骨特异性碱性磷酸酶在CKD-MBD中的作用研究

发布时间：2018-03-16 05:17

本文选题：甲状旁腺激素　切入点：碱性磷酸酶　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究将观察慢性肾脏病3期-慢性肾脏病5D期患者中骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BALP)的差别,及BALP与目前常用的CKD-MBD监测指标之间的关系,探讨BALP在CKD-MBD、尤其在骨代谢方面的价值,为慢性肾脏病矿物质骨代谢异常的早期诊断提供良好依据。方法:选择2016年7月至2017年1月就诊于秦皇岛市第一医院肾内科慢性肾脏病3期(CKD 3期)--慢性肾脏病5D期(CKD 5D期)患者59例,分为4组,iPTH150 pg/ml为A组13例,150 pg/mliPTH300pg/ml为B组15例,300 pg/mliPTH800 pg/ml为C组21例,i PTH800pg/ml为D组10例,原发病分别为糖尿病肾病、高血压肾损伤、多囊肾、新月体肾炎、IgA肾病、痛风性肾病、药物性肾损伤、肾动脉狭窄等疾病。收集患者的一般情况(性别、年龄),采集空腹静脉血,检测空腹全段甲状旁腺激素(intact parathyroid hormone,iPTH)、骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BALP)、碱性磷酸酶(alkaline phosphatase,ALP)、血肌酐(serum creatinine,Cr)、血尿素氮(serum urea nitrogen,BUN)、血尿酸(serum uric acid,UA)、血钙(serum calcium,Ca)、血磷(serum phosphorus,P)、白蛋白(serum albumin,Alb)。应用SPSS22.0统计软件进行处理,组间比较采用方差分析,多重比较用LSD方法,以P0.05为差别有统计学意义,用Spearman相关性分析进行相关性检测,ROC曲线确定BALP在CKD-MBD诊断值。结果:1各组间患者在年龄、性别、血钙、白蛋白均无统计学意义(P0.05)。BALP(ug/L)水平变化情况:D组(iPTH800 pg/ml)高于A组(iPTH150pg/ml),(15.73±29.32 vs 8.31±3.20,P=0.000);D组(iPTH800 pg/ml)高于B组(150 pg/mliPTH300 pg/ml)(15.73±29.32 vs 9.70±3.10,P=0.001);D组(iPTH800 pg/ml)高于C组(300 pg/mliPTH800 pg/ml)(15.73±29.32 vs 10.10±4.62,P=0.002),P0.05存在统计学差异。A组(i PTH150 pg/ml)与B组(150 pg/mliPTH300 pg/ml),(8.31±3.20 vs9.70±3.10,P=0.366);A组(iPTH150 pg/ml)与C组(300 pg/mliPTH800pg/ml),(8.31±3.20 vs 10.10±4.62,P=0.184);B组(150 pg/mliPTH300pg/ml)与C组(300 pg/mliPTH800 pg/ml),(9.70±3.10 vs 10.10±4.62,P=0.703),P0.05无统计学差异。2 Spearman相关分析显示BALP与i PTH、ALP存在正相关关系(r=0.398,P0.01;r=0.707,P0.01),ALP与iPTH无相关性(r=0.224,P0.05)。3 BALP对CKD-MBD患者的诊断界限值使用ROC曲线进行确定:ROC曲线下面积为0.765,标准误为0.091,95%置信区间为(0.586,0.945);BALP取不同灵敏度和1-特异度值见表5,综合灵敏度与特异度,BALP界限值为11.46 ug/L。结论:1.BALP可作为CKD-MBD的诊断指标。1.1BALP比ALP在诊断CKD-MBD尤其是骨代谢方面,灵敏度更高。1.2BALP与iPTH有更好相关性,比iPTH有更好的稳定性和可重复。2.BALP诊断CKD-MBD的界限值当BALP11.46 ug/L时诊断CKD3-5D期患者的CKD-MBD的灵敏度和特异度最高。
[Abstract]:Objective: to observe the difference of bone specific alkaline phosphatase (bone-specific alkaline phosphatase) in patients with chronic kidney disease from stage 3 to stage 5D, and the relationship between BALP and CKD-MBD monitoring indexes. To explore the value of BALP in CKD-MBD, especially in bone metabolism. Methods: from July 2016 to January 2017, patients with chronic kidney disease were selected from Qinhuangdao first Hospital of Qinhuangdao first Hospital of chronic Kidney Disease stage 3 of chronic Kidney Disease (CKD 3)-chronic Kidney Disease (CHD 3) to provide a good basis for the early diagnosis of abnormal mineral bone metabolism in chronic kidney disease (CHD). 