慢性肾病患者血清FGF23和Klotho蛋白与心脏并发症的关系  

Correlations of FGF23 and Klotho with cardiovascular injury in chronic kidney disease patients

作　　者：甘露[1] 周巧玲[1] GAN Lu ZHOU Qiaoling(Department of Nephrology, Xiangya Hospital, Central South University, Changsha 410008, China)

机构地区：[1]中南大学湘雅医院肾内科,长沙410008

出　　处：《中南大学学报（医学版）》2017年第9期1058-1065,共8页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(81470933)~~

摘　　要：目的:分析维持性血液透析患者血清钙、磷及成纤维细胞生长因子23(fibroblast growth factor,FGF23)、Klotho蛋白水平,探讨慢性肾病矿物质及骨代谢异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)患者血清FGF23、Klotho蛋白水平变化与心血管系统并发症的关系。方法:回顾性分析中南大学湘雅医院CKD-MBD未透析患者(NHD组)、CKD-MBD规律血液透析患者(HD组)及CKD-MBD伴继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)伴腺瘤样增生患者(SHPT组)各60例的MBD及心脏损伤发病情况,比较血液透析对患者病情的影响。同期收集体检中心体检健康的30例对象为对照组,记录其基本情况、收集钙、磷、全段甲状旁腺素(i PTH)等钙磷代谢指标及心脏彩超检查结果。通过酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测各组血清FGF23和Klotho蛋白情况,比较各组之间钙磷代谢相关生化指标、左室肥厚、左室扩大及心脏瓣膜异位钙化之间差异,分析上述指标间相关性,明确CKD-MBD患者心血管损伤的相关因素及其与FGF23蛋白和Klotho蛋白水平的关系。结果:维持性血液透析患者尤其是伴有SHPT的血液透析患者血清FGF23水平明显升高,而血清Klotho蛋白水平明显降低(P<0.01)。FGF23蛋白水平降低者发生异位钙化风险升高(OR=4.667);Klotho蛋白水平降低者发生心肌肥厚风险升高(OR=3.496)。在慢性肾病患者异位钙化诊断中的血清FGF23蛋白水平ROC曲线下面积为0.778(P<0.01);血清Klotho蛋白水平ROC曲线下面积为0.715(P<0.01)。结论:血清FGF23增多、Klotho蛋白减少是CKD心脏损伤的危险因素。FGF23和Klotho蛋白可作为诊断和预测CKD-MBD患者心脏异位钙化的临床指标。Objective： To analyze the levels of serum calcium, phosphate, fibroblast growth factor 23 （FGF23）, and Klotho proteins in patients with chronic kidney disease （CKD）, and to investigate the correlations of FGF23 and Klotho proteins with cardiac complicates in patients with chronic kidney disease-mineral and bone disorder （CKD-MBD）. Methods： A total of 180 CKD-MBD patients were enrolled for this study. Among them, 60 patients underwent regular hemodialysis, 60 patients did not undergo renal replacement therapy and 60 patients were diagnosed as second hyperparathyroidism （SHPT）.Thirty age and gender- matched health volunteers served as controls. Serum samples were collected and tested, and the demographical, clinical and biochemical data were all recorded. FGF23 and Klotho levels in serum samples were analyzed by enzyme-linked immunosorbent assay. Data of echocardiography and plain abdominal X rays were collected as well. The influential factors for cardiovascular injur^6 the relationship between biochemical indexes and ectopic calcification, and the correlations of FGF23 and Klotho with cardiac complicates were analyzed Results： Patients, who kept hemodialysis, especially those with SHPT, exhibited an increase in serum FGF23 level while a decrease in serum Klotho protein levels （P〈0.01）. Patients with higher levels of serum FGF23 were more likely to have ectopic calcification （OR=4.667）, while patients with lower levels of serum Klotho had high risks to get myocardial hypertrophy （OR=3.496）. Receiver operator characteristic （ROC） curve analysis showed that the area under the curve （AUC） for FGF23 was 0.778 （P〈0.01） while for Klotho was 0.715 （P〈0.01）. Conclusion： Patients, who kept hemodialysis, especially those with SHPT, have a significant increase in serum FGF23 protein levels and a significant decrease in serum Klotho protein levels. Serum FGF23 and Klotho protein levels are closely correlated with left ventricular enlargement and hypertrophy. Serum FGF2

关 键 词：成纤维细胞生长因子23 KLOTHO蛋白 慢性肾病矿物质及骨代谢异常 继发性甲状旁腺功能亢进 心血管损伤 

分 类 号：R54[医药卫生—心血管疾病] R692.5[医药卫生—内科学]