维持性血液透析患者血清碱性磷酸酶与钙磷代谢及炎症指标相关性分析

黄梦娣; 陈卫东; 刘磊

doi:10.16766/j.cnki.issn.1674-4152.002942

维持性血液透析患者血清碱性磷酸酶与钙磷代谢及炎症指标相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.002942

蚌埠医学院第一附属医院肾脏科, 安徽蚌埠 233004

基金项目:

安徽省重点研究与开发计划项目 202004j07020011

详细信息

通讯作者:
刘磊, E-mail: bbmcll@163.com

中图分类号: R459.5 R692
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出版历程
- 收稿日期: 2022-09-15
- 网络出版日期: 2023-05-31

Correlation analysis of serum alkaline phosphatase with calcium and phosphorus metabolism and inflammatory markers in maintenance hemodialysis patients

Department of Nephrology, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨维持性血液透析(MHD)患者血清碱性磷酸酶(ALP)水平变化情况及其临床应用价值。方法纳入2020年10月—2021年5月在蚌埠地区5家血液净化中心进行MHD的患者736例。根据血清ALP水平的四分位数分为4组，分别对4组患者一般资料、实验室指标进行统计学比较，并进一步分析血清ALP与钙磷代谢及炎症指标的相关性。结果纳入MHD患者男性415例(56.39%)，女性321例(43.61%)，年龄(56.61±13.40)岁，中位透析龄44（16, 74）个月。其中，低钙血症、高磷血症及继发性甲状旁腺功能亢进(SHPT)的患病率分别为25.54%、63.59%和20.11%。ALP分组中年龄、透析龄、收缩压、血钙、血磷、钙磷乘积、全段甲状旁腺激素(iPTH)、肌酐、尿素氮、白蛋白、超敏C-反应蛋白(hs-CRP)、白细胞计数(WBC)及铁蛋白(FER)水平组间差异均有统计学意义(均P < 0.05)。Pearson相关性分析结果显示血清ALP与血钙、iPTH、hs-CRP、WBC及FER呈正相关关系(均P < 0.05)。结论血清ALP联合血iPTH监测可更准确地鉴别肾性骨病的类型，且血清ALP水平与炎症指标密切相关。血清ALP可作为MHD患者心血管疾病发病率和死亡率的预测指标，还可有望成为MHD患者治疗的新靶点，从而改善患者预后。
- 慢性肾脏病 /
- 钙磷代谢 /
- 碱性磷酸酶 /
- 炎症指标
Abstract: Objective To investigate the changes of serum alkaline phosphatase (ALP) levels in maintenance hemodialysis (MHD) patients and its clinical application value. Methods A total of 736 patients who underwent MHD in five blood purification centers in Bengbu region from October 2020 to May 2021 were included. The patients were grouped according to the quartile of serum ALP. The general data and laboratory indicators of patients in the four groups were statistically compared. Furthermore, the correlation between serum ALP and calcium and phosphorus metabolism and inflammatory indexes was analyzed. Results The MHD patients included 415 males (56.39%) and 321 females (43.61%), with an average age of (56.61±13.40) years and a median dialysis age of 44(16, 74) months. The prevalence of hypocalcemia, hyperphosphatemia and secondary hyperparathyroidism (SHPT) were 25.54%, 63.59% and 20.11%, respectively. Among ALP groups, there were statistically significant differences in age, dialysis age, systolic blood pressure, serum calcium, serum phosphorus, calcium-phosphorus product, whole parathyroid hormone (iPTH), creatinine, urea nitrogen, albumin, hs-CRP, white blood cell count (WBC) and ferritin (FER) levels (all P < 0.05). Pearson correlation analysis showed that serum ALP was significantly positively correlated with serum calcium, iPTH, hs-CRP, WBC and FER (all P < 0.05). Conclusion Serum ALP combined with blood iPTH monitoring can more accurately identify the types of renal bone disease, and serum ALP level is closely related to inflammatory indicators. Serum ALP can be used as a predictor of cardiovascular disease morbidity and mortality in MHD patients, and is expected to be a new therapeutic target for MHD patients, thereby improving the prognosis of patients.
- Chronic kidney disease /
- Calcium and phosphate metabolism /
- Alkaline phosphatase /
- Inflammatory indexes

