Peach H, Compston J E, Vedi S, Horton L W
J Clin Pathol. 1982 Jun;35(6):625-30. doi: 10.1136/jcp.35.6.625.
Plasma calcium and phosphate concentrations and alkaline phosphatase activities were examined retrospectively in 50 patients with histologically proven osteomalacia and 50 age- and sex-matched control subjects with normal bone histology. An abnormal plasma alkaline phosphatase activity was more useful than an abnormal plasma calcium or phosphate concentration in distinguishing between normal and osteomalacic subjects, producing a false-negative rate of 14% and a false-positive rate of 8%. False-negative and false-positive rates of 10% and 8% respectively were obtained when the presence of an abnormality in any one of the three biochemical measurements was used as a predictor of histological osteomalacia. When discriminant analysis was applied to plasma calcium, phosphate and alkaline phosphatase together a false-negative rate of 12% and a false-positive rate of 0% was obtained.Sixty-two patients in whom a diagnosis of osteomalacia was suspected were investigated prospectively, using both single biochemical abnormalities and the classification functions derived from the discriminant analysis of all three biochemical measurements to predict the presence or absence of histological osteomalacia. Plasma alkaline phosphatase activity gave false-negative and false-positive rates of 10% and 32% respectively but was a more reliable predictor of abnormal bone histology than were plasma calcium or plasma phosphate concentrations or the presence of an abnormality in any one of the three measurements. Discriminant analysis using plasma calcium, phosphate and alkaline phosphatase together produced a false-negative rate of 16% and a false-positive rate of 10%. We conclude that plasma alkaline phosphatase activity is the best single routine biochemical screening test for osteomalacia, although a high false-positive rate may occur. Direct discriminant analysis of plasma calcium, phosphate and alkaline phosphatase together provides a more sensitive method of detecting histological osteomalacia which should be useful in determining the prevalence of osteomalacia within high-risk populations.
对50例经组织学证实为骨软化症的患者以及50例年龄和性别匹配、骨组织学正常的对照者的血浆钙、磷浓度及碱性磷酸酶活性进行了回顾性研究。在区分正常人和骨软化症患者方面，血浆碱性磷酸酶活性异常比血浆钙或磷浓度异常更有用，其假阴性率为14%，假阳性率为8%。当将三项生化指标中任何一项异常作为组织学骨软化症的预测指标时，假阴性率和假阳性率分别为10%和8%。对血浆钙、磷和碱性磷酸酶进行判别分析时，假阴性率为12%，假阳性率为0%。对62例疑似骨软化症的患者进行了前瞻性研究，使用单一生化异常以及从三项生化指标判别分析得出的分类函数来预测组织学骨软化症的有无。血浆碱性磷酸酶活性的假阴性率和假阳性率分别为10%和32%，但与血浆钙、血浆磷浓度或三项指标中任何一项异常相比，它是骨组织学异常更可靠的预测指标。同时使用血浆钙、磷和碱性磷酸酶进行判别分析，假阴性率为16%，假阳性率为10%。我们得出结论，血浆碱性磷酸酶活性是骨软化症最佳的单一常规生化筛查试验，尽管可能会出现较高的假阳性率。同时对血浆钙、磷和碱性磷酸酶进行直接判别分析提供了一种更敏感的检测组织学骨软化症的方法，这对于确定高危人群中骨软化症的患病率应该是有用的。
