血清Klotho、FGF23、ALP、25-（OH）D水平对持续非卧床腹膜透析患者心脏瓣膜钙化的影响*

Effect of Klotho, FGF23, ALP, 25-hydroxyvitamin D on heart valve calcification in continuous ambulatory peritoneal dialysis patients*

摘要:

目的 探讨血清Klotho、成纤维细胞生长因子23（FGF23）、碱性磷酸酶（ALP）、25羟维生素D[25-（OH）D]水平对持续非卧床腹膜透析（CAPD）患者心脏瓣膜钙化的影响。方法 选取2018年 1月—2019年1月内蒙古医科大学附属医院收治的132例CAPD患者，另选取同期医院体检中心接收的40例健康体检者，检测并对比CAPD患者与健康受试者血清Klotho、FGF23、ALP、25-（OH）D水平；根据心脏超声评估心脏瓣膜钙化情况将CAPD患者分为钙化组和非钙化组，对比两组血清Klotho、FGF23、ALP、25-（OH）D水平及其他可能导致心脏瓣膜钙化影响因素的差异，应用Logistic回归分析相关危险因素；绘制受试者工作特征（ROC）曲线，分析血清Klotho、FGF23、ALP、25-（OH）D水平对心脏瓣膜钙化的诊断效能。结果 CAPD患者血清Klotho、25-（OH）D水平均低于健康受试者，血清FGF23、ALP水平均高于健康受试者（P?<0.05）；钙化组血清Klotho、25-（OH）D水平均低于非钙化组，血清FGF23、ALP水平均高于非钙化组（P?<0.05）；钙化组残余肾功能（RRF）低于非钙化组，血磷水平高于非钙化组（P?<0.05）；Logistic回归分析显示，RRF、血磷、血清Klotho、FGF23、ALP、25-（OH）D水平均是导致心脏瓣膜钙化的危险因素（P?<0.05）；ROC结果显示，血清Klotho、FGF23、ALP、25-（OH）D诊断心脏瓣膜钙化的最佳截断点分别为401.10?ng/L、231.91?ng/L、 76.50?u/L、11.36?nmol/L，敏感性分别为88.68%、90.57%、71.70%及67.92%，特异性分别为88.61%、92.41%、77.22%及70.89%，AUC分别为0.903（95% CI：0.854，0.952）、0.927（95% CI：0.873，0.945）、0.714（95% CI：0.622，0.770）及0.698（95% CI：0.610，0.759）。结论 CAPD患者血清Klotho、25-（OH）D水平降低，FGF23、ALP水平升高，且均与CAPD心脏瓣膜钙化关系密切，所有指标对CAPD患者心脏瓣膜钙化有较高的诊断效能。

Abstract:

Objective To investigate the effects of Klotho, fibroblast activity factor 23 (FGF23), alkaline phosphatase (ALP) and 25 hydroxyvitamin D 25-(OH)D on heart valve calcification in continuous ambulatory peritoneal dialysis (CAPD) patients. Methods A total of 132 CAPD patients admitted to the Affiliated Hospital of Inner Mongolia Medical University from January 2018 to January 2019 were prospectively selected. Forty health checkups received by the physical examination center of the hospital in the same period were selected. The serum levels of Klotho, FGF23, ALP and 25-(OH)D were detected and compared between CAPD patients and healthy subjects. The CAPD patients were divided into calcification group and non-calcification group according to the assessment of cardiac valve calcification by echocardiography. The serum levels of Klotho, FGF23, ALP, 25-(OH)D and other factors that may lead to cardiac valve calcification were compared between the two groups. Logistic regression analysis was used to identify the risk factors, and receiver operating characteristic curve (ROC) was drawn to analyze the diagnostic efficacy of serum Klotho, FGF23, ALP and 25-(OH)D for cardiac valve calcification. Results The serum levels of Klotho and 25-(OH)D in CAPD patients were lower than those in healthy subjects, and the serum levels of FGF23 and ALP were higher than those in healthy subjects (P?