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表 1 4组进行MHD的患者临床资料比较

Table 1. Comparison of clinical data of four groups of patients with MHD

项目	总体(n=736)	Ⅰ组(n=184)	Ⅱ组(n=184)	Ⅲ组(n=184)	Ⅳ组(n=184)	统计量	P值
年龄(x±s，岁)	56.61±13.40	57.71±13.57	58.02±13.56	56.51±13.17	54.20±13.06	3.113^a	0.026
性别(男/女，例)	415/321	114/70	99/85	107/77	95/89	4.746^b	0.191
透析龄[M(P₂₅, P₇₅)，月]	44(16, 74)	38.00(15.00, 66.00)	34.00(11.25, 55.00)	47.50(15.00, 78.00)	54.50(24.00, 89.00)	28.768^c	<0.001
收缩压(x±s，mmHg)	140.49±22.69	135.89±21.49	143.93±22.27	141.35±23.95	140.80±22.41	4.090^a	0.007
舒张压(x±s，mmHg)	81.69±13.76	80.65±13.25	82.42±14.77	82.07±14.05	81.62±12.94	0.571^a	0.634
原发疾病(例)
慢性肾小球肾炎	271	59	67	71	74	2.962^b	0.398
糖尿病肾病	242	62	70	59	51	4.556^b	0.207
高血压肾病	116	38	30	27	21	6.140^b	0.105
Ca(x±s，mmol/L)	2.24±0.25	2.18±0.23	2.22±0.24	2.30±0.26	2.28±0.26	10.092^a	<0.001
P(x±s，mmol/L)	1.77±0.64	1.83±0.63	1.70±0.65	1.67±0.54	1.88±0.69	4.770^a	0.003
CPP(x±s，mg²/dL²)	49.14±18.23	49.65±18.06	46.52±18.44	47.52±15.89	52.87±19.81	4.416^a	0.004
iPTH[M(P₂₅, P₇₅)，pg/mL]	282.00(142.23, 513.00)	236.05(138.78, 399.13)	245.40(34.45, 245.40)	252.50(139.38, 515.25)	458.25(166.33, 909.88)	37.663^c	0.000
ALP[M(P₂₅, P₇₅)，U/L]	89.50(69.25, 112.75)	59.00(52.00, 65.00)	80.00(75.00, 83.00)	99.00(94.00, 105.00)	131.00(120.00, 170.75)	689.180^c	<0.001
Scr(x±s，μmol/L)	773.10±272.33	839.73±270.43	747.73±273.32	736.32±253.62	768.61±281.48	5.436^a	0.001
BUN(x±s，mmol/L)	20.08±7.31	21.04±6.95	19.39±7.00	19.09±6.81	20.79±8.27	3.335^a	0.019
UA[M(P₂₅, P₇₅)，μmol/L]	373.91(312.01, 444.76)	386.50(321.25, 455.00)	369.35(320.54, 437.91)	372.00(300.02, 431.50)	371.11(300.00, 453.99)	4.991^c	0.172
Alb(x±s，g/L)	41.19±5.74	39.25±5.63	41.10±5.79	42.03±5.39	42.38±5.68	11.426^a	<0.001
TC(x±s，mmol/L)	4.00±1.17	4.03±1.21	4.06±1.29	3.94±1.13	4.00±1.06	0.375^a	0.771
TG[M(P₂₅, P₇₅)，mmol/L]	1.55(1.10, 2.21)	1.46(1.10, 2.19)	1.58(1.10, 2.27)	1.50(1.06, 2.22)	1.64(1.10, 2.14)	0.744^c	0.863
hs-CRP[M(P₂₅, P₇₅)，mg/L]	4.12(2.29, 6.00)	3.32(1.80, 5.91)	4.03(2.03, 5.98)	4.00(2.34, 5.21)	4.56(2.91, 6.70)	16.391^c	0.001
FER[M(P₂₅, P₇₅)，ng/mL]	176.35(49.45, 439.53)	97.60(33.38, 374.93)	97.95(37.95, 316.25)	215.00(63.70, 398.25)	358.95(79.63, 628.13)	44.986^c	<0.001
WBC(x±s，×10⁹/L)	6.40±1.78	6.01±1.91	6.51±1.71	6.35±1.56	6.72±1.85	5.390^a	0.001
Hb(x±s，g/L)	108.95±20.41	106.67±19.11	107.33±21.46	111.52±20.68	110.27±20.10	2.399^a	0.067
PLT(x±s，×10⁹/L)	180.85±63.41	176.57±59.41	185.84±64.04	179.74±63.65	181.24±66.50	0.680^a	0.565
注：^a为F值，^b为χ²值，^c为Z值。1 mmHg=0.133 kPa。

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表 2 4组进行MHD的患者钙磷代谢紊乱及炎症患病情况分析[例(%)]

Table 2. Analysis of calcium and phosphorus metabolism disorder and inflammation in four groups of patients with MHD[cases(%)]

项目	总数	Ⅰ组	Ⅱ组	Ⅲ组	Ⅳ组	χ²值	P值
低钙血症	188(25.54)	69(37.50)	51(27.72)	34(18.48)	34(18.48)	23.947	<0.001
高磷血症	468(63.59)	127(69.02)	105(57.07)	110(59.78)	126(68.49)	8.779	0.032
血iPTH
150~600 pg/mL	392(53.26)	115(62.50)	119(64.67)	91(49.46)	67(36.41)	37.988	<0.001
>600 pg/mL	148(20.11)	15(8.15)	17(9.24)	39(21.20)	77(41.85)	84.168	<0.001
hs-CRP>3 mg/L	486(66.03)	103(55.98)	121(65.76)	125(67.93)	137(74.46)	14.417	0.002

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