單一鹼性磷酸酶升高：如何考慮？

案例

某天，一名患者拿著她 4 歲女兒的生化檢查單找到我，質疑檢測結果有問題，為什麼單獨鹼性磷酸酶這一項升高？其結果如下圖：

該患兒體型偏瘦，活潑好動，尿常規無異常，精神狀態也很好。藥物可引起鹼性磷酸酶升高，如紅霉素、慶大黴素、氯黴素等。經詢問病史，患兒沒有服用任何藥物。醫生說沒見過這麼高的，懷疑病毒感染造成的，建議先排除肝炎，於是給患兒做了病毒性肝炎檢測，甲型、乙型、丙型肝炎抗體都陰性。查看了當天質控，都很好，沒什麼問題，在控。

其他病人的鹼性磷酸酶結果也沒什麼問題。複查患兒鹼性磷酸酶，排除檢測錯誤，結果相差無幾，仍然非常高。肝臟疾患如各種肝炎、毛細膽管性肝炎等也可引起鹼性磷酸酶偏高的現象。該女孩總膽、直膽、轉氨酶等指標都正常，可排除肝臟疾病的可能。單一鹼性磷酸酶孤立性升高，那麼會是什麼原因造成的呢？

該女孩唯一的異常就是鹼性磷酸酶非常高，竟高達 1700 多。兒童鹼性磷酸酶活性的解釋是具有挑戰性的，因為與增長和青春期，導致不同性別和年齡動力學廣泛的變化 [17]。該患兒如果一般情況較好，可以拍個腕部 X 線檢查，查鈣、磷水平，如果都是正常的，可以考慮嬰幼兒暫時性高磷酸血症，不必過度檢查，如骨掃描等。分析其原因，最有可能與臨床醫師對 THI 缺乏認識有關。單純鹼性磷酸酶增高，提醒大家一定不要掉以輕心。不要放過任何一個異常的指標，一定要追根究底。

參考文獻

[1]Coleman JE.Structure and mechanism of alkaline phosphatase.Annu Rev Biophys Biomol Struct.1992,21:441-483.

[2]Ranchin B,Villard F,André JL,et al.Transienthyperphosphatasemia after organ transplantation in children.Pediatr Transplant.2002,6(4):308-312.

[3]Schutte R,Huisman HW, Malan L,et al.Alkaline phosphatase and arterial structure and function in hypertensive African men: the SABPA study.Int J Cardiol.2013,167(5):1995-2001.

[4]Perera S,Lohsoonthorn V,Jiamjarasrangsi W.et al.Association Between Elevated Liver Enzymes and metabolic Syndrome Among Thai Adults.Diabetes metab Syndr.2008,2(3):171-178.

[5]Cheung BM,Ong KL,Wong LY.Elevated serum alkaline phosphatase and peripheral arterial disease in the United States National Health and Nutrition Examination Survey 1999-2004.Int J Cardiol.2009,135(2):156-161.

[6]Cho SR,Lim YA,Lee WG.Unusually high alkaline phosphatase due to intestinal isoenzyme in a healthy adult.Clin Chem Lab Med.2005,43(11):1274-1275.

[7]Teitelbaum JE,Laskowski A, Barrows FP.Benign transient hyperphosphatasemia in infants and children: a prospective cohort.J Pediatr Endocrinol metab.2011,24(1-2):93-95.

[8]Ilham MA,Cookson A,Dheerendra S,et al.Idiopathic severe elevation of serum alkaline phosphatase following adult renal transplantation:case reports.Transplant Proc.2008,40(6):2059-2061.

[9]Behúlová D,Bzdúch V,Holesová D,et al.Transient hyperphosphatasemia of infancy and childhood:study of 194 cases.Clin Chem.2000,46(11):1868-1869.

[10]SuzukiM,Okazaki T,Nagai T,et al.Viral infection of infants and children with benign transient hyperphosphatasemia.FEMS Immunol Med Microbiol.2002,33(3):215-218.

[11]Arikan C,Arslan MT,Kilic M,et al.Transienthyperphosphatasemia after pediatric liver transplantation.Pediatr Int.2006,48(4):390-392.

[12]Trower K,Wilmot R,Barlow G,et al.A case oftransient hyperphosphatasemiaof infancy and early childhood in an HIV-positive adult possibly related to atazanavir.AIDS.2006,20(1):135-136.

[13]Crofton PM,Shrivastava A,Wade JC.et al.Bone andcollagenmarkers in preterm infants: relationship with growth and bone mineral content over the first 10 weeks of life.Pediatr Res.1999,46(5):581-587.

[14]Eriksen EF,Brixen K,Charles P.New markers of bone metabolism: clinical use in metabolic bone disease.Eur J Endocrinol.1995,132(3):251-263.

[15]Biswas A,Mohan J,Sastry KV.Age-dependent variation in hormonal concentration and biochemical constituents in blood plasma of Indian native fowl.Vet Med Int.2010,2010:737292.

[16]Tietz NW:Textbook of Clinical Chemistry.Third edition,Edited by Burtis and Ashwood.Philadelphia,PA,WB Saunders Company,Philadelphia,1999.

[17]Zierk J,Arzideh F,Haeckel R,et al.Pediatric reference intervals foralkalinephosphatase.Clin Chem Lab Med.2016 Aug 9.pii: /j/cclm.ahead-of-print/cclm-2016-0318/cclm-2016-0318.xml.