本文選題：甲狀旁腺激素　切入點(diǎn)：堿性磷酸酶　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究將觀察慢性腎臟病3期-慢性腎臟病5D期患者中骨特異性堿性磷酸酶(bone-specific alkaline phosphatase,BALP)的差別,及BALP與目前常用的CKD-MBD監(jiān)測指標(biāo)之間的關(guān)系,探討B(tài)ALP在CKD-MBD、尤其在骨代謝方面的價(jià)值,為慢性腎臟病礦物質(zhì)骨代謝異常的早期診斷提供良好依據(jù)。方法:選擇2016年7月至2017年1月就診于秦皇島市第一醫(yī)院腎內(nèi)科慢性腎臟病3期(CKD 3期)--慢性腎臟病5D期(CKD 5D期)患者59例,分為4組,iPTH150 pg/ml為A組13例,150 pg/mliPTH300pg/ml為B組15例,300 pg/mliPTH800 pg/ml為C組21例,i PTH800pg/ml為D組10例,原發(fā)病分別為糖尿病腎病、高血壓腎損傷、多囊腎、新月體腎炎、IgA腎病、痛風(fēng)性腎病、藥物性腎損傷、腎動(dòng)脈狹窄等疾病。收集患者的一般情況(性別、年齡),采集空腹靜脈血,檢測空腹全段甲狀旁腺激素(intact parathyroid hormone,iPTH)、骨特異性堿性磷酸酶(bone-specific alkaline phosphatase,BALP)、堿性磷酸酶(alkaline phosphatase,ALP)、血肌酐(serum creatinine,Cr)、血尿素氮(serum urea nitrogen,BUN)、血尿酸(serum uric acid,UA)、血鈣(serum calcium,Ca)、血磷(serum phosphorus,P)、白蛋白(serum albumin,Alb)。應(yīng)用SPSS22.0統(tǒng)計(jì)軟件進(jìn)行處理,組間比較采用方差分析,多重比較用LSD方法,以P0.05為差別有統(tǒng)計(jì)學(xué)意義,用Spearman相關(guān)性分析進(jìn)行相關(guān)性檢測,ROC曲線確定BALP在CKD-MBD診斷值。結(jié)果:1各組間患者在年齡、性別、血鈣、白蛋白均無統(tǒng)計(jì)學(xué)意義(P0.05)。BALP(ug/L)水平變化情況:D組(iPTH800 pg/ml)高于A組(iPTH150pg/ml),(15.73±29.32 vs 8.31±3.20,P=0.000);D組(iPTH800 pg/ml)高于B組(150 pg/mliPTH300 pg/ml)(15.73±29.32 vs 9.70±3.10,P=0.001);D組(iPTH800 pg/ml)高于C組(300 pg/mliPTH800 pg/ml)(15.73±29.32 vs 10.10±4.62,P=0.002),P0.05存在統(tǒng)計(jì)學(xué)差異。A組(i PTH150 pg/ml)與B組(150 pg/mliPTH300 pg/ml),(8.31±3.20 vs9.70±3.10,P=0.366);A組(iPTH150 pg/ml)與C組(300 pg/mliPTH800pg/ml),(8.31±3.20 vs 10.10±4.62,P=0.184);B組(150 pg/mliPTH300pg/ml)與C組(300 pg/mliPTH800 pg/ml),(9.70±3.10 vs 10.10±4.62,P=0.703),P0.05無統(tǒng)計(jì)學(xué)差異。2 Spearman相關(guān)分析顯示BALP與i PTH、ALP存在正相關(guān)關(guān)系(r=0.398,P0.01;r=0.707,P0.01),ALP與iPTH無相關(guān)性(r=0.224,P0.05)。3 BALP對CKD-MBD患者的診斷界限值使用ROC曲線進(jìn)行確定:ROC曲線下面積為0.765,標(biāo)準(zhǔn)誤為0.091,95%置信區(qū)間為(0.586,0.945);BALP取不同靈敏度和1-特異度值見表5,綜合靈敏度與特異度,BALP界限值為11.46 ug/L。結(jié)論:1.BALP可作為CKD-MBD的診斷指標(biāo)。1.1BALP比ALP在診斷CKD-MBD尤其是骨代謝方面,靈敏度更高。1.2BALP與iPTH有更好相關(guān)性,比iPTH有更好的穩(wěn)定性和可重復(fù)。2.BALP診斷CKD-MBD的界限值當(dāng)BALP11.46 ug/L時(shí)診斷CKD3-5D期患者的CKD-MBD的靈敏度和特異度最高。
[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 鹵29.32 vs 8.31 鹵3.20 P0. 000) compared with group B (150 pg/mliPTH300 pg/ml)(15.73 鹵29.32 vs 9.70 鹵3.10 pg/mliPTH800 鹵0.001g / L) than group C (300 pg/mliPTH800 pg/ml)(15.73 鹵29.32 vs 10.10 鹵4.62 P0.002pgml0.05). There was a significant difference between group A and group B (150 pg/mliPTH800 pg/ml)(15.73 鹵29.32 vs 10.10 鹵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 鹵29.32 vs 10.10 鹵4.62 P0.002pgml0.05). Vs9.70 鹵3.10pmliPTH800pgml-1 (9.70 鹵3.10 vs 10.10 鹵4.62pgml / ml) and C group (8.31 鹵3.20 vs 10.10 鹵4.62pgml / ml vs 10.10 鹵4.62pgml / ml vs 10.10 鹵4.62pgml / ml); 150pgr / mliPTH300pggml / ml in group B and C / c respectively (9.70 鹵3.10 vs 10.10 鹵4.62pgml / ml vs 10.10 鹵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 鹵3. 10 vs 10. 10 鹵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.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692

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