慢性肾脏病患者血清成纤维细胞生长因子23与肾功能及钙磷代谢的关系

doi:10.3969/j.issn.1004-583X.2016.03.017

摘要/Abstract

摘要： 目的了解慢性肾脏病(CKD)患者不同分期血中成纤维细胞生长因子23(FGF-23)的变化,探讨FGF-23与CKD患者肾功能及钙磷代谢的关系。方法选择CKD患者124例,健康对照组32例,测定患者的血清FGF-23、血钙、血磷、甲状旁腺激素(iPTH)、血清尿素氮(BUN)和肌酐(SCr),按照CKD-EPI公式计算肾小球滤过率(eGFR),分析FGF-23与肾功能及钙磷代谢的关系。结果 CKD患者血FGF-23水平较对照组显著升高(P<0.01)。随着肾功能减退,CKD患者血FGF-23和iPTH水平逐渐增高,在CKD3～4期与对照组比较差异有统计学意义(均P<0.01),在CKD5期明显高于对照组、CKD1～2期、CKD3～4期。随着肾功能减退血钙水平逐渐降低、血磷水平逐渐增高,CKD患者在CKD5期与对照组、CKD1～2期、CKD3～4期比较差异有显著统计学意义(均P<0.01)。相关分析显示,LogFGF-23与血磷、LogiPTH、BUN、SCr呈正相关,与eGFR呈负相关。多元线性回归表明,FGF-23与CKD患者BUN、SCr呈正相关。结论 CKD患者血清FGF-23在CKD3～4期就显著增高,变化早于血磷的增高。肾功能状态、血磷、iPTH与FGF-23相关。肾功能状态可能是CKD患者血FGF-23升高的主要影响因素。

关键词: 肾疾病, 胞间信号肽类和蛋白质类, 磷, 甲状旁腺素

Abstract: Objective To investigate the change of fibroblast growth factor 23(FGF-23) in patients with different stages of chronic kidney disease(CKD); To analyze the association of FGF-23 with renal function and calcium-phosphorus metabolism.Methods A total of 124 CKD patients were selected, and 32 healthy people were studied as control group. The levels of FGF-23, serum calcium, serum phosphorus, intact parathyroid hormone(iPTH),blood urea nitrogen(BUN) and serum creatinine(SCr) were measured in all subjects. The glomerular filtration rate(eGFR) was estimated according to CKD-EPI formula. The association of FGF-23 with renal function and calcium-phosphorus metabolism were analyzed.Results The serum FGF-23 in CKD patients increased more significantly than that in control group(P<0.01). The levels of serum FGF-23 and iPTH increased gradually with the decline of renal function. There were significant difference in FGF-23 and iPTH between CKD3-4 stages and control group (all P<0.01). The levels of serum FGF-23 and iPTH in CKD 5 stage increased more significantly than those in control group,CKD1-2 stages and CKD3-4 stages. With the decline of renal function,the level of serum calcium reduced gradually in CKD patients, serum phosphorus increased gradually in CKD patients. There were significant difference in serum calcium, serum phosphorus between CKD5 stage and control group,CKD1-2 stages,CKD3-4 stages (all P<0.01).The correlations showed that LogFGF-23 was positively correlated with serum phosphorus, LogiPTH, BUN and SCr.FGF-23 was negatively correlated with eGFR. Multiple linear regression analysis indicated that FGF-23 was positively correlated with BUN and SCr.Conclusion Serum FGF-23 increases significantly in CKD3-4 stages. FGF-23 increases earlier than serum phosphorus. FGF-23 is correlated significantly with renal function, serum phosphorus and iPTH. Renal function is an independent influence factor for FGF-23 increase in CKD patients.

Key words: kidney diseases, intercellular signaling pepatides and proteins, phosphorus, parathyroid hormone

中图分类号:

R692

朱颖辉,李国刚. 慢性肾脏病患者血清成纤维细胞生长因子23与肾功能及钙磷代谢的关系[J]. 临床荟萃, 2016, 31(3): 299-302.

