维持性血液透析合并恶性肿瘤患者血清碱性磷酸酶水平对心血管疾病死亡率的影响

Effect of Serum Alkaline Phosphatase Level on Cardiovascular Mortality in Maintenance Hemodialysis Patients with Chronic Kidney Disease Com-bined with Malignant Tumor

目的:探讨血清碱性磷酸酶(alkaline phosphatase,ALP)水平对行维持性血液透析(maintenance hemodialy-sis,MHD)的慢性肾脏疾病(chronic kidney disease,CKD)合并恶性肿瘤患者心血管疾病(cardiovascular disease,CVD)病死率的影响。方法:选择我院肾内血液科2015年1月至2020年9月收治的198例行MHD治疗的CKD合并恶性肿瘤患者作为研究对象,检测患者血清ALP水平,并采用四分位法分为<60 IU/L(A组)、60~<80 IU/L(B组)、80~<105 IU/L(C组)、≥105 IU/L(D组),全部研究对象随访至2022年12月31日,收集心血管疾病死亡事件,应用多因素Cox比例风险回归模型分析血清ALP水平与患者心血管疾病病死率的独立相关性。结果:随访期间CVD死亡60例(30.30%)。多因素Cox回归分析结果显示,年龄增大(HR=1.041)、透析前收缩压升高(HR=1.039)、血清ALP水平升高是行MHD治疗CKD合并恶性肿瘤患者CVD死亡的独立危险因素(均P<0.05)。不同ALP水平与CVD死亡的相关性显示,ALP≥105 IU/L患者的CVD死亡风险显著上升(HR=3.304),ALP≥105 IU/L是行MHD治疗CKD合并恶性肿瘤患者CVD死亡的独立危险因素(P<0.05)。结论:血清ALP水平与患者CVD死亡风险的增加相关,血清ALP水平是行MHD治疗CKD合并恶性肿瘤患者CVD死亡的独立危险因素,尤其是ALP≥105 IU/L时患者的CVD死亡风险显著上升。

Objective:To investigate the effect of serum alkaline phosphatase(ALP)level on the mortality of cardiovas-cular disease(CVD)in maintenance hemodialysis(MHD)patients with chronic kidney disease(CKD)combined with ma-lignant tumor.Methods:198 patients with CKD combined with malignant tumor who were treated with MHD in the depart-ment of nephrology and hematology in our hospital from January 2015 to September 2020 were included.Serum ALP levels were detected,and the patients were assigned to group A(<60 IU/L),group B(60~80 IU/L),group C(80~105 IU/L),group D(≥105 IU/L)by quartile method.All patients were followed up to December 31,2022 to collect cardiovascu-lar death events.Multivariate Cox proportional risk regression model was used to analyze the independent correlation between serum ALP level and mortality of CVD.Results:During the follow-up period,60 cases(30.30%)died of CVD.Multivariate Cox regression analysis showed that increases in age(HR=1.041),pre-dialysis systolic blood pressure(HR=1.039)and serum ALP level were independent risk factors for CVD death in MHD patients(all P<0.05).The correlation between different levels of ALP and CVD death showed that the risk of CVD death significantly increased in patients with ALP≥105 IU/L(HR=3.304).ALP≥105 IU/L was an inde-pendent risk factor for CVD death in MHD patients(P<0.05).Conclusion:There is a correlation between serum ALP lev-el and an increased risk of CVD death.Serum ALP level is an independent risk factor for CVD death in MHD patients with CKD combined with malignant tumor.When ALP≥105 IU/L,the risk of CVD death increased significantly.