From the Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, China; China National Clinical Research Center for Neurological Diseases, Beijing; Center of Stroke, Beijing Institute for Brain Disorders, China; and Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, China.
Stroke. 2018 May;49(5):1176-1182. doi: 10.1161/STROKEAHA.118.020237. Epub 2018 Apr 18.
Alkaline phosphatase (ALP) is associated with risk of adverse cardiovascular events in patients with kidney failure. However, there is little data about effects of ALP on stroke outcomes in patients with preserved kidney function. The study aimed to explore the association between serum ALP level and clinical outcomes after stroke in patients with preserved kidney function.
We included 16 367 stroke patients with preserved kidney function from the China National Stroke Registry for current analysis. Serum ALP levels were tested by automated enzymatic method using unfrozen samples in each center. Participants were divided into 5 groups according to ALP quintiles. Composite end point comprised of recurrent stroke, myocardial infarction, other ischemic vascular events, and all-cause mortality. Poor functional outcome is defined as modified Rankin Scale score of 3 to 6. Multivariable logistic regression was used to evaluate the independent association of serum ALP with 1-year all-cause mortality, recurrent stroke, composite end point, and poor functional outcome.
The mean age of the included 16 367 patients was 63.9 years, and 63.3% of them were men. Among the top ALP quintile (>98.0 U/L), 1-year incidences of all-cause mortality, recurrent stroke, composite end point, and poor functional outcome were 12.6%, 5.7%, 14.4%, and 27.0%, respectively. Compared with the lowest ALP quintile (≤59.0 U/L), the adjusted odds ratios of the top quintile were 1.36 (1.10-1.68) for all-cause mortality, 1.45 (1.11-1.90) for stroke recurrence, 1.35 (1.12-1.63) for composite end point, and 1.36 (1.17-1.60) for poor functional outcome. There was no significant interaction between age, sex, or alcohol consumption and ALP ( for interaction ≥0.10) for all outcomes.
In patients with preserved kidney function, ALP may be an independent predictor of all-cause mortality, stroke recurrence, composite end point, and poor functional outcome after stroke.
碱性磷酸酶（ALP）与肾功能衰竭患者发生不良心血管事件的风险相关。然而，关于 ALP 对肾功能正常的卒中患者卒中结局影响的数据较少。本研究旨在探讨血清 ALP 水平与肾功能正常的卒中患者卒中后临床结局之间的关系。
我们纳入了当前分析中来自中国国家卒中登记研究的 16367 例肾功能正常的卒中患者。使用每个中心的未冷冻样本通过自动酶法检测血清 ALP 水平。参与者根据 ALP 五分位值分为 5 组。复合终点包括卒中复发、心肌梗死、其他缺血性血管事件和全因死亡率。功能预后不良定义为改良 Rankin 量表评分 3 至 6 分。多变量 logistic 回归用于评估血清 ALP 与 1 年全因死亡率、卒中复发、复合终点和功能预后不良的独立相关性。
纳入的 16367 例患者的平均年龄为 63.9 岁，其中 63.3%为男性。在 ALP 五分位值的最高五分位组（>98.0 U/L）中，1 年全因死亡率、卒中复发、复合终点和功能预后不良的发生率分别为 12.6%、5.7%、14.4%和 27.0%。与最低 ALP 五分位组（≤59.0 U/L）相比，最高五分位组的调整比值比分别为全因死亡率 1.36（1.10-1.68）、卒中复发 1.45（1.11-1.90）、复合终点 1.35（1.12-1.63）和功能预后不良 1.36（1.17-1.60）。对于所有结局，年龄、性别或饮酒与 ALP 之间无显著交互作用（交互作用≥0.10）。
在肾功能正常的患者中，ALP 可能是全因死亡率、卒中复发、复合终点和卒中后功能预后不良的独立预测因子。