Zhu Yinghui,Li Guogang. Association of fibroblast growth factor 23 with renal function and calcium-phosphorus metabolism in patients with chronic kidney disease[J]. Clinical Focus, 2016, 31(3): 299-302.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2016.03.017

https://huicui.hebmu.edu.cn/CN/Y2016/V31/I3/299

参考文献

[1] 李国刚,朱颖辉,刘惠兰,等.慢性肾脏病患者血清成纤维细胞生长因子与血管钙化的关系初探[J].临床荟萃,2012,27(24):2164-2165.
[2] Fliser D, Kollerits B, Neyer U, et al. Fibroblast growth factor 23(FGF-23) predicts progression of chronic kidney disease: the Mild to Moderate Kidney Disease(MMKD)Study[J].J Am Soc Nephrol,2007,18(9):2600-2608.
[3] Xiao Y, Peng C, Huang W, et al. Circulating fibroblast growth factor 23 is associated with angiographic severity and extent of coronary artery disease[J].PLoS One,2013,8(8):e72545.
[4] Arnlv J, Carlsson AC, Sundstrom J, et al. Higher fibroblast growth factor-23 increases the risk of all-cause and cardiovascular mortality in the community[J].Kidney Int,2013,83(1):160-166.
[5] Yilmaz MI,Sonmez A,Saglam M, et al.FGF-23 and vascular dysfunction in patients with stage 3 and 4 chronic kidney disease[J].Kidney Int,2010,78(7):679-685.
[6] 彭燕,张威,郝静,等. 慢性肾脏病患者成纤维细胞生长因子23与肾功能及钙磷代谢的关系[J].中华肾脏病杂志,2010,26(2):81-85.
[7] 汤婷,冯丽萍,赵秀芬,等. 成纤维细胞生长因子23与慢性肾脏病矿物质代谢[J].肾脏病与透析肾移植杂志,2012,21(2):120-125.
[8] Mirza MA, Alsi J, Hammarstedt A, et al. Circulating fibroblast growth factor-23 is associated with fat mass and dyslipidemia in two independent cohorts of elderly individuals[J]. Arterioscler Thromb Vasc Biol,2011,31(1):219-227.
[9] 张敏芳,颜佳毅,朱铭力,等.成纤维细胞生长因子23可预测慢性肾脏病中晚期患者冠状动脉钙化的发生及不良预后[J].中国血液净化,2013,12(10):547-560.
[10] 李旻,周华,周萃星,等.终末期肾病患者成纤维细胞生长因子23-Klotho调节轴与血管内皮功能的关系[J]. 临床荟萃,2014,29(7):765-769.
[11] Isakova T. Fibroblast growth factor 23 and adverse clinical outcomes in chronic kidney disease[J]. Curr Opin Nephrol Hypertens,2012,21(3):334-340.
[12] Dilorio B, Di Micco L, Torraca S,et al. Acute effects of very-low-protein diet on FGF-23 levels:a randomized study[J].Clin J Am Soc Nephrol,2012,7(4):581-587.
[13] Oliveira RB, Cancela AL, Graciolli FG, et al. Early control of PTH and FGF-23 in normophosphatemic CKD patients:a new target in CKD-MBD therapy [J].Clin J Am Soc Nephrol,2010,5(2):286-291.
[14] Gonzalez-Parra E, Gonzalez-Casaus ML, Galan A, et al. Lanthanum carbonate reduces FGF-23 in chronic kidney disease Stage 3 patients[J]. Nephrol Dial Transplant,2011,26(8):2567-2571.
[15] 高聪普,陈宝平,时军,等.碳酸镧对慢性肾脏病四期伴有高磷血症患者血磷、甲状旁腺激素及成纤维细胞生长因子23影响的临床研究[J].中国医师进修杂志,2013,36(31):61-62.
[16] Soriano S, Ojeda R, Rodriguez M, et al. The effect of phosphate binders, calcium and lanthanum carbonate on FGF23 levels in chronic kidney disease patients[J]. Clin Nephrol,2013,80(1):17-22.
[17] 郭晓丹,凌毅生,林春华,等.磷结合剂对于血液透析高磷血症患者成纤维细胞生长因子23水平的影响[J].临床肾脏病杂志,2014,14(3):136-140.
[18] 朱丽娟,柯剑婷,李宓,等.不同血液净化模式对慢性肾衰竭患者成纤维细胞生长因子23清除的相关研究[J].中国中西医结合肾病杂志,2014,15(6):514-517.
[19] Larsson TE. The role of FGF-23 in CKD-MBD and cardiovascular disease: friend or foe[J]. Nephrol Dial Transplant,2010,25(5):1376-1381.
[20] Komaba H, Goto S, Fujii H, et al. Depressed expression of Klotho and FGF receptor 1 in hyperplastic parathyroid glands from uremic patients[J].Kidney Int,2010,77(3):232-238.
[21] Urena Torres P, Friedlander G, de Vernejoul MC,et al. Bone mass does not correlate with the serum fibroblast growth factor 23 in hemodialysis patients[J].Kidney Int,2008,73(1):102-107.