微炎症状态及血清PTH(1-84) BALP水平检测在维持性血液透析肾性骨病中的临床意义

doi:10.3969/j.issn.1006-6233.2023.06.012

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摘要 目的: 分析微炎症状态及血清全长甲状旁腺激素[PTH(1-84)]、骨特异性碱性磷酸酶(BALP)水平检测在维持性血液透析(MHD)肾性骨病中的临床意义。方法: 选取2019年1月至2022年7月我院肾内科收治的104例MHD患者为研究对象,根据是否并发肾性骨病分为肾性骨病组(n=36例)及非肾性骨病组(n=68例);同时选择50例健康志愿者为对照组。比较三组入组时的微炎症状态[C反应蛋白(CRP)、白细胞介素-6(IL-6)、β₂微球蛋白(β₂-MG)]及骨转化指标[PTH(1-84)、BALP、护骨素(OPG)]水平;Pearson相关分析肾性骨病组患者微炎症状态与骨转化指标的关系;以受试者工作曲线(ROC)分析上述微炎症及骨转化指标对MHD并发肾性骨病的预测价值。结果: 三组入组时的血清CRP、IL-6、β₂-MG水平比较:肾性骨病组>非肾性骨病组>对照组,差异有统计学意义(P<0.05);三组入组时的血清PTH(1-84)、BALP、OPG水平比较:肾性骨病组>非肾性骨病组>对照组,差异有统计学意义(P<0.05);Pearson相关性分析显示,肾性骨病组患者入组时的血清IL-6与PTH(1-84)水平呈明显正相关(P<0.05),β₂-MG与BALP水平呈明显正相关(P<0.05);ROC曲线显示血清CRP(AUC=0.769,截断值为18.41mg/L时敏感度77.80%、特异度77.90%)、IL-6(AUC=0.791,截断值为243.53pg/mL时敏感度83.30%、特异度69.10%)、β₂-MG(AUC=0.731,截断值为5.605mg/L时敏感度73.90%、特异度70.28%)、PTH(1-84)(AUC=0.839,截断值为173.235ng/L时敏感度77.80%、特异度85.30%)、BALP(AUC=0.810,截断值为23.575U/L时敏感度94.40%、特异度64.70%)、OPG(AUC=0.826,截断值为365.93pg/mL时敏感度83.30%、特异度76.50%)对诊断MHD合并肾性骨病的预测效能良好。结论: 骨转化指标[PTH(1-84)、BALP、OPG]及微炎症指标(CRP、IL-6、β₂-MG)水平在MHD患者中异常升高,对诊断MHD合并肾性骨病具有良好预测效能。

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	买尔哈巴·买买提
	王婷
	帕热旦木·托乎提
	韩媛媛

关键词 ：维持性血液透析, 肾性骨病, 微炎症状态, 甲状旁腺激素, 骨特异性碱性磷酸酶

Abstract：Objective: To analyze the clinical significance of micro-inflammatory state and serum levels of intact parathyroid hormone [PTH(1-84)] and bone-specific alkaline phosphatase (BALP) on patients with renal osteodystrophy undergoing maintenance hemodialysis (MHD). Methods: A total of 104 patients with MHD admitted to department of nephrology of the hospital from January 2019 to July 2022 were selected as the research subjects. According to the presence or absence of renal osteodystrophy, the patients were divided into renal osteodystrophy group (n=36) and non-renal osteodystrophy group (n=68). Another 50 healthy volunteers were enrolled as control group. The levels of micro-inflammatory state [C-reactive protein (CRP), interleukin-6 (IL-6), β₂-microglobulin (β₂-MG)] and bone turnover markers [PTH(1-84), BALP, osteoprotegerin (OPG)] were compared among the three groups at enrollment. Pearson correlation analysis was used to analyze the relationship between micro-inflammatory state and bone turnover markers in patients with renal osteodystrophy. Receiver operating characteristic (ROC) curve was applied to analyze the predictive value of the above micro-inflammatory indicators and bone turnover markers on MHD with renal osteodystrophy. Results: The levels of serum CRP, IL-6 and β₂-MG in the three groups at enrollment were as follows: renal osteodystrophy group>non-renal osteodystrophy group>control group, with statistically significant differences (P<0.05). The levels of serum PTH(1-84), BALP and OPG in the three groups were shown as renal osteodystrophy group>non-renal osteodystrophy group>control group (P<0.05). Pearson correlation analysis showed that the level of serum IL-6 at enrollment in renal osteodystrophy group was positively correlated with PTH(1-84) (P<0.05), and β₂-MG was positively correlated with BALP (P<0.05). ROC curve revealed that serum CRP, IL-6, β₂-MG, PTH (1-84), BALP and OPG had good predictive efficiency in the diagnosis of MHD with renal osteodystrophy (with AUC, sensitivity and specificity of 0.769, 77.80% and 77.90% when CRP cutoff value was 18.41 mg/L, 0.791, 83.30% and 69.10% when IL-6 cutoff value was 243.53 pg/mL, 0.731, 73.90% and 70.28% when β₂-MG cutoff value was 5.605 mg/L, 0.839, 77.80% and 85.30% when PTH (1-84) cutoff value was 173.235 ng/L, 0.810, 94.40% and 64.70% when BALP cutoff value was 23.575 U/L and 0.826, 83.30% and 76.50% when OPG cutoff value was 365.93 pg/mL respectively). Conclusion: The levels of bone turnover markers [PTH(1-84), BALP, OPG] and micro-inflammatory indicators (CRP, IL-6, β₂-MG) are abnormally increased in patients with MHD, and they have good predictive efficiency in the diagnosis of MHD with renal osteodystrophy.

Key words： Maintenance hemodialysis Renal osteodystrophy Micro-inflammatory state Parathyroid hormone Bone-specific alkaline phosphatase

基金资助:新疆维吾尔自治区自然科学基金项目,(编号:2022D01C484)

通讯作者: 韩媛媛

引用本文:

买尔哈巴·买买提, 王婷, 帕热旦木·托乎提, 韩媛媛. 微炎症状态及血清PTH(1-84) BALP水平检测在维持性血液透析肾性骨病中的临床意义[J]. 河北医学, 2023, 29(6): 941-946.
MAIERHABA Maimaiti, WANG Ting, PAREDANMU Tuohuti, et al. The Clinical Significance of Microinflammatory Status and Serum PTH (1-84) and BALP Levels in Maintenance Hemodialysis Renal Bone Disease. HeBei Med, 2023, 29(6): 941-946.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.06.012 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I6/941

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