骨显像和血清骨型碱性磷酸酶在鼻咽癌骨转移的应用

目的：探讨骨显像和血清骨型碱性磷酸酶对鼻咽癌早期骨转移的诊断价值。方法：对71例鼻咽癌患者进行骨显像并测定血清骨型碱性磷酸酶水平，比较骨转移组和无骨转移组的血清骨型碱性磷酸酶水平。结果：71例鼻咽癌患者中，骨转移者44例，无骨转移者27例，转移率62％；骨转移组血清骨型碱性磷酸酶水平与无骨转移组差异显著（P〈0.01）。结论：鼻咽癌骨转移率较高，且血清骨型碱性磷酸酶与骨显像有一致性。     

前列腺癌患者碱性磷酸酶的检测

[目的]探讨碱性磷酸酶在前列腺癌诊断中的价值。[方法]动态检测前列腺癌病人手术前后碱性磷酸酶的水平变化。[结果]前列腺癌确定有骨转移患者碱性磷酸酶（ALP）的水平[（780±123）U／L],明显高于正常对照组[（68±25）U／L],同时也高于前列腺癌未伴转移组[（89±46）U／L]。术后前列腺癌确定有骨转移患者碱性磷酸酶（ALP）的水平下降显著[（146±66）U／L]。[结论]血清碱性磷酸酶的水平与前列腺痛骨转移有明显关联,其可作为前列腺癌的诊断、预后诊断的参考指标,及是否伴有转移的预测指标。     

全身骨显像联合血清碱性磷酸酶谱对鼻咽癌患者骨转移的诊断价值

目的：通过99mTc-MDP全身骨显像与血清碱性磷酸酶谱的联合检查,探讨对鼻咽癌骨转移的诊断价值。方法：对65例经病理证实为鼻咽癌的患者行全身骨显像。在行全身骨显像的前后1周内进行血清碱性磷酸酶谱测定。结果：65例鼻咽癌患者中41例发生骨转移,占63.08%,其中低分化癌转移率最高。鼻咽癌骨转移患者以脊柱转移最多,其次是胸部。鼻咽癌骨转移组、未转移组血清碱性磷酸酶谱水平明显高于正常组（P<0.01）;鼻咽癌骨转移组血清碱性磷酸酶谱水平明显高于未转移组（P<0.01）;多发骨转移组明显高于单发骨转移组（P<0.05）。结论：全身骨显像联合血清碱性磷酸酶谱测定,对于诊断骨转移,特别是鼻咽癌发生的单发骨转移有重要的临床意义。     

血清骨型碱性磷酸酶测定与骨显像联合诊断恶性肿瘤骨转移的价值

目的了解血清骨型碱性磷酸酶(B-AKP)测定与骨显像联合诊断肿瘤骨转移的价值。方法对136例确诊肿瘤患者作骨型碱性磷酸酶和骨显像的联合检查并进行对比观察。结果在骨转移组,骨显像阳性82例,阳性率95%;在非骨转移组,骨显像阳性6例,假阳性率12%。B-AKP对骨转移诊断阳性率为88%;在非骨转移组阳性率为44%。两组之间测定值及阳性率比较差异均有统计学意义(P<0.001)。结论 B-AKP是诊断骨转移的一个较为有效的生化指标。但它在非骨转移组中的较高阳性率,决定了它在判断骨转移时的局限性,最好与骨显像密切结合,才能更好的做出判断。     

联合检测尿脱氧吡啶啉与骨源性碱性磷酸酶诊断骨质疏松症

目的探讨尿脱氧吡啶啉(DPD)排泄率及骨源性碱性磷酸酶(BAP)对骨质疏松症患者的诊断价值及两者的相关性。方法对73例骨质疏松症患者在其治疗前后联合测定尿DPD、Cr,血BAP、钙(Ca)、磷(P)、碱性磷酸酶(ALP)及跟骨骨密度(BMD),以50例健康人作对照。结果骨质疏松症患者BAP(U/L)比对照组(213±8.13比142±6.08),DPD/Cr排泄率(nmol/mmolCr)比对照组(6.11±2.14比3.24±1.62)均显著增高(P<0.01),且治疗前后差异有显著性(P<0.01)。两指标之间成正相关(r=0.52)。结论BAP、DPD/Cr测定结果灵敏,比BMD经济方便,可作为骨质疏松症患者诊断的指标。     

