急性冠脉综合征患者血清碱性磷酸酶水平对冠状动脉钙化的预测价值

Predictive value of serum alkaline phosphatase level in predicting coronary artery calcification in patients with acute coronary syndrome

目的在急性冠脉综合征(acute coronary syndrome,ACS)患者中,探讨血清碱性磷酸酶(alkaline phosphatase,ALP)水平对冠状动脉钙化的预测价值。方法回顾分析2017年1月至2018年12月因ACS入院行冠脉造影和血管内超声(intravascular ultrasound,IVUS)检查的328例患者的临床及影像资料,最终234例纳入本研究。对血清ALP水平进行三分位分组(<68IU/L,68-80IU/L和>80IU/L),比较各组患者冠脉钙化特征及分布情况,以二分类Logistic回归分析冠脉钙化的影响因素,采用ROC工作曲线评价ALP及传统冠脉钙化危险因素对冠脉钙化的预测价值。结果入选患者中,冠脉造影检出冠脉钙化者占37.6%,IVUS检出冠脉钙化者占63.7%,其中ALP>80IU/L组点状钙化比例最大。Logistic回归分析表明,血清ALP水平与冠脉钙化密切相关,ALP>80IU/L组患者冠脉钙化风险显著升高(OR2.85,95%CI1.38-5.90,P=0.005),ALP(Per10IU/L)(OR1.54,95%CI1.24-1.92,P<0.001)。ROC曲线分析显示,与单纯使用传统危险因素相比,使用传统危险因素联合ALP检测对冠脉钙化的预测能力明显提升(联合检测AUC0.714vs单纯传统因素AUC0.644,P<0.05)。结论血清ALP水平可能是冠脉钙化的独立预测因子,ALP水平升高与冠脉点状钙化分布增加有关,使用传统危险因素联合ALP检测可增加对冠脉钙化的临床预测能力。

Objective To investigate the predictive value of serum alkaline phosphatase (ALP) level for coronary artery calcification in patients with acute coronary syndrome (ACS).Methods The clinical and imaging data of 328 hospitalized ACS patients who underwent both coronary angiography (CAG) and intravascular ultrasound (IVUS) from January 2017 to December 2018 were analyzed retrospectively.Totally 234 patients were included in the final analysis.The patients were enrolled and divided into three groups according to serum ALP levels (AL P< 68,68-80,and >80 IU/L) to observe the distribution of calcification characteristics.Independent predictors of calcification were analyzed by binary logistic regression.The predictive value of ALP combined with traditional factors in coronary artery calcification was evaluated by ROC work curve.Results In the patients enrolled,calcification rates were 37.6% by CAG and 63.7% by IVUS,respectively.The spotty calcification rate was highest in ALP>80 IU/L group.By Logistic regression analysis,ALP remained an independent predictor of vascular calcification after fully adjusted,s including ALP >80 IU/L (OR 2.85,95%CI 1.38-5.90,P =0.005),ALP (Per 10IU/L)(OR 1.54,95%CI 1.24-1.92,P< 0.001 ).ROC curve analysis revealed that the ability of traditional factor combined with ALP (cutoff value) to predict calcium was significantly different from that of traditional factor (combined with AUC 0.714 vs traditional factor AUC 0.644,P< 0.05).Conclusion Serum ALP level is a potential independent predictor of coronary artery calcification.Patients with higher ALP level tend to present spotty calcification more often.Traditional factors combined with ALP can enhance the ability to predict coronary artery calcification.