血成纤维细胞生长因子23水平和颈动脉内中膜厚度对维持性血液透析患者长期预后的影响  

Impact of serum fibroblast growth factor(FGF)23 and carotid intima-media thickness on long-term outcome in maintenance hemodialysis patients

作　　者：陈爱群[1] 孙颖[1] 赵班[1] 崔菊[2] 王海涛[1] 曾平[3] 毛永辉[1] Chen Aiqun;Sun Ying;Zhao Ban;Cui Ju;Wang Haitao;Zeng Ping;Mao Yonghui(Department of Nephrology, Beijing Hospital, National Center of Gerontology, Beijing 100730, China;Beijing Hospital, Laboratory of Medical Molecular Biology, National Center of Gerontology, Beijing 100730, China;Beijing Hospital, Laboratory of Epidemiology, National Center of Gerontology, Beijing 100730, China)

机构地区：[1]北京医院肾内科国家老年医学中心,100730 [2]北京医院分子生物学实验室国家老年医学中心,100730 [3]北京医院流行病学实验室国家老年医学中心,100730

出　　处：《中华老年医学杂志》2019年第7期769-774,共6页Chinese Journal of Geriatrics

摘　　要：目的评估血成纤维细胞生长因子23(FGF23)和颈动脉内中膜厚度(CIMT)对维持性血液透析(MHD)患者长期预后的预测价值。方法共入组88例MHD患者,随访73.2个月(11.5~75.7个月),由经验丰富的B超医生对所有患者进行基线颈动脉B超检查,测量患者双侧CIMT及有无颈动脉斑块等,同时取血标本冻于-80℃冰箱用于检测血清FGF23。结果88例患者,平均年龄(64.2±11.5)岁,平均CIMT厚度为(1.34±0.38)mm,72例(81.8%)患者有颈动脉粥样斑块。60岁以上的老年MHD患者有58例(65.9%),相较于非老年患者,具有合并心血管疾病(CVD)的比例高和营养状态更差等特点。随访过程中,有34例患者死亡,其中23例患者死于CVD。Kaplan-Meier分析发现在CVD死亡率方面,CIMT正常组患者较增厚组具有更好的生存率(Log Rank P=0.003);血FGF23低水平组患者较高、中水平组有更好的生存率(Log Rank P=0.043)。多变量COX回归分析发现CIMT和FGF23是MHD患者CVD死亡的独立预测因素[HR为1.165(1.032~1.315),P=0.013;1.056(1.007~1.108),P=0.026]。在老年MHD患者中,多变量COX回归分析发现血钙、血红蛋白、FGF23和CIMT是患者CVD死亡的独立预测因素[HR为0.022(0.001~0.489),P=0.016;0.966(0.937~0.997),P=0.033;1.071(1.017~1.128),P=0.010和1.202(1.049~1.377),P=0.008]。结论血FGF23水平和CIMT是MHD患者心血管疾病死亡的重要预测因素。老年患者合并心血管疾病的比例更高,影响预后的临床因素也更加复杂。Objective To assess the predictive value of serum fibroblast growth factor(FGF)23 level and carotid intima-media thickness(CIMT)for the long-term outcome in maintenance hemodialysis(MHD)patients. Methods A total of 88 MHD patients were enrolled, with a median follow-up of 73.2 months(a range from 11.5 to 75.7 months). CIMT and atherosclerotic plaques were measured by B-mode Doppler ultrasound at baseline by an experienced sonographer.Blood samples were collected and stored in the -80℃ refrigerator for measuring serum FGF23 levels. Results The 88 patients were aged(64.2±11.5)years, with 52 males and 36 females, and the mean CIMT was(1.34±0.38)mm.Carotid artery atherosclerotic plaque was detected in 72(81.8%)subjects.Carotid artery atherosclerotic plaques(CASP)were found in 58(65.9%)patients aged 60 years and over.Compared with non-elderly patients, elderly patients had the characteristics of high incidence of cardiovascular disease and poor nutritional status.During the follow-up period, 34 patients died and 23(67.6%)patients died of cardiovascular disease.Kaplan-Meier curves showed that cardiovascular disease-free survival rate was higher in the normal CIMT group than in thickening CIMT group(Log Rank P=0.003). And subjects with low level of FGF23 had a better survival rate than those with moderate to high level of FGF23(Log Rank P=0.043). Multivariate COX regression analysis showed that FGF23(HR=1.056, 95%CI: 1.007-1.108, P=0.026)and CIMT(HR=1.165, 95%CI: 1.032-1.315, P=0.013)were independent predictors for cardiovascular mortality.Multivariate COX regression analysis showed that serum calcium(HR=0.022, 95%CI: 0.001-0.489, P=0.016), hemoglobin(HR=0.966, 95%CI: 0.937-0.997, P=0.033), FGF23(HR=1.071, 95%CI: 1.017-1.128, P=0.010)and CIMT(HR=1.202, 95%CI: 1.049-1.377, P=0.008)were independent predictors for cardiovascular mortality in elderly MHD patients. Conclusions Serum level of FGF23 and CIMT are the important predictors for cardiovascular mortality in MHD patients.The proportion of elderly patients with ca

关 键 词：维持性血液透析 血管中膜 成纤维细胞生长因子23 预后 

分 类 号：R459.5[医药卫生—治疗学]