Nationwide Cross-sectional Study of Association between Pterygium and Alkaline Phosphatase in a Population from Korea

Hyun Joon Kim; Sang Hoon Rah; Sun Woong Kim; Soo Han Kim

doi:10.3341/jkos.2020.61.1.9

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Kim, Rah, Kim, and Kim: Nationwide Cross-sectional Study of Association between Pterygium and Alkaline Phosphatase in a Population from Korea

Original Article

Journal of the Korean Ophthalmological Society 2020; 61(1): 9-16.

Published online: 15 January 2020

DOI: https://doi.org/10.3341/jkos.2020.61.1.9

Nationwide Cross-sectional Study of Association between Pterygium and Alkaline Phosphatase in a Population from Korea

Hyun Joon Kim, MD, PhD, Sang Hoon Rah, MD, PhD, Sun Woong Kim, MD, PhD, Soo Han Kim, MD, PhD

Department of Ophthalmology, Yonsei University Wonju College of Medicine, Wonju, Korea.

Address reprint requests to Soo Han Kim, MD, PhD. Department of Ophthalmology, Wonju Severance Christian Hospital, #20 Ilsan-ro, Wonju 26426, Korea. Tel: 82-33-741-1346, Fax: 82-33-741-0460, Dingo84@yonsei.ac.kr

Received 20 June 2019 Revised 25 July 2019 Accepted 30 December 2019

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

We determined whether elevated serum alkaline phosphatase (ALP) was related to prevalence, location, type, length, and recurrence of pterygium in a population from the Republic of Korea.

Methods

A nationwide cross-sectional dataset, the Korean National Health and Nutrition Examination Survey (2008–2011), was used in this study. All participants were > 30 years of age and underwent the ALP test and ophthalmic evaluation (n = 22,359). One-way analysis of variance, the chi-square test, and Fisher's exact test were used to compare characteristics and outcomes among participants. Multivariable logistic regression was used to examine the possible associations between serum ALP levels and various types of pterygium. Data were adjusted for known risk factors for development of pterygium and ALP elevation (age, sex, residence, sunlight exposure, drinking, smoking, hypertension, diabetes, BMI, AST, ALT, vitamin D, and HDL).

Results

The overall prevalence of pterygium was 8.1%, and participants with pterygium had higher levels of serum ALP (p < 0.001). Participants with higher serum ALP had a significantly higher prevalence of all types of pterygium than those in the lower serum ALP quartiles. After adjusting for potential confounding factors, multivariate logistic regression analysis revealed that ALP was associated with the prevalence of pterygium (odds ratio [OR], 1.001; p = 0.038). Trend analysis between the OR and ALP quartiles revealed a linear trend in overall prevalence and in the intermediate type of pterygium. Subgroup analysis revealed a stronger correlation in participants > 50 years of age. One-way analysis of variance revealed an association between the size of pterygium and serum ALP quartile levels. Serum ALP was not associated with recurrence of pterygium.

Conclusions

Increased serum ALP was associated with the prevalence and size of pterygium.

Keywords: Alkaline phosphatase, Korean National Health and Nutrition Examination Survey Pterygium

Figures and Tables

Figure 1

Association between alkaline phosphatase and size of pterygium. Linear trends in pterygium size.

Table 1

Demographic and clinical characteristics of the study participants

Data are expressed as weighted means or weighted frequency (%) with standard errors.

HBV = hepatitis B virus; HCV = hepatitis C virus; BMI = body mass index; AST = aspartate aminotransferase; ALT = alanine aminotransferase; HDL = high-density lipoprotein cholesterol; TG = triglyceride; ALP = alkaline phosphatase.

^*p < 0.05, chi-squared test.

Table 2

The relation of ALP quartile to prevalence, type, location and recurrence of pterygium

Values are presented as number (%). ‘ALP 1’ is <177 IU/L; ‘ALP 2’ is >177 IU/L, < 217 IU/L; ‘ALP 3’ is >217 IU/L, < 264 IU/L; ‘ALP 4’ is >264 IU/L.

ALP = alkaline phosphatase.

^*Fisher's exact test.

Table 3

Logistic regression analysis pterygium and associated demographic or clinical factors

‘Model 1’ is adjusted for age, sex, residence, sunlight exposure, drinking, smoking, hypertension and diabetes. ‘Model 2’ is adjusted for all factors in Model 1 and BMI, AST, ALT, Vitamin D and HDL.

OR = odd ratio; HBV = hepatitis B virus; HCV = hepatitis C virus; BMI = body mass index; AST = aspartate aminotransferase; ALT = alanine aminotransferase; HDL = high-density lipoprotein cholesterol; TG = triglyceride; ALP = alkaline phosphatase.

^*Logistic regression analysis.

Table 4

Odds ratios for association of pterygium and quantile of alkaline phosphatase

‘Model 1’ is Adjusted for age, sex, residence, sunlight exposure, drinking, smoking, hypertension and diabetes. ‘Model 2’ is Adjusted for all factors in Model 1 and BMI, AST, ALT, Vitamin D and HDL.

OR = odd ratio; BMI = body mass index; AST = aspartate aminotransferase; ALT = alanine aminotransferase; HDL = high-density lipoprotein cholesterol.

^*p < 0.05, multivariate logistic regression.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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