ALP、PSA及其相关指标与前列腺癌骨转移的关系

目的探讨ALP、PSA及其相关指标（fPSA、fPSA/tPSA、PSAD）与前列腺癌骨转移的关系,及对前列腺癌骨转移诊断的预测作用。方法回顾分析2005年9月至2009年2月在我院经前列腺穿刺活检或手术后病理检查确诊的167例前列腺癌患者。以ECT、X线片、CT/MRI或骨活检诊断骨转移,分析ALP、PSA、fPSA、fPSA/tPSA、PSAD与前列腺癌骨转移的关系及对骨转移的诊断价值。结果 167例前列腺癌患者中骨转移104例（62.3%）,非骨转移63例（37.7%）。骨转移组ALP、PSA及PSAD明显高于非骨转移组（均P〈0.01）,而两组间fPSA/tPSA差异无统计学意义（P〉0.05）。PSA〉50ng/ml组骨转移率明显高于PSA〉20～50ng/ml组、〉10～20ng/ml组和≤10ng/ml组（均P〈0.05）;ALP〉90U/L组骨转移率明显高于ALP≤90U/L组（P〈0.05）;PSAD〉0.4ng.ml-1.cm-3组骨转移率明显高于PSAD≤0.4ng.ml-1.cm-3组（P〈0.05）。以ALP〉90U/L、PSA〉50ng/ml和PSAD〉0.4ng.ml-1.cm-3为界分别分析ALP、PSA、PSAD、PSA＋ALP、PSA＋PSAD和PSA＋PSAD＋ALP对前列腺癌骨转移诊断的预测价值,发现指标联合应用后阳性预测值及阴性预测值较单一指标好,PSA＋PSAD＋ALP联合应用的敏感度、特异度、阳性预测值及阴性预测值最佳,分别为100%、79.17%、91.38%及100%。结论 ALP、PSA及PSAD均为判断前列腺癌患者有无骨转移的可靠指标,PSA＋PSAD＋ALP联合应用有助于预测前列腺癌骨转移,当患者PSA〈50ng/ml、PSAD〈0.4ng.ml-1.cm-3及ALP〈90U/L时,几乎可排除骨转移。     

骨碱性磷酸酶半定量检测诊断小儿佝偻病

骨碱性磷酸酶（BALP）是血清碱性磷酸酶（ALP）的同工酶,由成骨细胞合成,是骨钙化带形成的主要活性物质,是反映生成率最敏感的指标。当成骨细胞转化为骨细胞时,BALP活性逐渐下降。如果小儿体内缺乏维生素D,骨钙化不足,成骨细胞不能转化为骨细胞,代偿性增生,BALP活性则上升。本文对210例0～13岁患儿检测了骨碱性磷酸酶,研究骨碱性磷酸酶（BALP）与早期小儿佝偻病诊断的临床意义,现将结果报道如下。     

骨特异性碱性磷酸酶测定在糖尿病骨质疏松症中的应用

目的研究骨特异性碱性磷酸酶(BAP)、钙(Ca)、磷(P)在糖尿病骨质疏松症临床诊断中的应用价值。方法测定40例糖尿病(DM)患者和40例正常对照的血清BAP、Ca、P。结果与正常对照组比较,糖尿病患者BAP显著增高     

早期新生儿血钙、磷、骨碱性磷酸酶水平及临床意义

目的：检测早期新生儿血清钙（Ca）、磷（P）、骨碱性磷酸酶（BAP）水平,通过分析各指标的变化差异及相关关系,评价不同胎龄新生儿骨形成状况。方法：采用酶联免疫分析（ELISA）法测定。结果：血Ca、P、BAP水平的变化与胎龄有关。结论：骨碱性磷酸酶水平的异常增高和血磷的降低可作为早期诊断新生儿代谢性骨病的敏感指标。胎龄小于32周的早产儿易发生代谢性骨病。     

