老年维持性血液透析患者并发难治性继发性甲状旁腺功能亢进危险因素及血ALP与其相关性

Risk factors for fefractory secondary hyperparathyroidism in elderly maintenance hemodialysis patients and its correlation with serum ALP

目的探讨老年维持性血液透析(MHD)患者并发难治性继发性甲状旁腺功能亢进(SHPT)危险因素及血清碱性磷酸酶(ALP)与其相关性。方法横断面分析研究2020年5~6月在上海中医药大学附属龙华医院血液净化中心MHD老年患者156例,根据是否并发难治性SHPT分为难治组(39例)和非难治组(117例),收集临床资料,分析老年MHD患者并发SHPT危险因素及血清ALP与其相关性。结果两组脑梗死史、ALP、无机磷、甲状旁腺激素(PTH)、降钙素、总铁结合力(UIBC)差异有统计学意义(P<0.05),多因素Logistic回归分析可得ALP、肌酐、无机磷、UIBC是老年MHD患者并发难治性SHPT的独立危险因素。将难治组分为轻度组(PTH<800 pg/ml,25例)和重度组(PTH≥800 pg/ml,14例),两组ALP差异有统计学意义(P<0.05)。Spearman等级相关分析显示,ALP与老年MHD患者并发难治性SHPT正相关(r=0.401,P<0.001);ALP与难治性SHPT严重程度正相关(r=0.337,P=0.036);ALP与PTH正相关(r=0.449,P<0.001)。结合不同临床指标建立3个模型,采用受试者工作特征(ROC)曲线联合诊断显示ALP可以提高对老年MHD患者并发难治性SHPT的诊断,联合指标越多,曲线下面积越大。结论血清ALP、肌酐、无机磷、UIBC是老年MHD患者并发难治性SHPT的独立危险因素。血清ALP与老年MHD患者并发难治性SHPT及其严重程度正相关,可以提高诊断价值。

Objective To investigate the risk factors of elderly maintenance hemodialysis(MHD)patients with refractory secondary hyperparathyroidism(SHPT)and its correlation with serum alkaline phosphatase(ALP).Methods A cross-sectional analysis of 156 elderly patients with MHD in the Blood Purification Center of Longhua Hospital Shanghai University of Traditional Chinese Medicine from May to June 2020.According to whether complicated with refractory SHPT,the patients was divided into refractory group(39 cases)and non-refractory group(117 cases).The clinical data of patients were collected to analyze the risk factors of SHPT in elderly patients with MHD and its correlation with serum ALP.Results There were significant differences in history of cerebral infarction,ALP,inorganic phosphorus,parathyroid hormone(PTH),calcitonin and total iron binding capacity(UIBC)between the two groups(P<0.05).Multivariate logistic regression analysis showed ALP,creatinine,inorganic phosphorus and UIBC were independent risk factors for refractory SHPT in elderly patients with MHD.The refractory group was divided into mild group(PTH<800 pg/ml,25 cases)and severe group(PTH≥800 pg/ml,14 cases),the difference of ALP between the two groups was statistically significant(P<0.05).Spearman rank correlation analysis showed that ALP was positively correlated with refractory SHPT in elderly MHD patients(r=0.401,P<0.001);ALP was positively correlated with the severity of refractory SHPT(r=0.337,P=0.036);ALP was positively correlated with PTH(r=0.449,P<0.001).Combining different clinical indicators to establish three models,using receiver operating characteristic(ROC)curve combined diagnosis showed that ALP improved the diagnosis of refractory SHPT in elderly MHD patients.The more combined indicators,the larger the area under the curve.Conclusions Serum ALP,creatinine,inorganic phosphorus and UIBC are independent risk factors for refractory SHPT in elderly MHD patients.Serum ALP is positively correlated with refractory SHPT in elderly MHD patients and its severity,which could improve the diagnostic value of refractory SHPT in elderly MHD patients.