持续非卧床腹膜透析患者成纤维生长因子-23及可溶性klotho蛋白水平与心脏瓣膜钙化的关系  

Research on relationship of FGF-23 and sKL with cardiac valve calcification in CAPD patients

作　　者：付玉玲 胡坤[1] 沈艳萍[1] 施鑫[2] 乔青[1] FU Yu-ling1, HU Kun1, SHEN Yan-ping1, SHI Xin2, QIAO Qing1(1. Department of Renal Division, The First Affliated Hospital of Soochow University, Suzhou 215006, China; 2. Department of Cardiac Ultrasound, The First Affliated Hospital of Soochow University, Suzhou 215006, Chin)

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心超室,苏州215006

出　　处：《上海交通大学学报（医学版）》2018年第5期541-546,共6页Journal of Shanghai Jiao tong University:Medical Science

摘　　要：目的·探讨持续非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者血清成纤维生长因子-23(fibroblast growth factor-23,FGF-23)及可溶性klotho蛋白(soluble klotho,sKL)水平与心脏瓣膜钙化的关系。方法·收集苏州大学附属第一医院腹膜透析中心147例接受CAPD治疗患者的临床资料。采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定患者血清FGF-23和sKL浓度,超声心动图评估患者心脏瓣膜钙化情况,并将患者分为心脏瓣膜正常组(A组)与心脏瓣膜钙化组(B组)。使用SPSS 23.0统计软件对数据进行分析。结果·147例CAPD患者中,心脏瓣膜钙化发生率为54.42%。Spearman相关分析显示,CAPD患者心脏瓣膜钙化与年龄、透析龄、血清肌酐、校正钙、血清磷、血清碱性磷酸酶、甲状旁腺激素、FGF-23水平呈正相关(P=0.045,P=0.022,P=0.006,P=0.024,P=0.000,P=0.017,P=0.022,P=0.000),与尿素清除指数、sKL水平、残余肾功能呈负相关(P=0.045,P=0.000,P=0.011)。多因素Logistic回归分析显示,FGF-23水平升高(OR=5.007,95%CI为1.446~17.339,P=0.011)、sKL水平降低(OR=0.310,95%CI为0.108~0.891,P=0.030)、血磷水平升高(OR=7.433,95%CI为1.558~35.470,P=0.012)是腹膜透析患者心脏瓣膜钙化的独立危险因素。受试者工作特征曲线显示,FGF-23及sKL预测心脏瓣膜钙化的最佳临界值分别为2 172.64 pg/mL(敏感度91.3%,特异度91.0%)及231.88 pg/mL(敏感度88.8%,特异度92.5%)。结论·高水平的FGF-23及低水平的sKL是CAPD患者心脏瓣膜钙化的独立危险因素,两者对CAPD患者心脏瓣膜钙化诊断的准确性均较高。Objective To explore the relationship of fibroblast growth factor-23（FGF-23） and soluble klotho（sKL） with cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis（CAPD）. Methods 147 CAPD patients from the dialysis center of the First Affiliated Hospital of Soochow University were enrolled. The concentrations of FGF-23 and sKL were measured by enzyme-linked immunosorbent assays（ELISA）. Echocardiography was applied to evaluate cardiac valve calcification. The patients were divided into normal cardiac valve group（group A） and cardiac valve calcification group（group B）. SPSS 23.0 software was used for data analysis. Results The incidence of cardiac valve calcification in CAPD patients was 54.42%. The risk of cardiac valve calcification showed positive correlation with age, dialysis age, serum creatinine, corrected calcium, serum phosphorus, serum alkaline phosphatase, parathyroid hormone, and the level of FGF-23（P=0.045, P=0.022, P=0.006, P=0.024, P=0.000, P=0.017, P=0.022, P=0.000）, and negative correlation with urea clearance index, the level of sKL and residual renal function（P=0.045, P=0.000, P=0.011）. Multivariate Logistic regression analysis showed that the increase of FGF-23（OR=5.007, 95% CI 1.446-17.339, P=0.011） and serum phosphorus（OR=7.433, 95% CI 1.558-35.470, P=0.012） were two independent risk factors for cardiac valve calcification in CAPD patients, and the decrease of sKL（OR=0.310, 95% CI 0.108-0.891, P=0.030） was another independent risk factor as well. Receiver operator characteristic curves（ROC） indicated that to predict cardiac valve calcification in patients with CAPD, the optimal cut off points of FGF-23 and sKL were 2 172.64 pg/mL（sensitivity was 91.3%, specificity was 91%） and 231.88 pg/mL（sensitivity was 88.8%, specificity was 92.5%）, respectively. Conclusion The high level of FGF-23 and low level of sKL are two independent risk factors for cardiac valve calcification in CAPD patients. FGF-23 and sKL can be u

关 键 词：腹膜透析 心脏瓣膜钙化 成纤维生长因子-23 可溶性klotho蛋白 

分 类 号：R692.5[医药卫生—泌尿科学]