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  

Value of Serum 25-Hydroxyvitamin D Levels in the Prediction of Intravenous Immunoglobulin Resistance in Patients with Complete Kawasaki Disease

作　　者：黄君华 崔自明 张书婉 祝撷英[3] 曹三成[3] HUANG Jun-hua;CUI Zi-ming;ZHANG Shu-wan;ZHU Xie-ying;CAO San-cheng(Department of Medical Technology,Xi’an Medical University,Xi’an 710021,China;Department of Guangmingqiao Outpatient Jingdong Medical District,Chinese PLA General Hospital,Beijing 100061,China;Department of Clinical Laboratory,Xi’an Children’s Hospital,Xi’an 710003,China)

机构地区：[1]西安医学院医学技术学院,西安710021 [2]解放军总医院京东医疗区光明桥门诊部,北京100061 [3]西安市儿童医院检验科,西安710003

出　　处：《现代检验医学杂志》2022年第1期28-32,共5页Journal of Modern Laboratory Medicine

基　　金：陕西省自然科学基础研究计划项目(2020JQ-884);西安市儿童医院院级课题扶持项目(2019C10)。

摘　　要：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-off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-off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-off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。Objective To explore the value of serum 25-hydroxyvitamin D[25-(OH)D]levels in the prediction intravenous immunoglobulin(IVIG)resistance in patients with complete Kawasaki disease(CKD).Methods The total of 105 children with CKD hospitalized in Xi’an Children Hospital in 2018 were enrolled in this study to yield a receiver operating characteristic curve(ROC curve)and determine the cut-off value of 25-(OH)D concentration in predicting IVIG resistance.Meanwhile,45 healthy children were enrolled as control group.Then,evaluated the prediction efficiency of the cut-off value of serum 25-(OH)D for IVIG resistance in CKD population hospitalized in Xi’an Children Hospital in 2019.Electrochemiluminescence immunoassay was applied to measure the serum levels of 25-(OH)D of the enrolled individuals.Results The serum levels of 25-(OH)D were higher in control children than in CKD patients[36.1(29.3~46.2)ng/ml vs 25.2(18.9~33.1)ng/ml],the difference was statistically significant(Z=-4.823,P<0.001),and serum 25-(OH)D levels of IVIG resistance group[18.1(16.4~21.8)ng/ml]were significantly lower than that of non-IVIG resistance group[27.2(20.4~34.7)ng/ml],the difference was statistically significant(Z=-3.700,P<0.001).When the cut-off value of serum 25-(OH)D concentration was at 25.17 ng/ml,the area under the ROC curve(AUC)was 0.818 with a largest Youden index(0.473).Moreover,the cut-off value of 25.17 ng/ml to predict IVIG resistance yielded a sensitivity,specificity,positive predictive value,negative predictive value and diagnostic accuracy were 81.2%,62.1%,25.0%,95.5%and 64.7%,respectively.Conclusion Serum 25-(OH)D levels have a contributive role in the prediction of IVIG resistance in CKD.CKD patients with a serum 25-(OH)D concentration higher than 25.17 ng/ml might not develop IVIG resistance.

关 键 词：维生素D 川崎病 静脉注射免疫球蛋白抵抗 受试者工作特征曲线 

分 类 号：R725.5[医药卫生—儿科] R446.11[医药卫生—临床医学]