVCT/LVET, and MPI ([IVRT+IVCT]/LVET) were measured via Doppler echocardiography. The mean value for IVCT was found to be significantly higher (P<.001) and concomitant mean LVET value significantly lower (P=.027) in the patient group. Similarly, the mean value of MPI and the ratio of IVCT/LVET were found to be significantly higher (P<.001 for both) in the patient group. The value of the ratio of IVCT/LVET was found to have a significant negative correlation with the value of LVEF (r=-.947; P<.001) and a significant positive correlation with the value of MPI (r=.796; P<.001). The study reported here clearly demonstrates the noninferiority of the ratio of IVCT/LVET to MPI and the possibility of its substitution for MPI in the evaluation of LV systolic function.     

奇异值在评价舒张早期左心室流入血流中的应用

目的 探讨奇异值方法的左心室流入血流彩色多普勒信号特征,评估左室舒张功能变化.方法 选择左室舒张功能降低的各类心脏病患者163例,其中冠心病心肌梗死37例,冠心病心绞痛35例,扩张型心肌病45例,高血压46例,对照组30例.采用自制彩色多普勒超声分析系统,对舒张早期的左室血流图像进行彩色血流的色阶变化分析,自动显示与计算左室彩色血流传播速度的奇异值斜率(CV)与奇异值积分(AV).结果 左室舒张功能减低的心肌梗死、扩张型心肌病、心绞痛、高血压各组患者在所采集的舒张早期左室流人血流面积中,彩色血流奇异值CV(平均1.67～1.90)与奇异值AV(-0.11～-0.20)的绝对值均较对照组CV(2.40±0.22)、AV(-0.25±0.05)明显减小,差异具有统计学意义(P<0.001).结论 奇异值可反映左室彩色多普勒流入血流色阶差的变化,奇异值CV与奇异值AV能提示左室舒张功能的异常.     

醛固酮与肾素活性比值对原发性醛固酮增多症的诊断价值

目的 评价醛固酮与肾素活性比值(ALD/PRA,ARR)对原发性醛固酮增多症(PA)的诊断价值.方法 回顾性收集44例PA、9例嗜铬细胞瘤、8例无功能性瘤、12例库欣综合征、4例肾动脉狭窄及13例原发性高血压患者的ALD、PRA结果,计算ARR,采用受试者操作特性(ROC)曲线评价各项指标的诊断价值.结果 卧位ALD ROC曲线下面积为0.947,临界值(cut-off值)为174.1 ng/L时,敏感度为86.4%,特异度为91.3%.立位ALDROC曲线下面积为0.889,cut-off值为209.8 ng/L时,敏感度为84.1%,特异度为87.0%.卧位ARR ROC曲线下面积为0.978,cut-off值为40.8 ng·dl-1/ng·ml-1·h-1时,敏感度为95.5%,特异度为95.7%;立位ARR ROC曲线下面积为0.981,cut-off值为35.26 ng·dl-1/ng·ml-1·h-1时,敏感度为95.5%,特异度为93.5%;联合立位ARR和立位ALD,其诊断价值明显优于单一指标,当立位ALD>275 ng/L,立位ARR ROC曲线下面积为0.989,cut-off值为23.73 ng·dl-1/ng·ml-1·h-1时,特异度为100%,敏感度为95.7%.结论 ARR诊断PA的价值高于ALD、PRA,立位ARR优于卧位,当联合立位AID>275ng/L,则诊断价值更大.     

斑点追踪技术测量三尖瓣环位移评价右心室收缩功能的临床研究

目的 应用超声二维斑点追踪技术测定三尖瓣环收缩期位移(TAD),并分析其与右室射血分数(RVEF)之间的相关性,旨在为评价右室收缩功能寻找一种便捷、实用的新方法.方法 研究对象为24例健康志愿者(对照组)及16例充血性心力衰竭患者(心衰组,其中扩张型心肌病13例,缺血型心肌病3例),记录心尖四腔观二维图像并输入Qlab 6.0工作站自动测量右室游离壁处三尖瓣环收缩期峰值位移(TADla)、三尖瓣环连线中点处收缩期峰值位移(TADmid).应用实时三维超声心动图计算RVEF,并分析TAD参数与RVEF之间的关系.结果 40例受检者TADla平均(19.3±5.9)mm(7.8～28.4 mm),TADmid平均(15.3±4.6)mm(7.2～22.2 mm).与对照组比较,心衰组各参数均显著降低(P<0.01);TADla、TADmid与RVEF显著正相关,相关系数分别为0.87和0.91,直线相关方程分别为RVEF=2.2 TADla + 9.9和RVEF=3.0TADmid+7.1.TADla评价RVEF<45%的截断点值为17.2 mm,敏感性为89%,特异性为93%;TADmid评价RVEF<45%的截断点值为13.1 mm,敏感性为96%,特异性为100%.结论 超声二维斑点追踪技术测定的TAD与RVEF之间存在良好的相关性,有望成为临床常规评价右室整体收缩功能的新方法.     

