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

The associated factors with bone alkaline phosphatase in maintenance hemodialysis patients

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。

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 imrnunosorbent 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 [22.41 U/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 （t=-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 13-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.