中国血液净化

中国血液净化 ›› 2017, Vol. 16 ›› Issue (02): 95-99.doi: 10.3969/j.issn.1671-4091.2017.02.007

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清骨源性碱性磷酸酶的相关影响因素分析

蒋钻红1,陈孜瑾1,汪知玉1,马晓波1,张春丽1,钱莹1,王朝晖1,俞海瑾1,陈晓农1   

  1. 1. 上海交通大学医学院附属瑞金医院肾脏科
  • 收稿日期:2016-06-28 修回日期:2016-11-03 出版日期:2017-02-12 发布日期:2017-02-12
  • 通讯作者: 陈晓农 xiaonong@medmail.com.cn E-mail:xiaonong@medmail.com.cn
  • 基金资助:

    国家自然科学基金(81600590)；上海市自然科学基金(14ZR1425400)；上海市卫生计划生育委员会课题(20154Y0015)

The associated factors with bone alkaline phosphatase in maintenance hemodialysis patients

  • Received:2016-06-28 Revised:2016-11-03 Online:2017-02-12 Published:2017-02-12

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摘要： 目的探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清骨源性碱性磷酸酶(bone alkaline phosphatase,BAP)水平及其可能影响BAP 水平的因素。方法入选2012 年7 月于上海交通大学医学院附属瑞金医院血液透析中心的MHD 患者，年龄超过18 周岁，透析龄在3 个月以上。结果共入选的226 例MHD 患者, 男性144 例,中位年龄58.00 岁(48.00～68.00 岁)，中位透析龄41.00(21.00～72.25)月。中位BAP 浓度为19.71(14.85～26.72)U/L 和健康志愿者21.32(19.13～28.84)U/L无统计学差异(P＞0.05)。其中MHD 患者中，女性平均BAP 浓度22.41(16.37～32.01)U/L 显著高于男性平均BAP 浓度18.65(13.81～24.25)U/L(Z=-3.199,P＝0.001)。相关分析结果显示甲状旁腺激素(r=0.569,P＜0.001)、碱性磷酸酶(r=0.687,P＜0.001)、尿酸(r=0.133,P=0.045)、血磷(r=0.145,P=0.029)与BAP 正相关，身高(r=- 0.173,P=0.010)、血碳酸氢盐水平(r=- 0.158,P=0.017)、透析后平均动脉压(r= -0.135,P=0.043)与BAP 负相关。多因素Logistic 回归结果显示服用β-受体阻滞剂(OR 2.600, 95% CI 1.253～5.395,P=0.010)、女性(OR 2.693, 95% CI 1.336～5.312,P=0.004)、甲状旁腺激素(OR1.005, 95% CI 1.003～1.007,P＜0.001)是BAP 水平的独立影响因素(Forward Stepwise, P=0.458，Nagelkerke R Square 0.339)。结论BAP 是反应MHD 患者骨代谢的一个灵敏指标，女性、服用β-受体
阻滞剂、高甲状旁腺激素水平的透析患者血清BAP水平较高。

关键词: 慢性肾脏病, 血液透析, CKD-MBD, 骨源性碱性磷酸酶, 影响因素

Abstract: Objective To analyze serum bone alkaline phosphatase (BAP) level and its associated factors in maintenance hemodialysis (MHD) patients. Methods MHD patients treated in Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine in July 1, 2012, more than 18 years old, and more than 3 months of dialysis vintage were enrolled in this study. Clinical, biochemical, and medication data at baseline were collected. Serum BAP levels were determined by an enzyme-linked immunosorbent assay kit. Results This study recruited 226 MHD patients, of whom 144 were males, median age was 58.00 years (48.00～68.00 years), and median dialysis vintage was 41.00 months (21.00～72.25 months). There was no significant difference in serum BAP level between MHD patients and healthy controls [19.71 (14.85～26.72)U/L vs. 21.32 U/L (19.13～28.84 U/L), P>0.05]. In MHD patients, serum BAP level was significantly higher in females than in males [22.41U/L(16.37～32.01 U/L) vs. 18.65U/L(13.81～24.25U/L), Z=-3.199, P＝0.001]. Spearman correlation analyses showed that parathyroid hormone (r=0.569, P＜0.001), alkaline phosphatase (r=0.687, P＜0.001), uric acid (r=0.133, P=0.045), serum phosphorus (r=0.145, P=0.029) were positively correlated with serum BAP level, and body height (r=-0.173, P=0.010), blood bicarbonate level (r=- 0.158, P=0.017), post- dialysis mean arterial pressure (r=- 0.135, P=0.043) were negatively correlated with serum BAP level. Multivariate logistic regression showed that β-blocker treatment (OR 2.600, 95% CI 1.253～5.395, P=0.010), female (OR 2.693, 95% CI 1.336～5.312 , P= 0.004) and PTH (OR 1.005, 95% CI 1.003～1.007 , P＜0.001) were independently correlated with higher BAP in MHD patients (Forward stepwise, P=0.458, Nagelkerke R square 0.339). Conclusion BAP is a sensitive marker for bone metabolism in MHD patients. Females, patients with β- blocker treatment and higher PTH level may have a higher serum BAP level.

Key words: chronic kidney disease, maintenance hemodialysis, chronic kidney disease- mineral and bone disorder, bone alkaline phosphatase, associated factors