Behnke B, Kemper M, Kruse H P, Müller-Wiefel D E
Department of Pediatrics and Nephrology, University Hospital of Eppendorf, Hamburg, Germany.
Nephrol Dial Transplant. 1998 Mar;13(3):662-7. doi: 10.1093/ndt/13.3.662.
With the introduction of a new immunoradiometric assay based on two monoclonal antibodies (Tandem-Ostase, Hybritech) the determination of bone alkaline phosphatase (BAP) to evaluate bone metabolism in chronic renal failure has become easier and more valid.
Using this test we investigated BAP in a total of 90 paediatric patients, 42 (9.2+/-5.5 years) with chronic renal failure on conservative treatment, 22 (9.5+/-5.4 years) under chronic dialysis, and 26 (16.2+/-5.9 years) after renal transplantation, compared to 203 controls (10.1+/-5.7 years).
The physiological age dependency found in controls including two peaks during infancy and puberty was distinctly disturbed in chronic renal failure. However, in patients BAP significantly correlated with height velocity rather reflecting the last 6 (r=0.56 P<0.001) than the last 12 months. Although BAP correlated well with total alkaline phosphatase (TAP; r=0.95 P<0.001), a significant correlation with the serum level of the intact parathyroid hormone could only be detected for BAP (r=0.45 P<0.001) but not for TAP (r=0.19 n.s.). Furthermore, BAP positively correlated with trabecular (n=40; r=0.40 P<0.05) and inversely with cortical bone density (n=19; r=-0.58 P<0.01) but no relationship was found with conventional X-ray.
BAP determined by the new radioimmunoassay seems to represent an additional diagnostic tool to assess growth and bone turnover in paediatric patients with chronic renal failure that is complementary to the information provided by X-ray and total alkaline phosphatase.
随着基于两种单克隆抗体的新型免疫放射分析方法（串联骨碱性磷酸酶，Hybritech公司）的引入，测定骨碱性磷酸酶（BAP）以评估慢性肾衰竭患者的骨代谢变得更加简便有效。
我们使用该检测方法对总共90例儿科患者的BAP进行了研究，其中42例（9.2±5.5岁）为接受保守治疗的慢性肾衰竭患儿，22例（9.5±5.4岁）为接受慢性透析的患儿，26例（16.2±5.9岁）为肾移植术后患儿，同时与203例对照者（10.1±5.7岁）进行比较。
在对照组中发现的生理年龄依赖性，即在婴儿期和青春期出现两个峰值，在慢性肾衰竭患者中明显受到干扰。然而，在患者中，BAP与身高增长速度显著相关，反映的是过去6个月（r=0.56，P<0.001）而非过去12个月的情况。虽然BAP与总碱性磷酸酶（TAP；r=0.95，P<0.001）相关性良好，但仅在BAP中检测到与完整甲状旁腺激素血清水平有显著相关性（r=0.45，P<0.001），而TAP未显示相关性（r=0.19，无统计学意义）。此外，BAP与小梁骨密度呈正相关（n=40；r=0.40，P<0.05），与皮质骨密度呈负相关（n=19；r=-0.58，P<0.01），但与传统X线检查未发现相关性。
通过新型放射免疫分析测定的BAP似乎是评估慢性肾衰竭儿科患者生长和骨转换的一种额外诊断工具，可补充X线和总碱性磷酸酶所提供的信息。
