上海市嘉定区社区人群血清碱性磷酸酶水平与动脉硬化的相关性  

Correlation between serum alkaline phosphatase and arteriosclerosis in residents of Jiading district of Shanghai

作　　者：邓欣如[1] 王天歌[1] 徐佰慧[1] 孙侃[1] 李勉[1] 董文丽[1] 林琳[1] 黄小琳[1] 陆洁莉[1] 毕宇芳[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院内分泌代谢科,上海200025

出　　处：《上海医学》2013年第5期402-406,共5页Shanghai Medical Journal

摘　　要：目的探讨上海市嘉定区社区人群血清碱性磷酸酶(ALP)水平与动脉硬化的相关性。方法记录1705例上海市嘉定区菊园新区40岁以上社区居民标准化问卷调查、体格检查、生化检测和臂-踝动脉脉搏波传导速度(BaPWV)测量的结果,以任一侧肢体BaPWV≥1737.50cm/s定义为动脉硬化,根据受试者的血清ALP水平按四分位分组(≤65U/L组、66～78U/L组、79～95U/L组和≥96U/L组),分析血清ALP水平与动脉硬化的相关性。结果 4组受试者血清ALP水平与年龄(r=0.28,P<0.0001)、BaPWV(r=0.23,P<0.0001)、丙氨酸转氨酶(ALT,r=0.12,P<0.0001)、天冬氨酸转氨酶(AST,r=0.14,P<0.0001)、收缩压(r=0.18,P<0.0001)、三酰甘油(TG,r=0.11,P<0.0001)、总胆固醇(TC,r=0.09,P<0.0001)、低密度胆蛋白胆固醇(LDL-C,r=0.05,P=0.0317)、糖化血红蛋白(HbA1c,r=0.12,P<0.0001)水平呈正相关,与肾小球滤过率估计值(eGFR,r=-0.07,P=0.0014)呈负相差;随着ALP水平的升高,动脉硬化(P<0.0001)、高血压(P<0.0001)和糖尿病(P=0.0003)发生比例呈上升趋势,目前饮酒者比例(P=0.0488)呈下降趋势;与性别、体质指数(BMI)、目前吸烟者比例、舒张压、高密度脂蛋白胆固醇(HDL-C)等不相关(P值均>0.05)。在未校正任何混杂因素(模型1,P<0.0001),校正年龄、性别、BMI、目前吸烟及饮酒者比例因素(模型2,P=0.0005),校正年龄、性别、BMI、目前吸烟及饮酒者比例、TG、TC、LDL-C、HDL-C、eGFR因素(模型3,P=0.0039),以及校正年龄、性别、BMI、目前吸烟及饮酒者比例、TG、TC、LDL-C、HDL-C、eGFR、糖尿病、高血压因素(模型4,P=0.0093)的情况下,血清ALP水平与动脉硬化的患病风险均呈正相关,并呈剂量-反应关系。在模型4的情况下,≥96U/L组动脉硬化的患病风险较≤65U/L组增加55%(OR=1.55,95%CI为1.05～2.29,P=0.0250);对人群进行分层分析发现,男性组、≥65岁组、eGFR<90mL·min-1·1.73m-2组、糖尿病组及高血压组中,血清ALP水平与动脉硬化不相关(P�Objective To investigate the correlation between serum alkaline phosphatase （ALP） and arteriosclerosis in residents of Shanghai Jiading district. Methods A total of 1 705 subjects aged 40 years or above from Jiading district were enrolled in the present study. The questionnaire interview, physical examination, biochemical evaluation, and brachiai-ankle pulse wave velocity （BaPWV） were documented. Arteriosclerosis was defined as a BaPWV≥ 1 737.50 cm/s at either side. According to ALP level, the subjects were divided into 65 U/L group, 66-78 U/L group, 79-95 U/L group andS96 U/L group. Results The serum ALP level was positively related to age （r=0.28, P〈0.000 1）, BaPWV （r=0.23, P〈0.000 1）, ALT （r=0. 12, P〈 0.000 1）, aspartate aminotranferase （AST, r=0.14, P〈0. 000 1）, systolic blood pressure （SBP, r= 0. 18, P〈0. 000 1 ）, triacylglycerol （TG, r = 0.11, P〈0. 000 1）, cholesterol total （TC, r = 0.09, P〈0. 000 1 ）, lowdensity lipoprotein cholesterol （LDL-C, r = 0.05, P = 0. 031 7）, hemoglobin Alc （HbA1c, r = 0. 12, P〈 0. 000 1 ）, was negatively related to estimated glomeruar filtration rate （eGFR, r = - 0.07, P = 0.001 4）. With the serum ALP level increasing, prevalence of arteriosclerosis （ P〈0. 000 1 ）, hypertension （ P〈0. 000 1 ） and diabetes （ P = 0. 000 3） showed an increasing trend, and current alcohol users （ P = 0. 0488） showed an downward trend. Meanwhile, ALP level was not related to sex, body mass index （BMI）, current smokers, DBP or HDL-C （P〉0. 05）. In model 1 to model 4, there was a positive dose-response relationship between serum ALP level and risk of arteriosclerosis. In model 4, the incidence of arteriosclerosis in the subjects with ALP ≥96 U/L increased by 55 % as compared with the subjects with ALP 465 U/L （ OR = 1.55, 95 % CI = 1.05 - 2.29, P = 0. 025 0）. And significant association was found between serum ALP level and arteriosclerosis in females, subjects less than 65 years, eGFR≥90 mL . min-1 .

关 键 词：碱性磷酸酶 动脉粥样硬化 臂-踝动脉脉搏波传导速度 

分 类 号：R543.5[医药卫生—心血管疾病]