腹膜透析患者腹主动脉钙化与成纤维细胞生长因子23和可溶性Klotho的相关性  

Relationship between fibroblast growth factor-23,soluble Klotho and abdominal aortic calcification in CAPD patients

作　　者：胡坤[1] 李明[1] 卢国元[1] 沈艳萍[1] 付玉玲 周小飞[2] 乔青[1] 

机构地区：[1]苏州大学附属第一医院肾内科,苏州215006 [2]苏州大学附属第一医院影像科

出　　处：《肾脏病与透析肾移植杂志》2017年第4期312-316,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：百特中国肾科研究基金(CHN-RENAL-IIS-2012-046)

摘　　要：目的:探讨持续非卧床腹膜透析(CAPD)患者腹主动脉钙化与血清成纤维细胞生长因子23(FGF-23)和可溶性Klotho(s KL)水平之间的关系。方法:收集147例CAPD患者临床资料,采用ELASA法检测血清FGF-23和s KL浓度。采用腰椎侧位片评估患者腹主动脉钙化情况,比较腹主动脉非钙化组和腹主动脉钙化组的各项临床指标;用Logistic回归分析法分析患者发生腹主动脉钙化的危险因素;受试者工作特征曲线(ROC)评估FGF-23和s KL预测腹主动脉钙化的敏感度及特异度。结果:147例CAPD患者腹主动脉钙化的发生率为37.41%,腹主动脉钙化与FGF-23水平、s KL水平、年龄、透析龄、碱性磷酸酶(ALP)、血磷水平、三酰甘油(TG)、超敏C反应蛋白(hs CRP)相关。将单因素分析有统计学意义的变量纳入多因素Logistics回归,FGF-23中位水平以上者(>2 770.36 pg/ml),其发生腹主动脉钙化的危险度是中位水平及以下者的6.50倍(OR 6.50,95%CI 1.41~29.88);年龄每增加1岁,危险度增加7%(OR 1.07,95%CI 1.03~1.11);血磷>1.75 mmol/L者,其发生腹主动脉钙化的危险度是血磷≤1.75 mmol/L者的3.49倍(OR 3.49,95%CI 1.09~11.14)。s KL>296.53 pg/ml者,其腹主动脉钙化的危险度是s KL≤296.53 pg/ml者的0.25倍(OR 0.25,95%CI 0.13~0.52)。FGF-23预测腹主动脉钙化的ROC曲线下面积(AUC)为0.96(截点为2 045.14 pg/ml,其敏感度91.0%,特异度96.6%);s KL预测腹主动脉钙化的AUC为0.95(截点为434.78 pg/ml,其敏感度93.3%,特异度94.8%)。结论:CAPD患者腹主动脉钙化与FGF-23水平、s KL水平、年龄、透析龄、ALP、血磷水平、TG、hs CRP相关。血清FGF-23与s KL水平均有助于预测腹主动脉钙化,高FGF-23及低s KL的CAPD患者发生腹主动脉钙化的危险度高。Objective： To study the relationship between fibroblast growth factor-23（ FGF-23）,soluble Klotho（ s KL） and abdominal aortic calcification in patients with continuous ambulatory peritoneal dialysis（ CAPD）.Methodology： One hundred forty seven CAPD patients in our dialysis center were enrolled,whose clinical data were recorded. Serum FGF-23 and s KL were measured by ELISA. X-ray examination of pelvis was applied to evaluate abdominal aortic calcification. The binary logistic regression was used to analysis the risk factors of calcification. The sensitivity,specificity of FGF-23 and s KL in prediction of abdominal aortic calcification was evaluated by the receiver-operating characteristic curve（ ROC）. Results： 1.The incidence of CAPD patients with abdominal aortic calcification was 37. 4%The abdominal aortic calcification were positively correlated to FGF-23,age,dialysis vintage,serum phosphate（ P）,alkaline phosphatase（ ALP）,triglyceride（ TG）,high sensitivity C-reactive protein（ hs CRP）（ P〈0. 05）,and were negatively correlated to s KL（ P0. 05）. 2. Logistic regression showed that the risk of abdominal aortic calcification above the median FGF-23 level（ 2 770. 36 pg/ml） was 6. 50 times（ OR = 6. 50,95%CI 1. 41-29. 88） than in and under it. The abdominal aortic calcification risk increased by 7% with every 1 year older（ OR = 1. 07,95%CI 1. 03-1. 11）. The risk of abdominal aortic calcification above the median serum phosphate level（ 1. 75 mmol/L） was 3. 49 times（ OR = 3. 49,95%CI 1. 09-11. 14） than in and under it. The risk of abdominal aortic calcification above the median s KL level（ 296. 53pg/ml） was 0. 25 times（ OR = 0. 25,95%CI 0. 13-0. 52） than in and under it.3. The ROC curve analysis indicated that,the sensitivity,specificity and area under ROC curve of FGF-23 levels in abdominal aortic calcification patients were respectively 91. 0%,96. 6% and 0. 96（ the cut off point： 2 045. 14 pg/ml）. It was 93. 3%,94. 8% and 0. 95（ the cut off

关 键 词：腹膜透析 腹主动脉钙化 成纤维生长因子23 可溶性Klotho 

分 类 号：R692.5[医药卫生—泌尿科学]