成纤维细胞生长因子-23与慢性肾病患者钙磷代谢的相关性研究

摘要

Objective:To determine the serum level of fibroblast growth factor 23( FGF -23 ) in CKD patients and explore the relationship bewteen FGF - 23 and phosphorus and calcium metabloism. Methods: Serum FGF - 23 level was determined by enzyme - linked immunosorbent assay( ELISA ) in CKD patients and twenty healthy controls. The levels of serum iPTH and 25( OH )D3 were measured by radioimmunology. At the same time, some other paremeters including serun creatinine, calcium, phosphorus, albumin, hemoglobin and c -reactive protein were measured in patients and healthy volunteers. Results :( 1 )The levels of serum FGF -23 in CKD group were significantly higher than that in normal controls( P ＜ 0.01 ). ( 2 )In non - dialysis group, the level of serum FGF - 23 by Pearson relativity analysis was significantly correlated positively with intact parathomone( r= 0.619 ,P ＜ 0.01 ), calcium - phosphorus product product( r= 0.533,P ＜ 0.01 ), albumin( r= 0.312, P ＜ 0.05 ) and c - reactive protein( r= 0.306,P ＜ 0.05 ). The level of serum FGF -23 by Pearson relativity analysis was significantly correlated negatively with serum phosphorus( r= -0.621, P ＜0.01 ), corrected calcium( r= - 0.415, P ＜ 0.01 ), eGFR( r= - 0.602, P ＜ 0.01 ) and hemoglobin( r= - 0.628, P ＜ 0.01 ) in non -dialysis group. In MHD group, the level of serum FGF -23 by Pearson relativity analysis was significantly correlated positively with intact parathormone( r= 0.390, P ＜ 0.01 ) and c - reactive protein( r= 0.458,P ＜ 0.01 ). In non - dialysis group, serum phosphorus, intact parathormone and creatinine clearance rate were found to be three variables independently that influence the level of serum FGF - 23 by multiple regression model. ( 3 )The regression equation is as follow: Y( FGF - 23 ) = 1.700 + 0.106( P ) + 0.048( LogPTH ) - 0.003( Ccr ). In MHD group, intact parathormone and c - reactive protein were significant variables that influenced the level of serum FGF- 23 in multiple regression model. Conclusion: FGF -23 concentrations were significantly elevated in patients with CKD group compared with control group. In non -dialysis group, Serum phosphorus, intact PTH and eGFR are the major regulators that influence FGF - 23.%目的:检测CKD3～5期患者血中成纤维细胞生长因子23(FGF-23)水平,探讨FGF-23与钙磷代谢的关系.方法:采用酶联免疫分析法(ELISA)对108例CKD3～5慢性肾脏疾病患者及20例健康志愿者进行血清全段FGF-23测定,同时测定血清25(OH)D3、iPTH、血清肌酐(Scr)、血钙(Ca2+)、磷(P3-)、碱性磷酸酶(ALP)、血红蛋白(Hb)、白蛋白(Alb)、C反应蛋白等指标.观察各期患者以上指标的变化,及其与FGF-23的关系.结果:(1)CKD各组患者血清FGF-23水平均显著高于对照组.CKD各期FGF-23水平逐步升高,组间差异有统计学意义.(2)Pearson相关分析结果显示:非透析组血清FGF-23水平与肌酐清除率、血红蛋白、校正血钙、血磷存在显著负相关关系(P＜0.01);与钙磷乘积、全段甲状旁腺激素(P＜0.01)和白蛋白(P＜0.05)存在直线正相关关系.透析组血清FGF-23水平与全段甲状旁腺激素及C-反应蛋白(P＜0.01)存在正相关关系.(3)非透析组多元回归结果显示:血磷、iPTH、肌酐清除率是血清FGF-23水平的独立相关因素,其回归方程为:Y(FGF-23)=1.700+0.106(P)+0.048(LogPTH)-0.003(Ccr).透析组PTH、CRP是影响FGF-23的主要变量.结论:CKD患者血FGF-23明显升高,血磷和甲状旁腺激素可能是CKD患者血FGF-23水平的调节因子.