The Effect Of Bone-specific Alkaline Phosphatase In The Chronic Kidney Disease-mineral Bone Disorder

Objective: This study will explore the relationship between different i PTH and BALP,and evaluate the effect of PTH on BALP and its clinical significance.Methods: 59 patiants with chronic kidney disease 3-chronic kidney disease 5D(CKD3-5D)were enrolled in the Department of Nephrology,Qinhuangdao First Hospital frome July 2016 to January 2017,who were grouped according to PTH levels into A group(iPTH<150 pg/ml)consisted of13 patients,B group(150pg/ml<iPTH<300 pg/ml)consisted of 15 patients,C group(300 pg/ml <i PTH<800 pg/ml)consisted of 21 patients,D group(iPTH>800 pg/ml)consisted of 10 patients.The underlying disease included diabetic nephropathy,hypertensive kidney disease,polycystic kidney,crescentic glomerulonephritis,IgA nephropathy,nephropathy caused by hyperuricemia,drug-induced renal damage,renal artery stenosis and other diseases.Collected patients general condition(gender,age),The levels of plasma iPTH(intact parathyroid homone),at the same time,serum BALP(bone-specific alkaline phosphatase),ALP(alkaline phosphatase),Cr(creatinine),BUN(urea nitrogen),UA(uric acid),Ca(calcium),P(phosphorus),Alb(albumin)were detected on anempty stomach.All the data were processed by medical statistics software SPSS22.0.For comparison among samples,variance analysis and multiple comparisons were applied,the difference was considered statistically significant when P value was less than 0.05.Correlation analysis by Speaman method.Determination of BALP value in CKD-MBD by ROC curve.Results:1 BALP(ug/L)level of D group(iPTH>800 pg/ml)was higher than C group(300 pg/ml <iPTH<800 pg/ml)(15.73±29.32 vs10.10±4.62,P=0.002),there was significant difference in P<0.05 between two groups;The level of BALP(ug/L),D group(iPTH>800 pg/ml)was higher than that of B group(150 pg/ml<iPTH<300 pg/ml)(15.73±29.32 vs9.70±3.10,P=0.001),There was significant difference in P<0.05 between two groups;The level of BALP(ug/L)D group(iPTH>800 pg/ml)was higher than that of A group(iPTH<150 pg/ml)(15.73±29.32 vs 8.31±3.20,P=0.000),There was significant difference in P<0.05 between two groups.There were no significant differences in age,sex,serum calcium and albumin between the groups.2 Spearman correlation analysis showed that BALP was positively correlated with iPTH and ALP(r=0.398,P<0.01;r=0.707,P<0.01),ALP and PTH were not correlated(r=0.224,P>0.05).3 The diagnostic value of BALP in patients with CKD-MBD was analyzed by ROC curve: the area under the ROC curve was 0.765,standard deviation of 0.091,95% confidence interval(0.586,0.945).The ROC curve analysis showed that cutoff point which the evaluation BALP effecting the onset of CKD-MBD is at 11.46 ug/L.Conclusion:1.BALP can be used as a diagnostic index of CKD-MBD.1.1 BALP is more sensitive than ALP in the disgnosis of CKD-MBD,especially bone metabolism.1.2 BALP has better correlation with iPTH,and has better stability and repeatability than i PTH.2.Diagnostic value of BALP for CKD-MBDThe sensitivity and specificity of CKD-MBD in patients with stage CKD3-5D were highest when BALP>11.46 ug/L was diagnosed.