Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany.
Institut für Laboratoriumsmedizin, Deutsches Herzzentrum München, Technical University of Munich, Munich, Germany.
Clin Chim Acta. 2022 Aug 1;533:1-7. doi: 10.1016/j.cca.2022.05.024. Epub 2022 Jun 8.
The association between alkaline phosphatase (ALP) and mortality in patients with diabetes mellitus (DM) and ischemic heart disease (IHD) remains poorly investigated.
The study included 1426 patients with DM and IHD who underwent percutaneous coronary intervention. Patients were divided in groups according to tertiles of ALP activity: a group with ALP activity in 1st tertile (ALP activity: 20.8-65.0 U/L; n = 478), a group with ALP activity in 2nd tertile (ALP activity: 65.1-87.0 U/L; n = 473) and a group with ALP activity in 3rd tertile (ALP activity: 87.1-1520 U/L; n = 475). The primary endpoint was 3-year all-cause mortality.
At 3 years, all-cause deaths occurred in 182 patients: 50 deaths (12.4%) in patients of 1st tertile, 47 deaths (11.7%) in patients of 2nd tertile and 85 deaths (20.8%) in patients of 3rd tertile of ALP activity (adjusted hazard ratio [HR] = 1.20, 95% confidence interval [CI] 1.02 to 1.42, P = 0.031); cardiac deaths occurred in 110 patients: 28 deaths (7.0%) in patients of 1st tertile, 30 deaths (7.6%) in patients of 2nd tertile and 52 deaths (12.7%) in patients of 3rd tertile of ALP activity (adjusted HR = 1.27 [1.04-1.56], P = 0.021, with both risk estimates calculated for unit increment in the log scale of ALP activity). The C-statistic of the multivariable model with baseline data without and with ALP was 0.787 [0.750-0.818] and 0.804 [0.757-0.851], (P = 0.575) for all-cause mortality and 0.832 [0.798-0.864] and 0.876 [0.833-0.918], (P = 0.115) for cardiac mortality.
In patients with DM and IHD, elevated ALP activity was associated with increased risk of 3-year mortality.
碱性磷酸酶（ALP）与糖尿病（DM）和缺血性心脏病（IHD）患者的死亡率之间的关系尚未得到充分研究。
这项研究纳入了 1426 名接受经皮冠状动脉介入治疗的 DM 和 IHD 患者。根据 ALP 活性的三分位将患者分为三组：第 1 组 ALP 活性在第 1 分位（ALP 活性：20.8-65.0 U/L；n=478），第 2 组 ALP 活性在第 2 分位（ALP 活性：65.1-87.0 U/L；n=473），第 3 组 ALP 活性在第 3 分位（ALP 活性：87.1-1520 U/L；n=475）。主要终点是 3 年全因死亡率。
在 3 年时，共有 182 例患者发生全因死亡：第 1 分位组有 50 例死亡（12.4%），第 2 分位组有 47 例死亡（11.7%），第 3 分位组有 85 例死亡（20.8%）（调整后的危险比[HR]为 1.20，95%置信区间[CI]为 1.02 至 1.42，P=0.031）；心脏死亡 110 例：第 1 分位组 28 例死亡（7.0%），第 2 分位组 30 例死亡（7.6%），第 3 分位组 52 例死亡（12.7%）（调整后的 HR 为 1.27[1.04-1.56]，P=0.021，均为 ALP 活性对数刻度单位递增的风险估计值）。包含基线数据的多变量模型的 C 统计量为 0.787[0.750-0.818]和 0.804[0.757-0.851]（P=0.575）用于全因死亡率，0.832[0.798-0.864]和 0.876[0.833-0.918]（P=0.115）用于心脏死亡率。
在患有 DM 和 IHD 的患者中，ALP 活性升高与 3 年死亡率增加相关。