BALP在前列腺癌骨转移中的检测意义

目的 探讨BALP在诊断前列腺癌发生骨转移的意义。方法 50例前列腺癌患者中有40例有多发生骨转移灶。另外10例未发生骨转移为病理对照组。我们以骨显像加日后3—5个月追踪的CT、X线检测综合判断为金标准，并根据骨显像将骨转移分成3个等级，ELISA检测患者的PSA、BALP，应用硝基苯磷酸盐法测血中ALP活性，并统计应用不同方法诊断的敏感度和特异度。结果 骨转移组外周血PSA、A伸、BALP水平均显著高于对照组（P〈0．05），PSA、A伸、BALP浓度或活性变化均与骨转移的不同分级呈正相关（r=0．789，0．814，0．912；P=0．041，0．035，0．011），在诊断的敏感性和特异性的比较中，骨显像诊断的敏感度最高，可以达到95％，但是其特异度最低只有40％；而骨显像＋BALP敏感度最低为52．5％；但是可以提高特异度可以达到100％。结论 BALP在诊断前列腺癌发生骨转移中特异性较强，联合检测BALP＋骨显像可以提高诊断特异度。     

碱性磷酸酶同工酶分析在肝、骨性疾病中的鉴别应用

目的对电泳后的碱性磷酸酶(ALP)同工酶进行定量分析测定,用于鉴别诊断肝、骨疾病.方法总ALP活性用日立747测定,将收集的ALP总活性升高的血清用神经氨酸酶处理后,在HELENA电泳仪上做琼脂糖电泳.结果电泳后可将ALP同工酶分成几个独立的区带,其中以肝型及骨型ALP为主,可用于鉴别肝脏疾病、骨疾病及癌症骨转移疾病.结论神经氨酸酶处理的血清经电泳后,能够更加准确的为ALP总活性升高的患者确诊.     

Bone to Total Alkaline Phosphatase Ratios Improve Sensitivity and Specificity of Bone Alkaline Phosphatase Immunoassays

Objectives: Evaluate the ability of two bone alkaline phosphatase (ALP_B) immunoassays (Ostase, Hybritech Inc and Alkphase-B, Metra Biosystems) to clinically differentiate between osseous and non-osseous ALP sources.

Design and Methods: Specimens from patients with either liver or bone disease (Paget’s disease or metastatic cancer) were analyzed by both methods.

Results: There was a good correlation between these two assays. Values for ALP_B, whether determined as a concentration by the Ostase assay or as an activity by the Alkphase-B assay, were similar for subjects with liver disease or bone disease. However, total ALP (ALP_T) activity was higher in liver disease compared to bone. When ALP_B was expressed in relation to ALP_T, ratios were significantly greater in subjects with bone disease than in those with liver disease. ALP_B/ALP_T ratios improved the specificity of the Ostase assay from 52% to 86% and the Alkphase-B assay from 58% to 74%.

Conclusions: These two ALP_B assays have good analytical performance and their clinical utility can be enhanced by expressing ALP_B values in relation to ALP_T activity.     

Comparative Mortality-Predictability Using Alkaline Phosphatase and Parathyroid Hormone in Patients on Peritoneal Dialysis and Hemodialysis

♦ Background: In hemodialysis (HD) patients, serum alkaline phosphatase (ALP) and parathyroid hormone (PTH) derangements are associated with mortality, but outcome-predictability using ALP and PTH in peritoneal dialysis (PD) patients remains uncertain.♦ Methods: In a cohort of 9244 adult PD patients from a large national dialysis organization (entry period 2001 - 2006, with follow-up through 2009), we used multivariable Cox models adjusted for case-mix and laboratory covariates to examine the associations of time-averaged ALP and PTH with all-cause mortality. We then compared mortality-predictability using ALP and PTH in 9244 PD and 99 323 HD patients.♦ Results: In PD patients, ALP concentrations exceeding 150 U/L were associated with increased mortality (reference ALP: 70 to <90 U/L). Hazard ratios (HRs) and 95% confidence intervals (CIs) were 1.18 (1.03 to 1.36), 1.27 (1.08 to 1.50), 1.49 (1.23 to 1.79), and 1.35 (1.19 to 1.53) for ALP concentrations of 150 to <170 U/L, 170 to <190 U/L, 190 to <210 U/L, and ≥210 U/L respectively. In contrast, we observed a U-shaped association between PTH concentration and death risk in PD patients, with PTH concentrations of less than 200 pg/mL and 700 pg/mL or more associated with increased mortality (reference PTH: 200 to <300 pg/mL). Hazard ratios and 95% CIs were 1.25 (1.12 to 1.41), 1.12 (1.02 to 1.23), 1.06 (0.96 to 1.18), 1.09 (0.97 to 1.24), 1.12 (0.97 to 1.29), 1.18 (0.99 to 1.40), and 1.23 (1.09 to 1.38) for PTH concentrations of <100 pg/mL, 100 to <200 pg/mL, 300 to <400 pg/mL, 400 to <500 pg/mL, 500 to <600 pg/mL, 600 to <700 pg/mL, and ≥700 pg/mL respectively. Compared with PD patients having serum concentrations of ALP and PTH within reference ranges, patients on HD experienced increased mortality across all ALP and PTH concentrations, particularly those in the lowest and highest categories.♦ Conclusions: In summary, higher ALP concentrations are associated with increased mortality, and lower and higher PTH concentrations are both associated with death risk in PD patients. The utility of ALP in the management of chronic kidney disease mineral bone disorders in PD patients warrants further study.     

