维持性血液透析患者血清成纤维细胞生长因子23与腹主动脉钙化及预后的关系  

Association of serum FGF23 with abdominal aortic calcification and outcomes in maintenance hemodialysis patients

作　　者：祝旭颖 蔡宏[2] 张伟明[1] 朱铭力[1] 鲁嘉越[2] 朱旻霞[2] 占雅萍[2] 刘上[2] 倪兆慧[1] 钱家麒[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,200127 [2]上海交通大学医学院附属仁济医院南院肾脏科,201112

出　　处：《中华肾脏病杂志》2017年第9期678-685,共8页Chinese Journal of Nephrology

基　　金：基金项目：上海市卫生和计划生育委员会科研基金（201640100）,上海交通大学医学院附属仁济医院南院临床学科创新共建平台建设项目（2014MDT02）

摘　　要：目的探讨维持性血液透析（MHD）患者血清成纤维细胞生长因子23（FGF23）水平与腹主动脉钙化及预后的关系。方法收集114例MHD患者临床资料，采用ELISA法检测血清全段FGF23浓度。应用腹部侧位X线平片结果计算腹主动脉钙化积分（AACS），评判患者腹主动脉钙化情况。按血清FGF23水平的四分位数分成4组；按AACS分为无或轻度钙化组（AACS≤4）、中度钙化组（5≤AACS≤15）和重度钙化组（AACS≥16）。采用Logistic回归法分析MHD患者发生腹主动脉钙化危险因素，Kaplan．Meier生存法分析各组患者生存率的差异，Cox比例风险模型法分析MHD患者全因死亡及心血管疾病（CVD）死亡危险因素。结果114例MHD患者中有76例（66．7％）存在腹主动脉钙化，中位AACS为4．0（0，11．0），中位血FGF23浓度为7277．4（2535．0，9990．8）pg／ml。中位随访时间72．0（67．8，72．8）个月。全因死亡22例（19．3％），CVD死亡17例（14．9％）。Spearman相关分析显示FGF23与AAC呈正相关（r=0．285，P=0．002）。Logistic回归分析提示，FGF23浓度升高（OR=2．831，95％CI：1．010～7．937，P=0．048）、年龄增加（OR=I．059，95％CI：1．020～1．100，P=O．003）、透析龄长（OR=I．009，95％CI：1．000—1．017，P=0．039）、吸烟（OR=3．010，95％CI：1．177～7．696，P=0．021）是MHD患者腹主动脉中重度钙化的独立危险因素。Kaplan—Meier分析结果显示，随访期间中重度钙化组较无或轻度钙化组患者全因死亡率及CVD死亡率增高（P值分别为0．028和0．035）；多因素Cox回归分析结果显示，血清FGF23水平与患者全因死亡及CVD死亡无相关性。结论MHD患者腹主动脉钙化发生率高，腹主动脉中重度钙化患者全因死亡和CVD死亡率均较高。血清FGF23水平是腹主动脉中重度钙化的独立危险因素，但尚不能作为MHD患者全因死亡及CVD死亡的预测因子。Objective To explore the association of fibroblast growth factor-23 （FGF23） with abdominal aortic calcification（AAC） and adverse outcomes in maintenance hemodialysis patients. Methods One hundred and fourteen cases of MHD patients were collected prospectively. Serum intact FGF23 was detected by ELISA. Abdomen lateral plain was used as a criteria to determine the abdominal aortic calcification and the abdominal aortic calcification score was counted. Logistic regression analysis was used to determine the risk factors of AAC. Kaplan-Meier analysis was applied to compare the survival rate among different groups and COX regression analysis was used to determine the association of FGF23 and mortality in MHD patients. Results Seventy- six patients present abdominal aortic calcification. The median of AACS was 4.0（0.0, 11.0）. The median level of FGF23 was 7277.4（2535.0, 9990.8） pg/ml. The median follow-up duration was 72.0（67.8, 72.8） months. During the follow-up, 22 patients （19.3%） died of all-cause death and 17 cases （14.9%） died of cardiovascular diseases. Serum FGF23 level was positively correlated with AAC （r=0.285, P=0.002）. Logistic regression analysis showed that longer age （OR=1.059, 95%CI： 1.020-1.100, P=O.003） and dialysis vintage （OR= 1.009, 95% CI 1.000 - 1.017, P=0.039）, smoking history （OR=3.010, 95% CI 1.177 - 7.696, P=0.021） and higher FGF23 level（OR=2.831, 95%CI 1.010-7.937, P=0.048） were independent risk factors of moderate to severe AAC in MHD patients. Kaplan- Meier survival curves showed that the patients with AACS≤5 had significantly higher all-cause mortality（P=0.028） and CVD mortality （P= 0.035） than those with AACS 〈 5. However, the Kaplan-Meier analysis showed no significant difference regarding the level of serum FGF23 with the all-cause and CVD mortality. Cox regression demonstrated that FGF23 was not associated with increased mortality risk, neither in crude nor in multivariate adjusted models. Conclusions Abdominal aortic calci

关 键 词：肾透析 成纤维细胞生长因子 钙质沉着症 死亡原因 心血管疾病死亡 

分 类 号：R692.5[医药卫生—泌尿科学]