慢性肾脏病患者血清FGF23水平与钙磷代谢及临床相关性  

The relationship between serum FGF23 level and calcium-phosphorus metabolism and clinical relevance in patients with chronic kidney disease

作　　者：闫奇奇 郝丽[1] 张森[1] Yan Qiqi;Hao Li;Zhang Sen(Dept of Nephrology,The Second Affiliated Hospital of Anhui Medical University,Hefei 230601)

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《安徽医科大学学报》2019年第5期776-780,共5页Acta Universitatis Medicinalis Anhui

基　　金：安徽省公益性技术应用研究联动计划项目(编号:1604f0804021);安徽医科大学校科研基金项目(编号:2017xkj028)

摘　　要：目的探讨血清成纤维细胞生长因子23(FGF23)在慢性肾脏病(CKD)中的变化规律,在慢性肾脏病-矿物质骨代谢异常(CKD-MBD)早期诊断中价值及与临床的相关性。方法选取CKD患者140例,分为3期组、4期组、5期非透析组(5ND)、5期血液透析组(5HD),并将18例健康体检者纳入对照组,完善血钙(Ca)、血磷(P)、血红蛋白(Hb)、白蛋白(ALB)、血肌酐(SCr)、骨源性碱性磷酸酶(BALP)、甲状旁腺激素(PTH)、FGF23等指标及心脏彩色多普勒检查,监测清晨安静状态下血压。根据是否存在左心室肥厚(LVH)分为LVH组和非左心室肥厚(NLVH)组,根据是否存在心脏瓣膜钙化分为心脏瓣膜钙化组和非心脏瓣膜钙化组。结果①3期组(1.83±0.19)、4期组(1.91±0.16)、5ND期组(1.99±0.18)、5HD期组(2.12±0.12)logFGF23均显著高于对照组(1.74±0.14)(P<0.05),且随着CKD进展不断升高;②3期组Ca(2.13±0.19)、P(1.20±0.21)、logPTH(1.74±0.21)均在正常范围内;③5ND组Hb、Ca显著低于其他组(P<0.05),P显著高于其他组(P<0.05);④5ND组和5HD组BALP及logPTH水平显著高于3期组和4期组(P<0.05);⑤FGF23与P、SCr、BALP、PTH、收缩压呈正相关(P<0.05),与Hb呈负相关性(P<0.05);⑥R*C表χ~2检验示CKD分期与LVH存在中等强度相关,Cramer′s V=0.376,P=0.001,与心脏瓣膜钙化存在弱强度相关,Cramer′s V=0.264,P=0.044;⑦年龄、FGF23和收缩压是LVH的独立危险因素,年龄和FGF23是心脏瓣膜钙化的独立危险因素。结论 FGF23随着CKD进展不断升高,其变化早于Ca、P、PTH,且为LVH和心脏瓣膜钙化的独立危险因素,可作为CKD-MBD的预测指标,与临床密切相关。Objective To investigate the changes of serum fibroblast growth factor 23(FGF23) in patients with chronic kidney disease(CKD),its value in the early diagnosis of chronic kidney disease-abnormal mineral bone metabolism(CKD-MBD) and its clinical relevance. Methods A total of 140 CKD patients were enrolled in this study. CKD patients were divided into 3 stage group,4 stage group,5 stage non dialysis group(5ND) and 5 state hemodialysis group(5HD). 18 healthy persons were selected as control group. The laboratory indexes such as calcium(Ca),phosphorus(P),hemoglobin(Hb),albumin(ALB),bone alkaline phosphatase(BALP),parathyroid hormone(PTH) and FGF23 were measured,and echocardiography was undergone. Blood pressure was monitored in the morning quiet state. According to the presence or absence of left ventricular hypertrophy(LVH),they were divided into group LVH and group NLVH. According to the presence or absence of cardiac valve calcification,they were divided into cardiac valve calcification group and non cardiac valve calcification group. Results Relationship between Ca,P,Hb,ALB,BALP,PTH,FGF23 and renal function:the logFGF23 of 3 stage group(1.83±0.19),4 stage group(1.91±0.16),5ND group(1.99±0.18) and 5HD group(2.12±0.12) were significantly higher than those of the control group(1.74±0.14)( P <0.05),and increased with the CKD progressed. Ca(2.13±0.19),P(1.20±0.21),logPTH(1.74±0.21) in the 3 stage group were all within the normal range.Hb and Ca in the 5ND group were significantly lower than those in other groups( P <0.05). P was significantly higher than those in other groups( P <0.05).BALP and logPTH in the 5ND group and the 5HD group were significantly higher than those in the 3 stage group and the 4 stage group( P <0.05). FGF23 was positively correlated with P,SCr,BALP,PTH and SBP( P <0.05),and negatively correlated with Hb( P <0.05). Analysis of risk factors for LVH and cardiac valve calcification:R*C table χ 2 test showed that CKD stage was moderately correlated with left ventricular hypertrophy,Cramer′

关 键 词：慢性肾脏病 成纤维细胞生长因子23 钙磷代谢 左心室肥厚 心脏瓣膜钙化 

分 类 号：R692.5[医药卫生—泌尿科学]