探讨tPSA，fPSA，f／tPSA和PSAD对PSA灰区前列腺癌的诊断价值

目的：探讨总前列腺抗原（tPSA）、游离前列腺抗原（fPSA）、fPSA与tPSA比值（f／tPSA）及前列腺特异性抗原密度（PsAD）对前列腺特异性抗原（PsA）灰区前列腺癌（PCa）的诊断价值。方法：选择2011年5月一2012年5月就诊的前列腺癌患者14例,前列腺良性结节性增生患者50例,PSA值均在4～10ng／mL,统计实验室数据,计算PSAD,采用统计学软件SPSS进行统计学分析。结果：当PSA值位于诊断灰区（4～10ng／mL）时,tPSA,fPSA,f／tP—SA三项指标均不能对PCa和前列腺增生（BPH）进行鉴别,而PSAD指标可以很好鉴别PCa和BPH。结论：在血清PSA值为4～10ng／mL时,PSAD检测PCa效能高于其他三项指标。     

PSA及其F/T值与PSAD对前列腺癌和增生鉴别价值

目的 进一步了解前列腺特异抗原（PSA）、游离PSA/总PSA（F/T）比值及前列腺特异抗原密度（PSAD）在前列腺癌（PCa）与良性增生（BPH）鉴别中的价值。方法 用酶联免疫组化法检测91例BPH病人,46例PCa病人血清总PSA、游离PSA,计算F/T值。所有病人均行经直肠超声检查,计算前列腺体积及PSAD。结果 以PSA〉20 ng/mL为临界值,PSA诊断前列腺癌的灵敏度为69.6%,特异度为92.3%,阳性预测值为82.1%;在PSA〈20 ng/mL区域,两组间PSA差别无显著性（t=0.152,P〉0.05）;此时两组间F/T值及PSAD比较,差别均有极显著意义（t=3.680、4.436,P〈0.01）。F/T值取0.18,PSAD取0.20 ng/（mL.cm3）时,F/T值及PSAD诊断PCa的灵敏度、特异度、阳性预测值均较高,分别为76.1%、86.4%、68.6%和82.6%、84.6%、74.1%。结论 PSA〉20 ng/mL时高度怀疑前列腺癌;在PSA〈20 ng/mL时联合应用F/T值和（或）PSAD可以明显提高前列腺癌的检出率;以F/T值0.18,PSAD 0.20 ng/（mL.cm^3）作为临界值诊断PCa较为适宜。     

血清CA15-3和B-AKP检测在乳腺癌骨转移显像诊断中的应用

目的：探讨血清CA15-3和B-AKP在乳腺癌骨转移显像诊断中的应用。方法：对92例乳腺癌患者的核素骨显像结果、血清CA15-3和B-AKP结果进行回顾性研究。结果：①血清CA15-3和B-AKP的值随着骨转移分期的增高而逐步升高,且差异显著（P〈0.01）;②血清CA15-3和B-AKP与骨转移的数目呈正相关;③血清CA15-3〉25U/mL时,骨转移的阳性率为63.3%,血清CA15-3〈25 U/mL时,骨转移的阴性预测值为94.5%;血清B-AKP〉20U/L时,骨转移的阳性率为59.6%时,骨转移的阴性预测值为73.5%;当血清CA15-3〈25 U/mL同时B-AKP〈20U/L时,骨转移的阴性预测值为100%。结论：血清CA15-3和B-AKP测定在乳腺癌骨显像诊断中具有重要的应用价值。     

