血清碱性磷酸酶水平预测维持性血液透析患者冠状动脉钙化

Serum alkaline phosphatase level predicts coronary artery calcification in maintenance hemodialysis patients

目的:探究维持性血液透析(maintenance hemodialysis,MHD)患者冠状动脉钙化的相关危险因素。方法:纳入2018年3月—2020年3月在南京医科大学第一附属医院血液净化中心规律血液透析,且透析龄≥3个月的MHD患者188例,收集患者临床资料和实验室指标,冠状动脉多层螺旋CT测定冠状动脉钙化积分(coronary artery calcification score,CACS),分析冠状动脉钙化的相关危险因素。结果:冠状动脉钙化(CACS>100分)的发生率为54.8%(103/188),CACS中位数为143(0,728)分。与CACS<100分组相比,CACS≥400分组患者年龄、透析龄、血清钙、甲状旁腺激素(intact parathyroid hormone,iPTH)、碱性磷酸酶(alkaline phosphatase,ALP)等指标显著增高(P<0.05)。Spearman相关分析显示,CACS与年龄(r=0.292,P<0.001)、透析龄(r=0.242,P<0.001)、收缩压(r=0.167,P=0.024)、血钙(r=0.263,P<0.001)、iPTH(r=0.191,P=0.009)及ALP(r=0.171,P=0.019)呈正相关(P<0.05);多因素线性回归显示ALP与CACS显著相关(P=0.012)。受试者工作特征曲线分析示ALP预测重度冠状动脉钙化的曲线下面积是0.615(P=0.009),最佳临界值为226.5 U/L。多因素Logistic回归分析显示经过多因素校正后ALP≥226.5 U/L组患者重度冠脉钙化风险显著升高(OR=3.05,95%可信区间:1.30~7.18,P=0.011)。结论:血清ALP水平是MHD患者冠状动脉钙化的独立预测因子,ALP有望成为MHD患者心血管钙化的预测指标和干预靶点。

Objective:To investigate the risk factors of coronary artery calcification(CAC)in maintenance hemodialysis(MHD)patients.Methods:A total of 188 stable MHD(≥3 months)patients were enrolled in the study,their baseline characteristics and laboratory measurements were collected,coronary artery calcification score(CACS)was measured by multi-slice computed tomography(MSCT),the risk factors for CAC were analyzed.Results:CAC(CACS>100)was present in 54.8%(103/188)patients,the median CACS was 143(0,728).In comparison with the CACS<100 group,age,dialysis vintage,serum calcium,alkaline phosphatase(ALP)and intact parathyroid hormone(i PTH)levels were significantly higher than those in CACS≥400 group(P<0.05).Spearman correlation analysis revealed that CACS were positively correlated with age(r=0.292,P<0.001),dialysis vintage(r=0.242,P=0.001),systolic pressure(r=0.167,P=0.024),serum calcium(r=0.263,P<0.001),iPTH(r=0.191,P=0.009)and ALP(r=0.171,P=0.019).With multivariate linear regression analysis,serum ALP was the only biomarker which showed significant correlation with CACS.Receiver operating characteristic(ROC)curve analysis showed that the area under curve(AUC)of ALP predicted severe CAC was0.615(P=0.009),the optimal cutoff value was 226.5 U/L.By logistic regression analysis,serum ALP≥226.5 U/L was a robust predictor of CAC and was associated with the likelihood of CACS≥400(odds ratio 3.05,95%confidence interval 1.30 to 7.18,P=0.011).Conclusion:Serum ALP level is a potential independent predictor of CAC in MHD patients.ALP is suggested to be a promising predictor and interventional target for cardiovascular calcification in MHD patients.