新疆医科大学学报

目的 研究慢性肾衰竭(Chronic renal failure, CRF)患者外周血血小板分布宽度(Platelet distribution width, PDW)及碱性磷酸酶/白蛋白比值(Alkaline phosphatase to albumin ratio, APAR)与钙磷代谢紊乱之间的相关性。方法 以2021年1月1日-2023年12月31日安徽医科大学附属巢湖医院肾脏内科收治的200例CRF患者为研究对象。治疗前依据美国肾脏基金会肾脏病生存质量指导(Kidney disease outcomes quality initiative, KDOQI)指南所设定的分组依据将血清Ca水平在2.10～2.50 mmol/L,血清P浓水平在1.13～1.78 mmol/L,的患者纳入正常组(118例),其他患者纳入紊乱组(82例)。治疗前收集一般资料及实验室指标，包括年龄、原发疾病、病程、体重指数(Body mass index, BMI)、饮酒史、尿酸(Uric acid, UA)、总胆固醇(Total cholesterol, TC)、甲状旁腺素(Parathyroid hormone, PTH)、血红蛋白(Hemoglobin, HGB)、甘油三酯(Triglycerides, TG)、APAR、红细胞分布宽度(Red cell volume distribution width, RDW)、白蛋白(Albumin, ALB)、空腹血糖(Fasting plasma glucose, FPG)、降钙素(Calcitonin, CT)、碱性磷酸酶(Alkaline phosphatase, ALP)等。采用二元Logistic回归分析CRF患者的独立影响因素；采用受试者工作特征曲线(Receiver operating characteristic curve,ROC)分析PDW与APAR对钙磷代谢紊乱的预测价值；采用决策曲线(Decision curve analysis,DCA)评估预测模型的标准化净收益；采用Pearson相关分析评估CRP患者血清Ca、血清P水平与PDW、APAR之间的线性相关性；采用局部加权散点图平滑技术(Locally weighted scatterplot smoothing,Lowess)分析PDW、APAR与钙磷代谢紊乱发生率的关系。结果 与正常组比较，紊乱组患者PTH、ALP、ALB、CT、PDW、APAR水平均升高，差异有统计学意义(P<0.05)。二元Logistic回归分析结果显示，PDW(OR=1.583,95%CI:1.252～1.816)、APAR(OR=1.852,95%CI:1.583～2.124)均是CRF患者钙磷代谢紊乱的独立影响因素(P<0.05)。Pearson相关性分析结果显示，PDW与血清Ca水平呈正相关，APAR与血清P水平呈正相关。Lowess分析结果显示，PDW、APAR与钙磷代谢紊乱的发生率均呈正相关。基于上述独立危险因素构建临床预测模型；ROC曲线分析结果显示，PDW与APAR联合预测模型的AUC值为0.889;DCA分析结果显示，该联合预测模型在0%～93.79%阈值范围内均有较高的标准化净收益。结论 CRF患者PDW及APAR与钙磷代谢紊乱之间存在相关性，PDW、APAR是CRF患者钙磷代谢紊乱的独立危险因素，PDW、APAR与钙磷代谢紊乱发生率均呈正相关，两者联合构建预测模型时能更有效地预测CRF患者发生钙磷代谢紊乱的可能性。

Objective To investigate the correlation between platelet distribution width(PDW) and alkaline phosphatase to albumin ratio(APAR) in peripheral blood and calcium-phosphorus metabolism indicators in patients with chronic renal failure(CRF). Methods A total of 200 CRF patients admitted to thehospital from January 1, 2021, to December 31, 2023, were selected as the study subjects. Before the treatment, according to the target ranges for serum calcium(Ca) and serum phosphorus(P) in end-stage renal disease patients set by the Kidney Disease Outcomes Quality Initiative(KDOQI) guidelines, patients with Ca concentrations between 2.10～2.50 mmol/L and P concentrations between 1.13～1.78 mmol/L were assigned to the normal group(118 cases), while other patients were assigned to the disorder group(82 cases). General data and laboratory indicators were collected before the treatment, including age, primary disease, disease duration, Body Mass Index(BMI), history of alcohol consumption, Uric Acid(UA), Total Cholesterol(TC), Parathyroid Hormone(PTH), Hemoglobin(HGB), Triglycerides(TG), APAR, Red cell Volume Distribution Width(RDW), Albumin(ALB), Fasting Plasma Glucose(FPG), Calcitonin(CT), Alkaline Phosphatase(ALP), etc. The study employed binary Logistic regression to identify independent risk factors in chronic renal failure(CRF) patients. Receiver operating characteristic(ROC) curves were used to evaluate the predictive value of plasma desmoglein(PDW) and antiparathyroid hormone receptor(APAR) for calcium-phosphorus metabolic disorders. Decision curve analysis(DCA) was applied to assess the standardized net benefit of the predictive model. Pearson correlation analysis was conducted to evaluate the linear relationships between serum calcium(Ca) and phosphorus(P) levels with PDW and APAR. Additionally, locally weighted scatterplot smoothing(Lowess) was utilized to analyze the associations between PDW, APAR and the incidence of calcium-phosphorus metabolic disorders. Results Compared to the normal group, the patients in the disorder group showed significantly elevated levels of PTH, ALP, ALB, CT, PDW and APAR, with statistically significant differences(P<0.05). Binary Logistic regression analysis revealed that both PDW(OR=1.583, 95%CI:1.252～1.816) and APAR(OR=1.852,95%CI:1.583～2.124) were independent influencing factors for calcium phosphorus metabolism disorder in CRF patients(P<0.05). Pearson correlation analysis indicated that PDW was positively correlated with Ca levels, and APAR was positively correlated with P levels. Lowess analysis further demonstrated that both PDW and APAR were positively correlated with the incidence of calcium phosphorus metabolism disorder. A clinical prediction model was constructed based on the above independent risk factors. ROC curve analysis showed that the AUC of PDW and APAR combined model was 0.889. DCA analysis showed that the combined model had positive standardized net benefit in the range of 0%～93.79%. Conclusion There was a correlation between PDW, APAR and calcium-phosphorus metabolism indicators in CRF patients. Both PDW and APAR were independent risk factors for calcium-phosphorus metabolism imbalance in CRF patients and showed a positive correlation with the incidence of calcium-phosphorus metabolism disorders. A combined prediction model incorporating both PDW and APAR can more effectively predict the likelihood of thepatients developing calcium-phosphorus metabolism disorders.