극소 저체중 출생아의 골감소증 및 구루병 예견에 있어서 혈청 alkaline phosphatase의 유용성
Usefulness of Serum Alkaline Phosphatase in Predicting Osteopenia and Rickets in Very Low Birth Weight Infants
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목적: 본 연구는 혈청 alkaline phosphatase (ALP)가 출생체중1,500 g 미만의 극소 저체중 출생아에서 방사선적 골감소증 및 구루병을 예측하는데 유용한지 알아보고자 하였다. 방법: 2009년 1월부터 2011년 12월까지 신생아 집중치료실에 입원한 극소 저체중 출생아 258명의 의무 기록지를 후향적으로 조사분석하였다. 입원기간 중 가장 높은 ALP를 ALP max로 정의하고,450 IU/L 이상을 연구군(112명), 미만을 대조군(146명)으로 구분하여 인구학적, 주산기 위험 인자, 임상 항목 및 이환 질환을 비교해 보았다. 또한 두 군간 ALP max와 총 칼슘과 이온화 칼슘(i-Ca), 인(P)및 방사선적 골감소증 및 구루병 양성률 차이를 비교해보았다. 혈청ALP가 방사선적 골감소증 및 구루병을 예측하는데 유용한지 알아보고자 ALP max 기준에 따른 예민도와 특수도, 양성 예견도와 음성 예견도를 알아보고, ROC 곡선을 이용하여 방사선적 진단에 적절한 ALP max cut-off 값을 구해보았다. 결과: 연구군이 대조군에 비해 더 미숙하고 작았으며 주산기 위험인자가 많고 이환율도 높았다. ALP max 450 IU/L 기준시 방사선적진단의 예민도 68.8%, 특수도 64.9%, 양성 예견도 39.3%, 음성 예견도 86.3%로 유의하였고(P<0.001), ROC 곡선에서도 이 기준은 적절하다고 사료되었다. 결론: 극소 저체중 출생아에서 ALP max 450 IU/L 기준은 골감소증 및 구루병 예측에 유용하다고 사료되었다.
Abstract
Purpose: This study assesses the usefulness of alkaline phosphatase (ALP) in predicting the radiologic osteopenia and rickets for very low birth weight infants (VLBWI) below 1,500 g of birth weight. Methods: Medical records of 258 VLBWI who were admitted at NICU between January 2009 and December 2011 were reviewed retrospectively. ALP max was defined by maximum level of ALP during admission. Subjects were divided into two groups: the study (n=112, ALP max ≥450 IU/L) and the control group (n=146, ALP max <450 IU/L). The two groups were compared based on the demographic and perinatal risk factors, clinical parameters, and morbidity. Also compared between the groups were: the level of ALP max, total and ionized calcium, inorganic phosphorus, and radiologic finding. To assess the usefulness of ALP in predicting the radiologic osteopenia and rickets, the sensitivity, specificity, and the positive (PPV) and negative predictive values (NPV) according to ALP max level were examined. A receiver operator characteristic (ROC) curve was constructed to determine the optimal cut-off value of ALP for the radiologic diagnosis. Results: The study group was more immature and smaller, and had more perinatal risk factors with higher morbidity. The sensitivity and specificity for the radiologic finding on the basis of ALP max 450 IU/L were 68.8% and 64.9%, PPV 39.3%, and NPV 86.3% with a significance (P<0.001). In ROC curve, we observed the appropriate cut-off value to be 459.5 IU/L (P<0.001). Conclusion: The baseline of ALP max 450 IU/L was useful in predicting the radiologic osteopenia and rickets in VLBWI.
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