维持性血液透析患者外周血成纤维细胞生长因子23水平与心血管事件关系的研究

摘要

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者外周血成纤维细胞生长因子23(fibroblast growth factor-23,FGF-23)水平与心血管事件的关系.方法选择2008年10至2010年2月在第三军医大学血液净化中心接受MHD的慢性肾脏病(chronic kidney disease,CKD)5期患者155例,研究周期6个月,按6个月内有无发生心血管事件分成心血管事件组和非心血管事件组.对2组患者在性别、年龄、CKD基础病、血压控制、血红蛋白水平、营养状况、透析模式和药物使用等方面进行可比性分析.同时检测2组患者研究前后血清磷、钙、全段甲状旁腺激素(intact parathyroid hormone,iPTH)、FGF-23和血浆1,25(OH)2D3的水平,并进行比较分析.结果心血管事件组患者外周血FGF-23水平显著高于非心血管事件组FGF-23水平(P<0.001);相关分析发现,MHD患者外周血FGF-23水平与心血管事件的发生显著性正相关(r=0.77,P<0.001);非心血管事件组血液滤过(hemofiltration,HF)时间显著多于心血管事件组(P<0.001),非心血管事件组研究结束和研究开始时比较,血磷、iPTH和FGF-23水平均显著性降低(P<0.001).研究结束后,非心血管事件组和心血管事件组比较,血磷、iPTH和FGF-23也显著降低(P<0.001).结论 CKD 5期MHD患者外周血FGF-23水平可望作为心血管事件发生的预警指标之一;HF对血磷、iPTH和FGF-23有良好的清除作用,血液透析联合HF治疗可以有效减少MHD患者心血管事件的发生.%Objective To study the relationship between fibroblast growth factor-23 (FGF-23) in peripheral blood and cardiovascular complications in patients on maintenance hernodialysis (MHD). Methods A total of 155 patients with chronic kidney disease (CKD) at stage 5 treated in this hemodialysis center from Oct. 2006 to Feb. 2010 were enrolled in the study, and the study was lasted for 6 months. Patients were divided into cardiovascular event group or non-cardiovascular event group. The 2 groups were compared in gender, age, primary disease for CKD, blood pressure control, hemoglobin level, nutritional status, dialysis modality and drugs used. Serum phosphorus (P), calcium (Ca), intact parathyroid hormone (iPTH), FGF-23 and plasma 1,25(OH)2D3 levels were determined before and after the study. Results FGF-23 levels in peripheral blood were significantly higher in cardiovascular event group than in non-cardiovascular event group (P＜0.001). Correlation analysis indicated that the FGF-23 levels in peripheral blood correlated significantly with the cardiovascular events in MHD patients (P ＜0.001). Hemofiltration (HF) time was obviously longer in non-cardiovascular event group than in cardiovascular event group (P＜ 0.001). In non-cardiovascular event group, serum P, iPTH, and FGF-23 were lower at the end of the study, as compared with those at the beginning of the study (P＜ 0.001). At the end of the study, serum P, iPTH,and FGF-23 also reduced in non-cardiovascular event group, as compared with those in cardiovascular event group (P＜ 0.001). Conclusion FGF23 levels in peripheral blood correlate significantly with cardiovascular events in MHD patients, suggesting that FGF-23 level in peripheral blood may be used as an early warning indicator for cardiovascular events in MHD patients. HF has the better abilities to excrete P, iPTH and FGF-23. Hemorndialysis combined with HF effectively reduce the cardiovascular events in MHD patients.