Alkaline Phosphatase: Diagnostic Value of Isoenzyme Determination

Abstract. The isoenzyme pattern of the alkaline phosphatases was determined in the sera of 51 normal subjects, 28 patients with hepatobiliary diseases and 17 patients with bone diseases. Two quick and technically simple methods of differentiation were used for a semiquantitative determination: stereospecific sensitivity to L-phenylalanine, especially of the small intestine phosphatase, and the separation of the bone and liver/biliary tract phosphatases by a combination of heat inactivation and stereo-specific inhibition. The basic principles of these methods are described. The results, statistically evaluated, are discussed. The alkaline phosphatase activity in the serum of healthy adults stems from isoenzymes of the small intestine (about 20%), of bone and of hepatobiliary origin. In hepatobiliary diseases the proportion of bone to liver/biliary tract phosphatases changes significantly in favour of the latter. In diseases of the skeleton, however, which are accompanied by increased activity of serum alkaline phosphatase, there is a significant increase in the absolute fraction of bone phosphatase in the total activity. In addition to the demonstration of these qualitative and quantitative changes in the isoenzyme distribution patterns, limiting values were determined for a normal group; values outside these can be considered as pathognomonic for diseases of the liver and biliary tract and the skeleton respectively. Of particular importance for early diagnosis is the fact that changes in the isoenzyme distribution pattern are demonstrable not only when the total activity is increased, but at a time when the serum activity lies still within normal limits. The methods used are suitable for a rapid and reproducible semiquantitative determination of the isoenzymes of alkaline phosphatase, and for early differential diagnosis of diseases of the skeleton (especially metastatic tumours), the liver and biliary tract.     

经直肠前列腺穿刺活组织检查阳性结果分析

目的通过研究前列腺特异性抗原(PSA)的水平来评价与前列腺癌(PCa)的关系。方法采用8针活组织检查(活检)方法,对血清PSA>4μg/L,直肠指诊检查前列腺质地异常、结节,经直肠前列腺超声怀疑前列腺占位病变的328例患者进行经直肠前列腺活检,所得结果进行病理分析。结果良性前列腺增生(BPH)192例,占58.5%;PCa 103例,占31.4%,其中包括前列腺基底细胞癌1例;前列腺炎14例,占4.3%;前列腺上皮内瘤9例,占2.8%;非典型性腺瘤样增生6例,占1.8%;结核2例,占0.6%;平滑肌肉瘤1例,占0.3%;淋巴瘤1例,占0.3%。根据PSA值分5组:≤4μg/L组(B超或直肠指诊有异常),4.1～10.0μg/L组,10.1～20.0μg/L组,20.1～100.0μg/L组,>100.0μg/L组。各组PCa检出率依次为:8.9%、13.3%、23.1%、37.9%和73.2%。各组间阳性率比较,差异有统计学意义(P<0.01),采用相关性分析,各组阳性率与血PSA值呈正相关。结论在PSA水平不高的情况下前列腺肿瘤的检出率也不低,在合理筛选患者的前提下,经直肠前列腺穿刺活检阳性结果与PSA水平...     

T-PSA，F-PSA联合骨扫描对前列腺癌早期骨转移诊断中的意义

【目的】分析血清总前列腺特异性抗原（TPSA）和游离前列腺特异性抗原（F-PsA）及放射性核素骨显像对前列腺癌早期骨转移的诊断价值。【方法】选择80例前列腺癌患者,70例良性疾病患者全部进行血清PSA,FPSA检测,并同时对80例临床确诊的前列腺癌患者进行放射性核素全身骨显像。另选择60例健康男性检测血清PSA,FPSA结果作为对照组。并计算FPSA／PsA比值。【结果】前列腺癌骨转移组患者血清PSA,FPSA结果显著高于良性疾病患者及正常健康男性（P〈0．01）。【结论]PSA,FPSA检测联合骨显像对前列腺癌早期骨转移具有重要意义。