DSC-MRI和IVIM在鉴别高级别脑胶质瘤术后复发和放射性脑损伤的初步研究

目的探讨磁共振动态磁敏感对比增强(dynamic susceptibility weighted contrast enhanced,DSC-MRI)和体素不相干运动扩散加权成像(intravoxelincoherentmotion,IVIM)在鉴别高级别脑胶质瘤术后复发及放射性脑损伤的应用价值。材料与方法收集高级别脑胶质瘤术后切除+同步放化疗后行MRI检查的32例患者,且MRI影像检查中出现新增异常强化灶。根据二次手术或随访结果分为肿瘤复发组(22例)及放射性脑损伤组(10例)。测量两组患者的相对脑血容量(relative cerebral blood volume,rCBV)、纯扩散系数(true diffusion coefficient,D)、灌注相关扩散系数(perfusion related diffusion coefficient,D^*)、灌注分数(perfusionfraction,f)等参数。采用独立样本t检验分析两组间的差异,进行受试者工作特征(receiver operating characteristic,ROC)曲线的绘制并计算曲线下面积、敏感度、特异度;采用Pearson检验分析参数间相关性。结果复发组rCBV值、D^*值、f值均高于放射性脑损伤组,差异有统计学意义(P<0.05),复发组D值低于放射性脑损伤组,差异有统计学意义(P<0.05),ROC曲线分析,rCBV值、D值、D^*值、f值曲线下面积为0.832、0.709、0.814、0.780,灵敏度分别为72.7%、86.4%、81.8%、95.5%,特异度分别为90.0%、50.0%、80.0%、50.0%。DSC-MRI联合IVIM诊断时,曲线下面积为0.891,灵敏度及特异度分别为81.8%、90.0%;D^*值(r=0.542,P<0.05)、f值(r=0.352,P<0.05)与rCBV值成正相关。结论DSC-MRI联合IVIM在胶质瘤复发和放射性脑损伤的鉴别诊断中具有重要的临床应用价值,且rCBV值与D^*、f值之间有一定的相关性。     

3.0T MR ADC值与T2值定量测量在颈部淋巴瘤诊断价值的研究

目的比较3.0T MR ADC值及T2值定量测量在颈部淋巴瘤诊断中的价值。材料与方法对24例颈部淋巴瘤初发患者（初发组）及24例正常对照组进行MRI及ADC值和T2值的测量,淋巴瘤病例在治疗3个月后作为治疗后组再次进行扫描及测量。ADC值及T2值由ADC图和T2图直接获得。用LSD检验进行组间两两比较。结果在DWI上,无论是淋巴瘤患者或正常志愿者,淋巴结均呈高信号,在ADC图上呈低信号。在T2扫描序列,在不同的T2回波时间,淋巴结呈高信号,T2图上淋巴结呈等信号。ADC值和T2值在淋巴瘤初发组、治疗后组及正常对照组之间分别为（745.92±109.74）×10-6mm2/s和（87.18±9.35）ms,（1303.97±276.59）×10-6mm2/s和（93.30±11.21）ms,（1116.91±82.08）×10-6mm2/s和（96.44±4.40）ms;除T2值在治疗后组与正常对照组间差异无统计学意义（P〉0.05）,其余两两比较,差异均有统计学意义（P〈0.05）。根据ROC曲线,区分淋巴瘤患者及正常对照的ADC值最佳诊断界值是1003.065×10-6mm2/s,此时敏感度为100%,特异度为91.7%。T2值的最佳诊断界值90.92ms,此时敏感度为62.5%,特异度为91.7%。结论 3.0TMRADC值和T2值定量测量是颈部淋巴瘤诊断的重要测量指标。ADC值的诊断敏感度及特异度优于T2值。.     

磁共振弥散张量成像对弥漫性轴索损伤的研究

目的探索高场强磁共振弥散张量成像(DTI)对弥漫性轴索损伤的评价价值.方法脑外伤病人12例及正常对照组13例,分别应用常规MR扫描及弥散张量成像技术.在FA图上分别测量创伤组及对照组双侧半球白质感兴趣区镜像部位FA值,将两组相应感兴趣区FA值均值进行比较,观察有无明显差异.并将创伤组FA值均值与临床GCS评分进行相关分析.结果创伤组与对照组FA值有明显差异,创伤组双侧内囊后肢FA值与GCS评分有较好相关性.结论磁共振弥散张量成像技术对白质损伤敏感,并能反映其损伤程度,是目前活体诊断弥漫性轴索损伤准确的检查方法.     

完全性川崎病患儿血清 25-羟基维生素 D水平检测对预测 IVIG抵抗的价值研究

目的　探讨完全性川崎病（ complete Kawasaki disease, CKD）患儿血清 25-羟基维生素 D[25-hydroxyvitamin D, 25-(OH)D]预测静脉注射免疫球蛋白（ intravenous immunoglobulin, IVIG）抵抗的价值。方法　以 2018年全年在西安市儿童医院确诊为 CKD的患儿 105例为研究对象（其中 IVIG抵抗者 14例），绘制 25-(OH)D预测 IVIG抵抗的受试者工作特征曲线（ receiver operator characteristic curve，ROC），并确定截断值（ cut-o.值）；同期 45例健康儿童为对照。以 2019年全年的 CKD患者检验该 cut-o.值预测 IVIG抵抗的效能。所有研究对象血清 25-(OH)D浓度由电化学发光法测定。结果　健康对照组血清 25-(OH)D水平 [36.1（29.3~46.2）ng/ml]高于 CKD组 [25.2（18.9~33.1）ng/ml]，差异有统计学意义（Z=-4.823, P<0.001）；IVIG抵抗组 [18.1（16.4~21.8）ng/ml]低于 IVIG敏感组 [27.2（20.4~34.7）ng/ml]，差异有统计学意义（ Z=-3.700, P<0.001）；血清 25-(OH)D在 25.17 ng/ml时尤登指数最大（为 0.473），ROC曲线下面积 0.818。在实际应用中，以 25.17 ng/ml为 cut-o.值，血清 25-(OH)D预测 CKD-IVIG抵抗的敏感度、特异度、阳性预测值、阴性预测值、诊断准确度分别为 81.2%，62.1%，25.0%，95.5%和 64.7%。结论　血清 25-(OH)D的定量检测对 CKD患儿 IVIG抵抗有较好的预测作用；CKD患儿血清 25-(OH)D高于 25.17ng/ml时发生 IVIG抵抗的可能性较低。