终末期肾病患者不同透析方式下血浆成纤维细胞生长因子21水平及临床意义

摘要

Objective:To compare the effect of different dialysis methods on the plasma levels of fibroblast growth factor⁃21( FGF⁃21) in patients with end stage renal disease ( ESRD) and to investigate the correlation between the FGF⁃21 and the qualities of the patients� lives. Methodology:Two hundred eleven subjects including 80 peritoneal dialysis patients ( PD) , 47 hemodialytic patients( HD) , 42 ESRD patients without dialysis ( ESRD) and 42 healthy control subjects were recruited. Clinical and laboratory data were collected,. The plasma levels of FGF⁃21 and adiponectin were estimated by enzyme⁃linked immunosorbent( ELISA) and the clinical and biochemical parameters such as renal function, glucose and lipid metabolism, inflammation, nutrition state, calcium phosphorus metabolism and cardiac function were measured. Grouping comparison、Correlation analysis and multivariate regression analysis were performed. Results:Plasma FGF⁃21 levels in HD group was significantly higher than that in PD group ( P<0�01) . However, there was no significant difference in plasma FGF⁃21 level between PD group and ESRD group ( P>0�05) . For patients with ESRD, the plasma FGF⁃21 levels in patients with residual renal function were significantly lower than those in patients without residual renal function,The plasma FGF⁃21 levels in patients with left ventricular hypertrophy were significantly higher than those in patients without left ventricular hypertrophy, the difference was statistically significant (P<0�01). There was no correlation between plasma FGF⁃21 level and sex, diabetes, coronary heart disease in ESRD patients (P>0�05). Furthermore, the plasma FGF⁃21 levels in ESRD patients correlated positively with ADPN and CRP, but negatively with TC, LDL and EF% (all P<0�05). Multiple linear regression analysis indicated that plasma FGF⁃21 was independently associated with ADPN and LDL ( P< 0�05); Conclusion:The levels of plasma FGF⁃21 in patients with different dialysis methods were different, and plasma FGF⁃21 levels in ESRD patients were closely related to inflammation, plasma lipids and cardiac function parameters.%目的：比较不同透析方式下终末期肾病患者血浆成纤维细胞生长因子21（ FGF⁃21）水平，探究血浆FGF21与患者生存质量各项指标的相关性。方法：选取腹膜透析（ PD）患者80例、血液透析（ HD）患者47例、非透析终末期肾病（ ESRD）患者42例和同期体检健康人群42例（对照组），共211例受试者，收集临床资料，采用酶联免疫吸附法（ ELISA）测定血浆FGF⁃21、人脂联素（ ADPN）水平，检测肾功能、糖脂代谢、炎症、营养、钙磷代谢及心功能等临床相关指标行分组比较，并进行相关性分析及多元线性回归分析。结果：HD组血浆FGF⁃21水平明显高于PD组（ P＜0�01）及ESRD组（ P＜0�05）；但PD组与ESRD组血浆FGF⁃21水平差异无统计学意义（ P＞0�05）；对于ESRD患者，有残余肾功能的患者血浆FGF⁃21水平低于无残余肾功能者，合并左心室肥厚患者血浆FGF⁃21水平高于无左心室肥厚者（ P＜0�01）；且ESRD患者血浆FGF⁃21与性别、是否合并糖尿病、冠心病并无相关（ P＞0�05）；血浆FGF⁃21水平与ADPN、C反应蛋白成正相关，与三酰甘油、低密度脂蛋白（ LDL）及射血分数值成负相关（ P＜0�05），多元线性回归分析显示FGF⁃21与ADPN、LDL独立相关（ P＜0�05）。结论：不同透析方式下ESRD患者血浆FGF⁃21水平不同，且ESRD患者血浆FGF⁃21水平与血脂、炎症及心功能等相关指标密切相关。