微炎症状态、血清BALP水平对肾性骨病患者血液透析后临床转归的预测价值

Value of microinflammatory status and serum BALP level in predicting the clinical outcome of renal bone disease after hemodialysis

目的 探讨微炎症状态、血清骨特异性碱性磷酸酶(BALP)水平预测肾性骨病(RBD)患者血液透析后临床转归的预测价值。方法 回顾性分析2021年6月至2023年6月在山西白求恩医院接受血液透析治疗的90例肾性骨病患者的临床资料,依据患者治疗后临床转归情况,将临床显效+有效归为疾病控制组,无效归为疾病未控制组。90例肾性骨病患者经血液透析治疗2个月后显效40例(44.44%),有效22例(24.44%),纳入疾病控制组;无效28例(31.12%),纳入疾病未控制组。统计两组基础资料信息及血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、β2-微球蛋白(β2-MG)和BALP水平,采用多因素Logistic回归分析影响肾性骨病患者血液透析治疗后临床转归的因素,绘制受试者操作特征(ROC)曲线评估微炎症状态、血清BALP水平预测肾性骨病患者血液透析治疗后临床转归的效能。结果 两组性别构成比、年龄、体重指数、透析时间、吸烟史、饮酒史、原发疾病比较,差异均无统计学意义(P>0.05);疾病未控制组CRP、IL-6、β2-MG及BALP水平均显著高于疾病控制组,差异均有统计学意义(P<0.05)。经多因素Logistic回归分析证实,CRP、IL-6、β2-MG及BALP水平升高均是影响肾性骨病患者经血液透析治疗后临床转归的危险因素(P<0.05)。经ROC因素分析证实,血清CRP、IL-6、β2-MG及BALP均可用于肾性骨病患者经血液透析治疗后临床转归的评估,曲线下面积分别为0.753、0.889、0.847、0.832,均有较好的预测价值(P<0.05)。结论 微炎症状态(CRP、IL-6、β2-MG)、血清BALP水平升高会影响肾性骨病患者血液透析后临床治疗转归,临床上应引起足够重视。

Objective To investigate the value of microinflammatory status and serum bone-specific alkaline phosphatase(BALP)level in predicting clinical outcomes after hemodialysis in patients with renal bone disease.Methods The clinical data of 90 patients with renal bone disease who received hemodialysis treatment in Shanxi Bethune Hospital from June 2021 to June 2023 were retrospectively analyzed.According to the clinical outcomes of patients after treatment,clinically significant+effective patients were classified into the disease control group,while the ineffective patients were classified into the uncontrolled group.After 2 months of hemodialysis treatment,40 cases(44.44%)of the 90 cases of RBD patients were significantly effective,and 22 cases(24.44%)were effective,which were included in the disease control group.A total of 28 cases(31.12%)were included in the uncontrolled group.Basic data and serum C-reactive protein(CRP),interleukin-6(IL-6),β2-microglobulin(β2-MG)and BALP levels of the two groups were statistically analyzed.Multivariate Logistic regression was used to analyze the factors affecting clinical outcome in renal bone disease patients after hemodialysis treatment.The efficacy of microinflammatory status and serum BALP level in predicting clinical outcome after hemodialysis treatment in renal bone disease patients were evaluated by drawning receiver operating characteristic(ROC)curve.Results There were no significant differences in gender composition ratio,age,body mass index,dialysis time,smoking history,drinking history and primary disease between the two groups(P>0.05);the levels of CRP,IL-6,β2-MG and BALP in the uncontrolled group were significantly higher than those in the disease control group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis confirmed that CRP,IL-6,β2-MG and BALP levels were all risk factors for clinical outcome in renal bone disease patients after hemodialysis treatment(P<0.05).ROC analysis confirmed that serum CRP,IL-6,β2-MG and BALP could be used to evaluate clinical outcome in renal bone disease patients after hemodialysis treatment,and the areas under the curve were 0.753,0.889,0.847 and 0.832,respectively,which had good predictive value(P<0.05).Conclusion Elevated microinflammatory status(CRP,IL-6,β2-MG)and serum BALP levels will affect the outcome of clinical treatment after hemodialysis in renal bone disease patients,and should be paid sufficient attention to clinically.