慢性肾衰继发性甲旁亢甲状旁腺细胞对FGF-23抵抗性的研究  

The Study of secondary hyperparathyroidism of chronic renal failure hyparathroid cell resistant to fibroblast growth factor-23

作　　者：张建荣[1] 孙振学[2] 耿燕秋[1] 邵素荣[1] 

机构地区：[1]中国人民武装警察部队总医院肾内科 [2]中国人民武装警察部队总医院门诊部

出　　处：《中国急救复苏与灾害医学杂志》2013年第12期1094-1097,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的探讨继发性甲旁亢甲状旁腺细胞对血清FGF23的抵抗性。方法无肾脏病史的尸体甲状旁腺组织供体6例为健康组，手术切取其正常甲状旁腺组织。收集武警总医院肾内科2009年1月-2011年6月行甲状旁腺切除术的继发性甲状旁腺功能亢进（sHPT）患者30例为甲旁亢组，手术切取其甲状旁腺组织。免疫组化方法检测受试对象甲状旁腺组织中成纤维细胞生长因子R（FGFRl）、klotho、Ki67、维生素D受体（VDR）的表达情况。全自动生化分析仪测定受试者术前血清生化指标，酶联免疫法（ELISA）法检测血清成纤维细胞生长因子23（FGF-23）水平，化学免疫发光法测定PTH水平。结果甲旁亢组血清FGF-23、胛H水平明显高于健康组（926．60＋373．68pg／mlV830．70±11．27pg／ml，P〈0．05）、（2666．56~953．41pg／mlV835．00-9．64pg／ml，P〈0。05），甲旁亢组血清FGF一23与PTH呈正相关（R。=0．547，P〈O．05）；甲旁亢组结节性增生与弥漫性增生的甲状旁腺组织中FGFRl、klotho、VDR的表达均显著低于健康组【（176．25±75．33）VS（326．48±65．93）VS（702．00±35．59）1，P〈0．05；（101．07±73．88）VS（253．12±46．23）VS（574．67±23．63），P〈O．05；（30．96±11．06）％vs[（49．03±12．23场VB（86．87±2．74）％，P〈O．05）】，Ki67高于健康组『（23．50±11．47）％vs（14．09±6．21）％VS（0．70±0．95）％，P〈0．05】。甲旁亢组（结节性增生＋弥漫性增生）的甲状旁腺组织中FGFRl、klotho、VDR的表达低于健康组[（265．35±20．53）VS（702．00±35．59），P〈0．05；（173．17±30．12）VS（574．67±23．63），p〈0．05；（40．14±9．17）％vs（86．87±2．74）％，P〈0．05]，Ki67高于健康组【（20．12±7．02）％VS（0．70±0．95）％，（P〈0．05）】。（4）甲旁亢组血清FGF-23水平与甲状旁腺组织FGFRl、Klotho的表达分别呈负相关Objective To discuss the resistance of secondary hyperparathyroidism of chronic renal failure. Methods A comparison analysis was conducted between the control group of six healthy parathyroid glands and SHPT group from 30 patients with SHPT in between January 2009 and June 2011. Protein expression of FGFR1, Klotho, Ki67, VDR in parathyroid tissue were detected from Immunohistochemistry. All the objects were remained blood serum of empty stomach before operation. Serum fibroblast growth factor-23 （FGF-23） was detected by ELISA. Related Serum biochemical indicators were assessed by autobiochemistry. PTH was detected by the chemical immunoluminescence. Results Levels of serum FGF-23 and PTH of SHPT group were increased significantly compared with control group [（926.60-e373.68） pg/ml vs （30.70±l l.27）pg/mi, P 〈0.05], [（2666.56±953.41）pg/ml vs （35.00 ± 9.64）pg/ml, P 〈0.05]. Serum FGF-23 was positively correlated with serum PTH in SHPT patients （R2=0.547, P 〈0.05）. There were 18 parathyroid glands with nodular hyperplasia and 12 parathyroid glands with diffuse hyperplasia in SHPT group. The expression of FGFR1, Klotho and VDR were significantly lower in parathyroid glands with nodular hyperplasia and diffuse hyperplasia compared with the control group [（176.25±5.33） vs （326.48±5.93） vs （702.00±5.59）, P 〈0.05; （101.07±73.88） vs （253.12±46.23） vs （574.67 ±23.63）, P 〈0.05; （30.96±11.06）% vs （49.03 ± 12.23）% vs （86.87 ± 2.74）%, P 〈0.05]. Ki67 was significantly higher in parathyroid tissue of SHPT patients compared with control group [（23.50 ± 11.47）% vs （14.09±.21）% vs （0.70±.95）%, P 〈0.05]. The expression of FGFR1,Klotho and VDR were lower in parathyroid glands with SHPT patients included nodular hyperplasia and diffuse hyperplasia compared with the control group [（265.35±20.53） vs （702.00±5.59）, P 〈0.05; （173.17±0.12） vs （574.67±3.63）, P 〈0.05; （40.14±.17）% vs （86.87±2.74）%,P 〈0.05]. K

关 键 词：慢性肾衰 继发性甲状旁腺功能亢进 成纤维细胞生长因子-23 抵抗性 

分 类 号：R692.5[医药卫生—泌尿科学]