5D patients with CKD5D), The patients were divided into four groups: group A (n = 13), group B (n = 15), group B (n = 15), group C (n = 21), group C (n = 21), group D (n = 21). The primary diseases were diabetic nephropathy, hypertensive renal injury, polycystic kidney disease, crescentin nephritis and gouty nephropathy. Drug induced renal injury, renal artery stenosis and other diseases. General information of patients (gender, age, fasting venous blood, etc.) was collected. The fasting parathyroid hormone (PTH), bone specific alkaline phosphatase (BALP), alkaline phosphatase (ALP), serum creatinine (Cr), serum urea nitrogen (urea) nitrogenBUNA, serum uric acidine UAA, serum calcium serum, serum phosphorus serum, albumin serum Albumin were detected. The analysis of variance was used in the intergroup comparison, the LSD method was used for multiple comparisons, and the difference was statistically significant with P0.05. The correlation analysis of Spearman correlation analysis was used to determine the diagnostic value of BALP in CKD-MBD. Results: the age, sex, blood calcium of the patients in different groups were determined. There was no significant difference in the level of albumin between group D and group A (P 0.05 卤29.32 vs 8.31 卤3.20 P0. 000) compared with group B (150 pg/mliPTH300 pg/ml)(15.73 卤29.32 vs 9.70 卤3.10 pg/mliPTH800 卤0.001g / L) than group C (300 pg/mliPTH800 pg/ml)(15.73 卤29.32 vs 10.10 卤4.62 P0.002pgml0.05). There was a significant difference between group A and group B (150 pg/mliPTH800 pg/ml)(15.73 卤29.32 vs 10.10 卤4.62 P0.002pgml0.05). The difference between group A and group B was higher than that in group B (150 pg/mliPTH800 pg/ml)(15.73 卤29.32 vs 10.10 卤4.62 P0.002pgml0.05). Vs9.70 卤3.10pmliPTH800pgml-1 (9.70 卤3.10 vs 10.10 卤4.62pgml / ml) and C group (8.31 卤3.20 vs 10.10 卤4.62pgml / ml vs 10.10 卤4.62pgml / ml vs 10.10 卤4.62pgml / ml); 150pgr / mliPTH300pggml / ml in group B and C / c respectively (9.70 卤3.10 vs 10.10 卤4.62pgml / ml vs 10.10 卤4.62P0. 703pgml / ml). No significant correlation was found between BALP and iPTH iPTH. 0. 398P0. 01rnr0. 707P0. 01P and iPTH R0. 24P0. 05 BALP BALP CKD-MBD. 0. 24P0. 0. 05. The threshold of ROC use in patients with CKD-MBD was not correlated with that of C group (9. 70 卤3. 10 vs 10. 10 卤4. 62P0. 703P0.05). The area under the 1: ROC curve is 0.765, the standard error is 0.091 / 95% confidence interval is 0.586 / 0.945 BALP, the values of sensitivity and 1- specificity are shown in Table 5, the limit value of comprehensive sensitivity and specificity is 11.46 ugL / .Conclusion: (1) BALP can be used as diagnostic index of CKD-MBD. 1.1BALP ratio ALP. In the diagnosis of CKD-MBD, especially bone metabolism, Higher sensitivity. 1.2BALP had better correlation with iPTH, better stability than iPTH and repeatable. 2.BALP had the highest sensitivity and specificity when BALP11.46 ug/L was used to diagnose CKD3-5D patients.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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