成纤维细胞生长因子-23与慢性肾脏病患者矿物质代谢紊乱的相关性研究  

Association of fibroblast growth factor 23 and mineral disorder in patients with chronic kidney disease

作　　者：胡志娟[1] 史亚男[1] 刘琼[1] 董春霞[1] 牛凯[1] 刘冰[1] Zhi-juan Hu;Ya-nan Shi;Qiong Liu;Chun-xia Dong;Kai Niu;Bing Liu(Department of Nephrology,Hebei General Hospital,Shijiazhuang,Hebei 050051,China)

机构地区：[1]河北省人民医院肾内科

出　　处：《中国现代医学杂志》2019年第21期95-99,共5页China Journal of Modern Medicine

摘　　要：目的观察慢性肾脏病(CKD)非透析患者的血清钙、磷、全段甲状旁腺激素(iPTH)、25-羟维生素D、成纤维细胞生长因子-23(FGF-23)水平,以及肱踝脉搏波传导速度(baPWV),并探讨FGF-23与上述指标的相关性。方法选取河北省人民医院35例健康者(对照组)、34例CKD 1期、35例CKD 2期、34例CKD 3a期、33例CKD 3b期、38例CKD 4期和32例CKD 5期患者。检测各组患者的血压、体重指数(BMI)、血清白蛋白、肌酐、钙、磷、25-羟维生素D、iPTH、FGF23水平及baPWV。结果对照组及CKD各期患者的年龄、性别构成及BMI无差异(P>0.05)。与对照组比较,CKD 3a^5期组和CKD 2~5期组患者的收缩压和舒张压升高(P<0.05);CKD各期患者的24 h尿白蛋白定量升高(P<0.05),CKD 3a^5期组患者的血肌酐、血磷、iPTH水平升高,血清白蛋白、血钙水平下降(P<0.05);CKD 2~5期组患者的25-羟维生素D水平下降,CKD 3a^5期组患者的FGF-23水平升高(P<0.05);7组不同水平25-羟维生素D例数所占比例比较有差异(P<0.05);与对照组及CKD 1期组分别比较,CKD 3a^5期组患者的baPWV加快(P<0.05);所有CKD患者中血清FGF-23与血钙(r=-0.175,P=0.000)、25-羟维生素D(r=-0.130,P=0.000)呈负相关,与血磷(r=0.236,P=0.000)、iPTH(r=0.249,P=0.000)呈正相关。结论CKD患者血清iPTH、FGF-23水平的变化先于血钙、磷的变化。随着eGFR的降低,25-羟维生素D的下降时间早于iPTH和FGF-23水平的升高。在CKD的早期即出现血管僵硬度增加。Objective To assess the serum levels of calcium,phosphate,intact parathyroid hormone(iPTH),25-hydroxyvitamin D,fibroblast growth factor-23(FGF-23)and pulse wave velocity(baPWV)in non-dialysis patients with chronickidney disease(CKD)and to analyze the relationships between FGF-23 and chroic kidney disease-mineral bone disorder(CKD-MBD)parameters.Methods Totally 34 CKD stage 1,35 CKD stage 2,34 CKD stage 3a,33 CKD stage 3b,38 CKD stage 4,32 CKD stage 5 patients and 35 healthy subjects were enrolled into the study.Blood pressure,body weight index(BMI),serum albumin,creatinine,calcium,phosphate,25-hydroxyvitamin D,iPTH,FGF-23 and baPWV were measured.Results No significant difference in age,gender among seven groups were identified(P>0.05).CKD stage 3a-5 and CKD stage 2-5 patients experienced higher levels of systolic pressure and diastolic pressure respectively(P<0.05).Urinary protein of 24 hours were much higher than those in healthy subjects(P<0.05).Increased serum creatinine,phosphate,iPTH,decreased albumin,calcium were found in CKD stage 3a-5 patients(P<0.05).The level of 25-hydroxyvitamin D decreased in patients with CKD stage 2-5,in the mean time,the level of FGF-23 increased in patients with CKD stage 3a-5(P<0.05).There were significant differences in the proportion of 25-hydroxyvitamin D among 7 groups(P<0.05).The mean baPWV was increased by declining eGFR levels(P<0.05).The serum FGF-23 concentration was negatively correlated with serum calcium,serum level of 25-hydroxyvitamin D(r=-0.175 and-0.130 respectively,all P=0.000),and positively correlated with serum phosphate and iPTH(r=0.236 and 0.249 respectively,all P=0.000).Conclusions Increases in both serum FGF-23 and iPTH precede changes of serum calcium and phosphate in patients with CKD.The 25-hydroxyvitamin D levels decrease earlier than the increase of serum FGF23 or iPTH,with declining eGFR level.Increased vascular stiffness occurs in early-stage CKD.

关 键 词：慢性肾脏病-矿物质和骨代谢紊乱/肾疾病 25-羟维生素D 甲状旁腺素 成纤维细胞生长因子-23 

分 类 号：R586.9[医药卫生—内分泌]