维持性血液透析患者口服小剂量骨化三醇对FGF-23及血管钙化的影响  

The effect of oral low-dose calcitriol on FGF-23 and vascular calcification in maintenance hemodialysis patients

作　　者：刘继红[1,2] 赵银娥[1,2] 李荣山[1,2] 郭珲[1,2] 李新平[1,2] 

机构地区：[1]山西省长治医学院附属和济医院肾内科,长治046000 [2]山西医科大学第二医院肾内科,太原030001

出　　处：《中国血液净化》2014年第11期755-758,共4页Chinese Journal of Blood Purification

基　　金：山西省国际合作项目;项目号2013081056;山西省出国留学基金;项目号2013117;太原市科技资助项目;项目号12016904;山西省科技攻关项目;项目号20130313022-3;国家自然基金;项目编号81102198

摘　　要：目的探讨维持性血液透析(Maintenance hemodialysis,MHD)患者血清FGF-23水平与血管钙化的关系及口服小剂量骨化三醇对成纤维细胞生长因子-23(Fibroblast growth factor-23,FGF-23)及血管钙化的影响。方法选择MHD患者63例,其中已口服小剂量骨化三醇治疗3个月以上的患者有33例(占52.38%)。用ELISA法检测FGF-23,化验肝肾功能、血糖血脂、甲状旁腺素(i PTH)、铁蛋白(FER)和超敏C-反应蛋白(hs CRP),用彩色超声仪检测有无心肌及瓣膜钙化、颈动脉内膜中层厚度(IMT)及有无动脉斑块形成,腰椎侧位X片查腹主动脉钙化。统计学处理采用SPSS17.0统计软件包,以P<0.05为差异有统计学意义。结果 63例MHD患者中有不同部位血管钙化的31例(钙化组)。多因素logistic回归分析血管钙化的危险因素显示:年龄(OR=1.066,P=0.163)、hs CRP(OR=1.195,P=0.065)、钙磷乘积(OR=1.154,P=0.011)、FGF-23(OR=1.048,P=0.012)是发生血管钙化的主要危险因素,高水平的ALB(OR=0.575,P=0.0.016)和口服骨化三醇(OR=0.004,P=0.006)为保护性因素。结论小剂量骨化三醇治疗对FGF-23无明显影响,可能减轻血管钙化。Objective To investigate the relationship between serum FGF-23 level and vascular calcification, and the effects of oral low-dose calcitriol on FGF-23 and vascular calcification in maintenance hemodialysis （MHD） patients. Methods A total of 63 MHD patients were enrolled in this study, and 33 cases of them （52.38%） took oral low-dose calcitriol for more than 3 months. Serum FGF-23 was determined by ELISA. Liver and kidney functions, blood glucose and lipids, parathyroid hormone （iPTH）, ferritin （FER）, and high- sensitive C-reactive protein （hsCRP） were measured in these patients. Myocardial and valvular calcification, carotid artery intima media thickness （IMT）, and arterial plaques were examined by ultrasonography. Abdomi- nal aortic calcification was detected by lateral lumbar X-ray imaging. Statistical analysis was performed by using SPSS 17.0 statistical software package, and P〈0.05 was regarded as statistically significant difference. Results Among the 63 MHD cases, vascular calcification was found in 31 cases （calcification group）. Multivariate logistic regression demonstrated that age （OR=1.066, P=-0.163）, hsCRP （OR=1.195, P=0.065）, calciumphosphorus product （OR=1.154, P=-0.011）, serum FGF-23 （OR=1.048,P=-0.012） were the major risk factors of vascular calcification, while higher serum albumin （OR=0.575, P=-0.0.016） and calcitriol administration （OR= 0.004, P=-0.006） were the protective factors. Conclusions Oral low-dose calcitriol has no significant effect on serum FGF-23 level, but may reduce the incidence of vascular calcification.

关 键 词：维持性血液透析 FGF-23 骨化三醇 血管钙化 

分 类 号：R318.16[医药卫生—生物医学工程]