骨碱性磷酸酶对维生素D缺乏性佝偻病的临床诊断价值探讨

Exploration on the clinical value of bone alkaline phosphatase in diagnosis of children with vitamin D deficiency rickets

目的:探讨骨碱性磷酸酶(B-ALP)对儿童维生素D缺乏性佝偻病的诊断价值以及血清25-(OH)D与B-ALP的部分影响因素。方法:以551例4月～12岁小儿为研究对象,其中婴幼儿占86.99%。取静脉血测定血清25-(OH)D与B-ALP。结果:①以血清25-(OH)D<50 nmol/L为维生素D(V itD)缺乏的标准,B-ALP>250 U/L时,特异度为69.01%,敏感度为18.12%,阳性似然比为0.58;B-ALP>300 U/L时,特异度为95.91%,敏感度为2.50%,阳性似然比为0.61;②血清25-(OH)D与儿童服用V it D的情况显著相关(r=0.449,P=0.000);③血清25-(OH)D与儿童饮用的奶粉量显著相关(r=0.156,P=0.018);④血清25-(OH)D与B-ALP无相关(r=0.041,P=0.535)。结论:B-ALP诊断儿童维生素D缺乏性佝偻病不能同时满足特异度、灵敏度较高的要求,B-ALP水平越高,特异度越高(误诊率越低),灵敏度越低(漏诊率越高);儿童血清25-(OH)D水平与服用V it D制剂及饮用的奶粉量密切相关。

Objective：To explore the value of bone alkaline phosphatase in diagnosis of children with vitamin D deficiency rickets and the partial effect factors of serum 25-（OH） D and bone alkaline phosphatase.Methods：551 children aged 4 months～12 years were selected as study objects,and infants accounted for 86.99%.The venous blood samples were abstracted to detect serum 25-（OH） D and bone alkaline phosphatase levels.Results：Serum 25-（OH） D 〈50 nmol/L was used as the criterion of vitamin D deficiency,when the level of bone alkaline phosphatase was more than 250 U/L,the specificity was 69.01%,the sensitivity was 18.12%,the positive likelihood ratio was 0.58;when the level of bone alkaline phosphatase was more than 300 U/L,the specificity was 95.91%,the sensitivity was 2.50%,the positive likelihood ratio was 0.61.There was significant correlation between serum 25-（OH） D and the intake condition of vitamin D（γ=0.449,P=0.000）;there was significant correlation between serum 25-（OH） D and the intake dose of milk powder（γ=0.156,P=0.018）;there was no significant correlation between serum 25-（OH） D and bone alkaline phosphatase（γ=0.041,P=0.535）.Conclusion：Bone alkaline phosphatase can’t simultaneously satisfy high specificity and sensitivity in diagnosis of children with vitamin D deficiency rickets,when the level of bone alkaline phosphatase increases,the specificity increases and the sensitivity decreases;the level of serum 25-（OH） D is closely related to the intake of vitamin D and the intake dose of milk powder.