Xiangyu Piao, Zhao Jie, Wu Yue
Department of Neurology, Affiliated Zhongshan Hospital of Dalian University, Dalian, China.
Clin Invest Med. 2019 Mar 23;42(1):E47-E52. doi: 10.25011/cim.v42i1.32392.
Vascular calcification is one of the mechanisms underlying the pathogenesis of cerebral small vessel disease (CSVD). Whether higher levels of serum alkaline phosphatase (ALP), a predictor of vascular calcification, are independently associated with CSVD remains inconclusive.
The present study explored the link between levels of circulating ALP and CSVD in a Chinese population.
A total of 568 participants were recruited from the healthcare center at the affiliated Zhongshan Hospital of Dalian University and the Fifth People Hospital of Dalian between January 2010 and December 2016. The subjects were divided into three groups based on the infarct and severity of white matter hyper-intensities (WMH) as categorized by brain magnetic resonance imaging (MRI) analysis and Fazekas rating scales: no/mild cerebral WMH (nm-WMH); moderate-to-severe WMH (MS-WMH); and silent lacunar infarct (SLI). The subjects were also divided into three tertiles based on circulating levels of ALP: ≤64, 65-105 and ≥106 (IU/L). Information regarding the risk factors, such as coronary artery disease, diabetes mellitus, hypertension and serum ALP level, C-reactive protein, homocysteine (HCY), and other laboratory results, were collected. The associations of ALP with WMH and SLI were evaluated using logistic regression analysis.
After adjustment for vascular risk factors, subjects with MS-WMH and SLI were more likely to have ALP levels ≥106 IU/L than ≤64 IU/L. The mean circulating level of ALP was substantially increased in patients with MS-WMH or SLI compared with patients with nm-WMH. The multivariate model revealed that this significant difference remained when MS-WMH or SLI was added to the model, after adjustment for confounding factors.
The circulating level of ALP was positively correlated with a high risk of silent lacunar infarct and white matter hyperintensity; important indicators of small vessel disease.
血管钙化是脑小血管病（CSVD）发病机制的潜在机制之一。血管钙化的预测指标血清碱性磷酸酶（ALP）水平升高是否与CSVD独立相关仍无定论。
本研究探讨中国人群中循环ALP水平与CSVD之间的联系。
2010年1月至2016年12月期间，从大连大学附属中山医院和大连第五人民医院的医疗中心招募了568名参与者。根据脑磁共振成像（MRI）分析和 Fazekas 评分量表对梗死和白质高信号（WMH）的严重程度，将受试者分为三组：无/轻度脑WMH（nm-WMH）；中度至重度WMH（MS-WMH）；以及无症状腔隙性梗死（SLI）。受试者还根据循环ALP水平分为三个三分位数：≤64、65-105和≥106（IU/L）。收集有关危险因素的信息，如冠状动脉疾病、糖尿病、高血压和血清ALP水平、C反应蛋白、同型半胱氨酸（HCY）以及其他实验室检查结果。使用逻辑回归分析评估ALP与WMH和SLI的关联。
在调整血管危险因素后，与ALP水平≤64 IU/L相比，MS-WMH和SLI受试者更有可能ALP水平≥106 IU/L。与nm-WMH患者相比，MS-WMH或SLI患者的平均循环ALP水平显著升高。多变量模型显示，在调整混杂因素后，当将MS-WMH或SLI添加到模型中时，这种显著差异仍然存在。
ALP的循环水平与无症状腔隙性梗死和白质高信号的高风险呈正相关；小血管疾病的重要指标。
