血清ALP水平预测急性失代偿性心力衰竭并发肾功能恶化的价值

Value of serum ALP level in predicting renal function deterioration in patients with acute decompensated heart failure

目的探讨血清碱性磷酸酶(ALP)水平预测急性失代偿性心力衰竭(ADHF)并发肾功能恶化(WRF)的价值。方法选择ADHF患者121例,入院7 d内并发WRF 57例(WRF组)、未并发WRF 64例(非WRF组)。收集两组一般人口学资料(包括性别、年龄、BMI)、相关临床资料(包括收缩压、舒张压,合并高血压、糖尿病、冠心病以及吸烟史)、实验室检查资料(包括血清Hb、Alb、TC、TG、HDL、LDL、Cr、UA、Na^+、K^+、ALP、CRP、NT-proBNP及eGFR和LVEF)。采用Logistic回归分析获取ADHF并发WRF的独立影响因素。采用受试者工作特征(ROC)曲线评估血清ALP水平预测ADHF并发WRF的价值。结果单因素Logistic回归分析显示,两组年龄、BMI,合并糖尿病、冠心病比例及血清Alb、Cr、UA、ALP、CRP水平和eGFR比较P均<0.05,其余临床资料比较P均>0.05。多因素Logistic回归分析显示,年龄和血清Cr、UA、ALP水平是ADHF并发WRF的独立危险因素,而eGFR、血清Alb水平是ADHF并发WRF的独立保护因素(P均<0.05)。ROC曲线分析显示,血清ALP水平预测ADHF并发WRF的曲线下面积为0.832,最佳截断值为241.4 U/L,此时其预测ADHF并发WRF的敏感性、特异性、准确性分别为83.7%、84.2%、83.6%。结论血清ALP水平是ADHF并发WRF的独立危险因素,可作为预测ADHF并发WRF的生物标志物。

Objective To investigate the value of serum alkaline phosphatase(ALP)level in predicting renal function deterioration(WRF)in patients with acute decompensated heart failure(ADHF).Methods Totally 121 ADHF patients,including 57 ADHF patients with concurrent WRF(WRF group)and 64 ADHF patients without WRF(non-WRF group)within 7 days after admission,were selected.The general demographic data(including gender,age,BMI),relevant clinical data(including systolic blood pressure,diastolic blood pressure,hypertension,diabetes,coronary heart disease and smoking history),and laboratory examination data(including serum Hb,Alb,TC,TG,HDL,LDL,Cr,UA,Na^+,K^+,ALP,CRP,NT-proBNP,eGFR and LVEF)were collected.Logistic regression analysis was used to obtain independent influencing factors for WRF in ADHF patients.Receiver operating characteristic(ROC)curve was used to evaluate the value of serum ALP level in predicting WRF in patients with ADHF.Results Univariate Logistic regression analysis showed that significant differences were found in the gender composition,proportion of diabetes and coronary heart disease,serum Alb,Cr,UA,ALP,CRP and eGFR between these two groups(all P<0.05),and no significant differences were found in the remaining clinical data(all P>0.05).Multiple Logistic regression analysis showed that age and serum Cr,UA and ALP levels were independent risk factors for WRF in patients with ADHF,while eGFR and serum Alb levels were independent protective factors for WRF in patients with ADHF(all P<0.05).ROC curve analysis showed that the area under the curve of serum ALP level in predicting WRF of ADHF patients was 0.832,and the optimal cut-off value was 241.4 U/L.At this time,the sensitivity,specificity and accuracy were 83.7%,84.2%,and 83.6%,respectively.Conclusion Serum ALP level is an independent risk factor for WRF in ADHF patients and can be used as a serological marker to predict WRF in ADHF patients.