成纤维细胞生长因子23预测重症患者急性肾损伤预后的价值  

Prognostic value of fibroblast growth factor 23 in critical care patients with acute kidney injury

作　　者：许书添 董建华 周玉超 李喆 郑春霞 周敏林 尹茹 朱萍 李世军 刘志红 XU Shutian;DONG Jianhua;ZHOU Yuchao;LI Zhe;ZHENG Chunxia;Zhou Minlin;YIN Ru;ZHU Ping;LI Shijun;LIU Zhihong(National Clinical Research Center of Kidney Diseases,Jinling Hospital,Nanjing Universtity School of Medicine,Nanjing 210016,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院) [2]南京大学医学院附属金陵医院(东部战区总医院)国家肾脏疾病临床医学研究中心全军肾脏病研究所

出　　处：《肾脏病与透析肾移植杂志》2019年第5期407-411,417,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：江苏省创新能力建设专项(BM2015004);东部战区总医院院管课题(2015029)

摘　　要：目的:观察和评估成纤维细胞生长因子(FGF-23)能否成为预测重症患者急性肾损伤(AKI)肾功能恢复的生物标志物。方法:观察2014年6月至2015年7月国家肾脏疾病临床医学研究中心重症监护病房(ICU)收治的AKI患者FGF-23水平,并比较AKI肾功能恢复情况与FGF-23之间的相关性,采用Logistic回归分析影响AKI预后的危险因素。结果:纳入104例AKI患者及本中心生物样本库纳入健康对照60例。AKI患者FGF-23水平高于健康对照组;AKI患者FGF-23升高与高磷血症正相关;出院时肾功能完全恢复、部分恢复以及未恢复分别24例(23.1%)、50例(48.1%)和30例(28.8%)。肾功能未恢复的FGF-23水平高于肾功能完全恢复组(P<0.05)。单因素Logistic回归分析发现出院时肾功能预后不良与高龄、高FGF-23、高磷血症、血清肌酐(SCr)高、血Cystatin C高、尿视黄醇结合蛋白高、贫血、脓毒症、慢性肾脏病(CKD)有关联,多因素Logistic回归分析发现出院时肾功能预后不良与FGF-23、CKD、年龄与SCr峰值相关,CKD基础是影响AKI肾脏预后的主要因素。FGF-23对判断AKI肾功能恢复的诊断阈值为237.79 pg/ml。结论:AKI患者FGF-23水平升高,并与高磷血症相关。FGF-23可作为预测AKI患者肾功能恢复的生物标志物。Objective:To observe and evaluate whether fibroblast growth factor 23(FGF-23)can be a biomarker for predicting renal function recovery in critical care patients with acute kidney injury(AKI).Methodology:Patients with AKI admitted to the renal intensive care unit(ICU)of Jinling Hospital from June 2014 to July 2015 were included,to analysis FGF-23 level in AKI,and to compare the correlation between renal function recovery and FGF-23,and analysis risk factors affecting prognosis of AKI.Results:104 AKI patients were included,and 60 healthy controls were included from the biological sample bank of our center.FGF-23 level of AKI patients was higher than that of healthy control group.FGF-23 in AKI patients was positively correlated with serum phosphate level.FGF-23 level in non-recovery group was higher than that of complete recovery group(P<0.05).Single factor Logistic regression analysis found that poor prognosis of kidney function at discharge were related with elderly age,higher FGF-23,hyperphosphatemia,peak serum creatinine(SCr)blood cystatin C,urine RBP,anemia,sepsis and chronic kidney disease(CKD).The multi-factor Logistic regression analysis found that renal poor prognosis of AKI patients were associated with FGF-23,CKD,age and peak SCr.CKD history is the main factor influencing renal prognosis of AKI patients.The diagnostic threshold of FGF-23 for judging renal function recovery of AKI was 237.79 pg/ml.Conclusion:FGF-23 level was elevated in AKI patients,which was correlated with serum phosphate level.FGF-23 could be used as a biomarker to predict renal function recovery in AKI patients.

关 键 词：急性肾损伤 成纤维细胞生长因子23 高磷血症 生物标志物 

分 类 号：R692[医药卫生—泌尿科学] R459.7[医药卫生—外科学]