目的 探讨血清骨硬化蛋白(sclerostin)、骨特异碱性磷酸酶(bone-specific alkaline phosphatase，BALP)联合检测对腹膜透析(peritoneal dialysis，PD)患者骨质疏松(osteoporosis,OP)的诊断价值。 方法 选择2023年1月1日一20日于首都医科大学附属北京潞河医院PD门诊随诊的患者为研究对象，入组患者均测定股骨近端的骨密度T值及Z值，依据骨密度值将患者分为骨质正常组与骨质疏松组。收集并比较2组患者的一般资料、生化指标、全段甲状旁腺激素(iPTH)、血清骨硬化蛋白、BALP水平等。应用多因素Logistic回归分析影响PD患者骨质疏松发生的危险因素。绘制ROC曲线，以AUC评价血清骨硬化蛋白、BALP及两者联合检测对PD患者骨质疏松的诊断价值。 结果 ①共纳入136例PD患者，男性62例(45.58%)，中位年龄58.00(49.25,65.00)岁，中位透析龄36.00(25.00,49.75)月，骨质疏松患者71例(52.20%)，合并糖尿病74例(54.41%)，合并高血压64例(47.06%)。骨质正常组(n=65)与骨质疏松组(n=71)患者在年龄(Z=-3.273,P=0.001)、透析龄(Z=-4.359,P＜0.001)、合并糖尿病(χ2=25.520，P＜0.001)方面比较差异有统计学意义。②多因素Logistic回归分析结果显示：年龄(OR=1.065,95% CI：1.005～1.128,P=0.034)、透析龄(OR=1.042,95% CI：1.006～1.078，P=0.020)、糖尿病(OR=3.607,95% CI：1.217～10.687，P=0.021)、骨硬化蛋白(OR=1.012,95% CI：1.006～1.019，P＜0.001)及BALP(OR =1.212,95% CI：1.095～1.342，P＜0.001)为影响PD患者骨质疏松发生的危险因素。③ROC曲线分析结果显示血清骨硬化蛋白、BALP及两者联合对PD患者骨质疏松诊断的敏感性分别为71.8%、64.8%、81.7%，特异性分别为76.9%、84.6%、93.8%，AUC分别为0.817、0.789、0.902，约登指数分别为0.494、0.488、0.755。 结论 血清骨硬化蛋白及BALP水平是PD患者骨质疏松发生的独立危险因素，血清骨硬化蛋白及BALP两者联合检测对PD患者骨质疏松的诊断效能较高。
Objective To explore the diagnostic value of serum Sclerostin and BALP in the diagnosis of osteoporosis in patients with peritoneal dialysis (PD). Methods A total of 136 patients who were followed up in PD outpatient Department of Beijing Luhe Hospital affiliated to Capital Medical University from January 1 to 20, 2023 were selected as the study objects. Bone mineral density (BMD) T and Z values of proximal femur were measured in all enrolled patients, and the patients were divided into normal bone group and osteoporosis group according to the BMD values. Meanwhile, the general data, biochemistry, IPTH, Sclerostin and bone-specific alkaline phosphatase (BALP) were collected. The clinical data, biochemical indexes, serum Sclerostin and BALP levels were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of osteoporosis in PD patients. Receiver operating characteristic (ROC) curve was drawn, and the area under ROC curve (AUC) was used to evaluate the diagnostic value of serum Sclerostin, BALP and their combined detection on osteoporosis in PD patients. Results ①Among the 136 PD patients included in the study, 62 were males, with a median age of 58.00 (49.25, 65.00) and a median dialysis age of 36.00 (25.00, 49.75) months, 71 were osteoporosis patients (52.20%), 74 were diabetic patients (54.41%), and 64 were hypertensive patients (47.06%). There were significant differences in age (Z=-3.273, P=0.001), dialysis age (Z=-4.359, P<0.001) and diabetes mellitus (χ2=25.520, P<0.001) between the normal bone group (n=65) and the osteoporosis group (n=71). ②The results of multivariate Logistic regression analysis showed that age (OR=1.065, 95% CI, 1.005，1.128, P=0.034), dialysis duration (OR=1.042, 95% CI, 1.006～1.078, P=0.020), diabetes (OR=3.607,95% CI,1.217～10.687，P=0.021), Sclerostin (OR=1.012, 95% CI, 1.006～1.019，P＜0.001) and BALP (OR=1.212, 95% CI, 1.095～1.342, P＜0.001) were all risk factors affecting the occurrence of osteoporosis in PD patients (P<0.05). ③ROC curve analysis showed that the sensitivity of serum Sclerostin, BALP and their combination for the diagnosis of osteoporosis in peritoneal dialysis patients were 71.8%, 64.8% and 81.7%, and the specificity was 76.9%, 84.6% and 93.8%, respectively. The AUC was 0.817, 0.789 and 0.902, and the Jorden index was 0.494, 0.488 and 0.755, respectively. Conclusion Serum Sclerostin and BALP levels are independent risk factors for osteoporosis in PD patients, and the combined detection of serum Sclerostin and BALP is more effective in the diagnosis of osteoporosis in peritoneal dialysis patients.
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