终末期肾脏病患者血清FGF23与心衰及死亡发生风险的前瞻性队列研究  

A prospective cohort study on the relationship between serum FGF23 and the risk of heart failure and death in end-stage renal disease patients

作　　者：王晓霞 周昕源 杨相杰 周润哲 孟雨晴 张定欣 张瑾[3] 王盈 Wang Xiaoxia;Zhou Xinyuan;Yang Xiangjie;Zhou Runzhe;Meng Yuqing;Zhang Dingxin;Zhang Jin;Wang Ying(Dept of Epidemiology and Biostatistics,School of Public Health,Anhui Medical University,Hefei 230032;Dept of Cardiac Imaging Center,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Dept of Nephropathy,The First Affiliated Hospital of Anhui Medical University,Hefei 230022)

机构地区：[1]安徽医科大学公共卫生学院流行病与卫生统计学系,合肥230032 [2]安徽医科大学第一附属医院心脏影像中心,合肥230022 [3]安徽医科大学第一附属医院肾脏内科,合肥230022

出　　处：《安徽医科大学学报》2024年第5期874-880,共7页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:82200833);安徽医科大学第一附属医院博士后科研基金(编号:1458)。

摘　　要：目的探讨终末期肾脏病(ESRD)患者成纤维细胞生长因子-23(FGF23)血清浓度与心力衰竭及全因死亡的相关性。方法采用前瞻性队列研究,纳入医院肾脏内科收治的无心衰症状的ESRD患者,采用基线问卷和体格检查、超声心动图检查、实验室检查收集患者数据,采用酶联免疫吸附法(ELISA)检测患者血清FGF23浓度。随访时间2年,以随访发生新发的心力衰竭(ACC/AHA stage C-D)和全因死亡为复合终点结局事件,采用Cox比例风险模型分析患者发生结局事件的危险因素,通过亚组分析和交互作用分析,进一步探讨FGF23与结局事件的关联在不同亚组中是否存在异质性。结果该研究最终纳入ESRD患者107例,平均年龄(52.00±12.51)岁,男性39(36.45%)例,中位随访时间为23个月(21,25个月),出现结局事件32(29.9%)例,其中新发心衰22(20.6%)例,全因死亡10(9.3%)例。该研究结果显示结局事件组患者血清FGF23浓度显著高于非事件组[(4.40±1.16)pmol/ml vs(3.85±0.82)pmol/ml,P<0.05]。Cox比例风险模型结果显示升高的FGF23可以增加ESRD患者发生结局事件的风险(HR=1.730,95%CI:1.164~2.570,P=0.007)。亚组分析显示FGF23水平与性别对于结局事件发生风险存在交互作用,尤其在男性ESRD患者中升高的FGF23风险更高(P_(-交互作用)<0.05)。结论升高的血清FGF23是ESRD患者发生心衰和全因死亡的独立危险因素,尤其在男性患者中风险更高。Objective To explore the correlation between serum fibroblast growth factor-23(FGF23)concentration and heart failure and all-cause death in patients with end-stage renal disease(ESRD).Methods The prospective cohort study design was used in the present study.The ESRD patients who were admitted to the department of nephropathy in the Hospital and without heart failure symptoms were recruited in this study.The data of patients was collected through baseline questionnaires,physical examinations,echocardiography,and laboratory examinations.The serum FGF23 levels were measured by enzyme-linked immunosorbent assay(ELISA).The follow-up time was 2 years.The onset of heart failure(ACC/AHA stage C-D)and all-cause death were composite endpoint events.The Cox proportional risk model was used to explore the risk factors of outcome events.Through subgroup analyses and interaction analyses,further exploration was conducted to determine whether there was heterogeneity in the association between FGF23 and outcome events in different subgroups.Results Ultimately,107 ESRD patients were included in this study,with an average age of(52.00±12.51)years.There were 39 males(36.45%),and the median follow-up time was 23 months(21,25 months).There were 32(29.9%)outcome events,of which 22(20.6%)onset of heart failure and 10(9.3%)all-cause of deaths.The results of this study showed that the concentration of FGF23 in the outcome event group was significantly higher than that in the non-event group[(4.40±1.16)pmol/ml vs(3.85±0.82)pmol/ml,P<0.05].The Cox proportional risk model showed that the elevated FGF23 was associated with increased risk of the composite endpoint events in ESRD patients(HR=1.730,95%CI:1.164-2.570,P=0.007).Subgroup analyses showed that there was an interactive effect between FGF23 levels and gender on the risk of cardiovascular outcome events.Especially in male ESRD patients,the increased FGF23 level was correlated with a higher risk of cardiovascular events(P_(-interaction)<0.05).Conclusion Elevated serum FGF23 is an inde

关 键 词：终末期肾脏病 血清成纤维细胞生长因子-23 心力衰竭 全因死亡 前瞻性队列研究 

分 类 号：R692.5[医药卫生—泌尿科学]