高通量透析对终末期肾衰患者FGF-23及微炎症状态的影响  

Effects of high-flux hemodialysis on FGF-23 and micro-inflammatory state in end-stage renal diseases patients

作　　者：张志坚[1] 陈涵枝[1] 孙铸兴[1] 陈彩妹[1] 薛婧[1] 刘晓斌[1] 王凉[1] 

机构地区：[1]南京医科大学附属无锡市人民医院肾内科,214023

出　　处：《中华医学杂志》2015年第26期2074-2078,共5页National Medical Journal of China

基　　金：南京医科大学科技发展基金（2010NJMU101）

摘　　要：目的 观察高通量血液透析（HFHD）对终末期肾衰竭（ESRD）患者成纤维细胞生长因子23（FGF-23）水平及微炎症状态的影响,了解HFHD在减少ESRD患者并发症上的优势.方法 回顾性分析2012年1月至2013年12月在我院血液净化中心透析治疗的ESRD患者临床资料,根据透析方式分为高通量组（30例）和低通量组（30例）,记录两组患者透析前及规律透析3个月的FGF-23、血清学指标变化,分析透析患者FGF-23的影响因素及不同透析方式对微炎症状态、生化指标、透析充分性等的影响.结果 两组患者性别、年龄、基础疾病、营养状况和药物使用及治疗前的血红蛋白（Hb）、白蛋白（ALB）、估算肾小球滤过率（eGFR）、血清Ca^2＋、p^3-、甲状旁腺激素（PTH）、FGF-23差异均无统计学意义.高通量组透析3个月后Hb[（109 ±15）比（80±14） g/L,P＜0.001]、ALB[（37 ±4）比（30 ±4） g/L,P＜0.001]、血清Ca^2＋[（2.2±0.3）比（1.9±0.3）mmol/L,P=0.002],1,25-二羟维生素D3[1,25-（OH）2VitD3][（35 ±7）比（26±8）pmol/L,P=0.001]均较透析前显著升高,而血清P^3-[（1.6±0.4）比（2.2 ±0.4）mmol/L,P＜0.001]、C反应蛋白（GRP）[（8.2±2.3）比（12.9±1.4） mg/L,P＜0.001]、白细胞介素（IL）-6[（107 ±13）比（126±13） ng/L,P＜0.001]、PTH[（281±115）比（467±202） ng/L,P=0.001]、FGF-23[（263±83）比（383±134） ng/L,P=0.002]均较透析前显著降低.低通量组透析3个月后Hb[（98±10）比（79±11） g/L,P＜0.001]、ALB[（37 ±4）比（31 ±5） g/L,P＜0.001]、血清Ca^2＋[（2.2±0.2）比（1.9±0.4）mmol/L,P=0.005]均较透析前显著升高,而1,25-（OH）2 VitD3[（29±8）比（27±8）pmol/L,P=0.343]则升高不明显,血清P^3-[（1.9 ±0.3）比（2.2±0.4） mmol/L,P=0.009]、CRP[（10.6±1.9）比（14.1 ±5.7）mg/L,P＜0.001]较透析前显著降低,而IL-6[（125±12）比（126±12） ng/L,P=0.743]、PTH[（439±147）比（488 ±199） ng/L,P=0.38Objective To explore the effects of high-flux hemodialysis （HFHD） on fibroblast growth factor 23 （FGF-23） and micro-inflammatory state in end-stage renal diseases （ESRD） patients to understand the advantages of HFHD in reducing complications in ESRD patients.Methods A total of 60 subjects sheduled for hemodialysis at our hospital in 2012 were randomly divided into two groups of 3-month HFHD and 3-month low-flux hemodialysis （LFHD） （n =30 each）.The levels of serum factors,such as FGF-23,were observed before and after 3-month hemodialysis to evaluate the hemodialysis sufficiency of two groups and analyze the effects of FGF-23 related factors as well as different kinds of hemodialysis on microinflammatory state,biochemical indices and dialysis sufficiency.Results Before hemodialysis,no intergroup statistical difference （P 〉 0.05） existed in age,gender,basic disease,nutrition and levels of hemoglobin （Hb）,albumin （ALB）,estimated glomerular filtration rate （eGFR）,Ca2＋,p3-,parathyroid hormone （PTH） and FGF-23 before treatment.After 3-month hemodialysis in two groups,there were a negative correlation between FGF-23,Ca2＋ or 1,25-（OH）2VitD3,a positive correlation between FGF-23 and ALB,p3-,PTH,C-reactive protein （CRP） or interleukin-6 （IL-6） and a negative correlation between FGF 23 and HFHD group （P 〈 0.05） and no significant correlation between FGF-23 and Hb or KT/V （P 〈 0.05）.Variance analyses were conducted for each factor before and after hemodialysis,indicating that Hb,ALB and Ca2 ＋ significantly increased in both groups after 3-month hemodialysis （P 〈 0.05） and 1,25-（OH）2VitD3 significantly elevated in HFHD group （P 〈 0.05） but not in LFHD （P 〉 0.05）.Serum phosphate significantly decreased after 3-month hemodialysis in both groups （P 〈 0.05） and CRP,IL-6,PTH and FGF-23 significantly decreased in HFHD group （P 〈 0.05）,but not in LFHD group （P 〉 0.05）.The levels of P3-,CRP,IL-6,PTH and FGF-23 after 3-month

关 键 词：肾透析 肾功能衰竭 成纤维细胞生长因子23 微炎症状态 

分 类 号：R692.5[医药卫生—泌尿科学]