Zhang Yuanyuan, Li Huan, Xie Di, Li Jianping, Zhang Yan, Wang Binyan, Liu Chengzhang, Song Yun, Wang Xiaobin, Huo Yong, Hou Fan Fan, Xu Xiping, Qin Xianhui
Division of Nephrology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
National Clinical Research Center for Kidney Disease, Guangzhou, China.
Front Cardiovasc Med. 2021 Dec 10;8:749196. doi: 10.3389/fcvm.2021.749196. eCollection 2021.
The relation of alkaline phosphatase (ALP) with stroke risk remains uncertain. We aimed to examine the association between serum ALP and the risk of first stroke, and explore the possible effect modifiers in the association, among adults with hypertension. A total of 19,747 participants with baseline ALP measurements and without liver disease at baseline from the China Stroke Primary Prevention Trial (CSPPT) were included. The primary outcome was a first stroke. Over a median follow-up of 4.5 years, there was a positive association between serum ALP levels and the risk of first stroke (per SD increment, adjusted HR, 1.10; 95%CI: 1.01, 1.20). When serum ALP was evaluated as quartiles, a significantly higher risk of first stroke was observed in those in quartile 2-4 (ALP ≥79 IU/L; adjusted HR, 1.38; 95% CI: 1.11, 1.71), compared with participants in quartile 1 (ALP <79 IU/L). Similar results were found for first ischemic or hemorrhagic stroke. Similar findings were also found in those with a normal range of baseline ALP levels (20-140 IU/L) (per SD increment, adjusted HR, 1.15; 95%CI: 1.05, 1.27). None of the variables, including sex, age, body mass index, smoking, alcohol drinking, blood pressure, total cholesterol, fasting glucose levels at baseline, and blood pressure levels during the treatment period, significantly modified the association. In summary, our study suggests that higher serum ALP levels, even in normal range, were significantly related to higher risk of first stroke among Chinese hypertensive adults.
碱性磷酸酶（ALP）与中风风险之间的关系仍不确定。我们旨在研究血清ALP与首次中风风险之间的关联，并探讨高血压成年人中该关联可能的效应修饰因素。纳入了中国脑卒中一级预防试验（CSPPT）中19747名基线时测量了ALP且无肝脏疾病的参与者。主要结局是首次中风。在中位随访4.5年期间，血清ALP水平与首次中风风险呈正相关（每标准差增加，校正后风险比为1.10；95%置信区间：1.01，1.20）。当将血清ALP按四分位数评估时，与第1四分位数（ALP<79 IU/L）的参与者相比，第2 - 4四分位数（ALP≥79 IU/L）的参与者首次中风风险显著更高（校正后风险比为1.38；95%置信区间：1.11，1.71）。首次缺血性或出血性中风也有类似结果。在基线ALP水平正常范围（20 - 140 IU/L）的人群中也发现了类似的结果（每标准差增加，校正后风险比为1.15；95%置信区间：1.05，1.27）。包括性别、年龄、体重指数、吸烟、饮酒、血压、总胆固醇、基线空腹血糖水平以及治疗期间血压水平在内的所有变量，均未显著改变该关联。总之，我们的研究表明，即使在正常范围内，较高的血清ALP水平也与中国高血压成年人首次中风的较高风险显著相关。
