Alkaline phosphatase in pediatric patients with genu varum caused by vitamin D-deficient rickets
Alkaline phosphatase in pediatric patients with genu varum caused by vitamin D-deficient rickets
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DOI：
10.1507/endocrj.ej20-0622
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发表时间：
2021-01-01
影响因子：
2
通讯作者：
Ozono, Keiichi
中科院分区：
文献类型：
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作者：
Mukai, Masashi;Yamamoto, Takehisa;Ozono, Keiichi
血清碱性磷酸酶（ALP）水平升高是儿童佝偻病的标志之一，但它也与骨形成有关。然而，它在诊断儿童维生素D缺乏性佝偻病患者内翻中的作用仍然是未知的。为了阐明血清碱性磷酸酶水平在评估内翻性佝偻病严重程度中的作用，我们回顾性研究了这一问题，使用佝偻病的数据，如血清全段甲状旁腺激素（iPTH）、25羟维生素D、1，25-二羟维生素D、碱性磷酸酶、肌酐水平占年龄中位数的百分比（%Cr），以下肢干骺端骨干角（MDA）作为内翻畸形严重程度的指标。多元回归分析显示，对数ALP和%Cr值与MDA值呈负相关。线性混合模型也证实了前者的关联，而路径模型分析表明iPTH与MDA呈正相关。为了阐明iPTH存在下ALP与MDA的相关性，我们通过神经网络分析研究了三维图形。这表明ALP与MDA存在双相关联：第一相增加而第二相减少MDA。后一种现象被认为与由于下肢上负载的机械应力导致的骨形成增加有关。这些发现对于儿科医生了解血清ALP水平在维生素D缺乏引起的儿童内翻中的意义具有重要意义。
An elevated serum alkaline phosphatase (ALP) level is one of the markers for the presence of rickets in children, but it is also associated with bone formation. However, its role in diagnosing genu varum in pediatric patients with vitamin Ddeficient rickets is still unknown. To clarify the role of the serum ALP level in assessing the severity of genu varum, we retrospectively investigated this issue statistically using data on rickets such as serum intact parathyroid hormone (iPTH), 25hydroxyvitamin D, 1,25-dihydroxyvitamin D, ALP, the level of creatinine as the percentage of the median according to age (%Cr), and the metaphyseal diaphyseal angle (MDA) in the lower extremities as an index of the severity of genu varum. A multiple regression analysis revealed that log ALP and %Cr values were negatively associated with MDA values. The former association was also confirmed by a linear mixed model, while iPTH was positively associated with MDA by path model analysis. To elucidate the association of ALP with MDA in the presence of iPTH, we investigated three-dimensional figures by neural network analysis. This indicated the presence of a biphasic association of ALP with MDA: the first phase increases while the second decreases MDA. The latter phenomenon is considered to be associated with the increase in bone formation due to the mechanical stress loaded on the lower extremities. These findings are important and informative for pediatricians to understand the significance of the serum ALP level in pediatric patients with genu varum caused by vitamin D deficiency.