血清碱性磷酸酶水平预测维持性血液透析患者冠状动脉钙化
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国家自然科学基金(81900349)


Serum alkaline phosphatase level predicts coronary artery calcification in maintenance hemodialysis patients
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    摘要:

    目的:探究维持性血液透析(maintenance hemodialysis,MHD)患者冠状动脉钙化的相关危险因素。方法:纳入2018年3月—2020年3月在南京医科大学第一附属医院血液净化中心规律血液透析,且透析龄≥3个月的 MHD患者188 例,收集患者临床资料和实验室指标,冠状动脉多层螺旋CT测定冠状动脉钙化积分(coronary artery calcification score,CACS),分析冠状动脉钙化的相关危险因素。结果:冠状动脉钙化(CACS>100分)的发生率为54.8%(103/188),CACS中位数为143(0,728)分。与CACS<100分组相比,CACS≥400分组患者年龄、透析龄、血清钙、甲状旁腺激素(intact parathyroid hormone,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)等指标显著增高(P<0.05)。Spearman相关分析显示,CACS与年龄(r=0.292,P<0.001)、透析龄(r=0.242,P<0.001)、收缩压(r=0.167,P=0.024)、血钙(r=0.263,P<0.001)、iPTH(r=0.191,P=0.009)及ALP(r=0.171,P=0.019)呈正相关(P<0.05);多因素线性回归显示ALP与CACS显著相关(P=0.012)。受试者工作特征曲线分析示ALP预测重度冠状动脉钙化的曲线下面积是0.615(P=0.009),最佳临界值为226.5 U/L。多因素Logistic回归分析显示经过多因素校正后ALP≥226.5 U/L组患者重度冠脉钙化风险显著升高(OR=3.05,95%可信区间:1.30~7.18,P=0.011)。结论:血清ALP水平是MHD患者冠状动脉钙化的独立预测因子,ALP有望成为MHD患者心血管钙化的预测指标和干预靶点。

    Abstract:

    Objective:To investigate the risk factors of coronary artery calcification(CAC)in maintenance hemodialysis(MHD)patients. Methods:A total of 188 stable MHD(≥3 months)patients were enrolled in the study,their baseline characteristics and laboratory measurements were collected,coronary artery calcification score(CACS)was measured by multi-slice computed tomography(MSCT),the risk factors for CAC were analyzed. Results:CAC(CACS>100)was present in 54.8%(103/188)patients,the median CACS was 143(0,728). In comparison with the CACS<100 group,age,dialysis vintage,serum calcium,alkaline phosphatase(ALP)and intact parathyroid hormone(iPTH)levels were significantly higher than those in CACS≥400 group(P < 0.05). Spearman correlation analysis revealed that CACS were positively correlated with age(r=0.292,P < 0.001),dialysis vintage(r=0.242,P=0.001),systolic pressure(r=0.167,P=0.024),serum calcium(r=0.263,P < 0.001),iPTH(r=0.191,P=0.009)and ALP(r=0.171,P=0.019). With multivariate linear regression analysis,serum ALP was the only biomarker which showed significant correlation with CACS. Receiver operating characteristic(ROC) curve analysis showed that the area under curve(AUC) of ALP predicted severe CAC was 0.615(P=0.009),the optimal cutoff value was 226.5 U/L. By logistic regression analysis,serum ALP≥226.5 U/L was a robust predictor of CAC and was associated with the likelihood of CACS≥400(odds ratio 3.05,95% confidence interval 1.30 to 7.18,P=0.011). Conclusion:Serum ALP level is a potential independent predictor of CAC in MHD patients. ALP is suggested to be a promising predictor and interventional target for cardiovascular calcification in MHD patients.

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郭 静,曾 鸣,张 浩,王 军,盛燕辉,刘 静.血清碱性磷酸酶水平预测维持性血液透析患者冠状动脉钙化[J].南京医科大学学报(自然科学版),2021,(10):1457-1462

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  • 收稿日期:2021-05-13
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  • 在线发布日期: 2021-11-05
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