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

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。

Abstract:

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?