血清全段成纤维细胞生长因子－23在2型糖尿病肾病不同分期中的变化

摘要

目的：研究2型糖尿病肾病（ DN ）不同临床分期患者血清全段成纤维细胞生长因子－23（iFGF－23）水平的变化，探讨2型糖尿病患者血清iFGF－23水平、尿微量白蛋白排泄率（UAER）和肾功能变化的相关性。方法选取2型糖尿病患者共119例，根据尿微量白蛋白排泄率分为4组：尿微量白蛋白排泄率正常组（DM1组，8°UAER ＜20μg／min，血清肌酐水平正常）30例；微量白蛋白尿组（DM2组，8°UAER 20～200μg／min，血清肌酐水平正常）30例；临床蛋白尿组（DM3组，8°UAER＞200μg／min，血清肌酐水平正常）28例；尿毒症血液透析组（ DM4组）31例。正常对照组（ N组）29例。收集受试者基本资料，空腹静脉采血测血糖、血脂，肝、肾功能，全段甲状旁腺激素（ iPTH），血清iFGF－23， DM1组、 DM2组、 DM3组留取8 h尿检测8°UAER。所有资料应用SPSS 22．0软件包进行统计学分析。结果 DM4组血清iFGF－23为558．93（168．65～2333．5） pg／mL水平显著高于其他组（P＜0．001），但其他各组间差异无统计学意义。血清iFGF－23水平和肾小球滤过率（eGFR）呈负相关，与血清肌酐（Scr），尿素氮（BUN），葡萄糖（GLU），血磷（ P），碱性磷酸酶（ ALP）， iPTH呈正相关。结论糖尿病肾病晚期血清iFGF－23水平显著升高，血清iFGF－23水平与血磷、血清肌酐、尿素氮和iPTH呈正相关，与eGFR水平显著负相关。提示iFGF－23不能作为DN早期的生化标志物。%Objective To investigate the changes of serum intact fibroblast growth factor 23 ( iFGF-23) levels in type 2 diabetes ( T2DM) patients with diabetic nephropathy in different stages, and analysis the correlation of the lev-els of serum iFGF-23 with the levels urinary albumin excretion rate ( UAER) and renal functions.Methods A total of 119 patients with type 2 diabetes and 29 healthy control subjects were enrolled.According to urinary albumin excretion rate and renal function, the patients with type 2 diabetes were divided into four groups:urinary albumin excretion rate in normal group ( group DM1, 8°UAER <20 μg/min, serum creatinine was normal, n=30 ) , microalbuminuria group (group DM2, 8°UAER 20~200 μg/min, serum creatinine level is normal, n=30), clinical albuminuria group (group DM3, 8°UAER>200 μg/min, serum creatinine level is normal, n=28) , uremic hemodialysis group ( DM4 group, n=31), normal control group (group N, n=29).The general data of the subjects was recorded.Fasting venous blood sam-ples were collected for glucose, lipid, liver and kidney function, intact parathyroid hormone ( iPTH) , and serum iFGF-23 determination.8 hour urine (from 10pm to 6am) was also collected for UAER detection.Results Serum iFGF-23 of 558.93 (168.65-2 333.5) pg/mL levels in DM4 group was significantly increased than other groups (P<0.001), but no significant difference among the other groups.The levels of serum iFGF-23 negatively correlated with estimated glomer-ular filtration rate ( eGFR) , but positively correlated with serum creatinine ( Scr) , blood urea nitrogen ( BUN) , glucose ( GLU) , serum phosphorus ( P) and iPTH.Conclusion The levels of iFGF-23 increased significantly in the late stage of diabetic nephropathy.The levels of iFGF-23 were positively correlated with the levels of creatinine, blood urea nitro-gen, phosphorus and iPTH, and were negatively correlated with eGFR.This study suggested that the levels of serum iFGF-23 can not be used as a new biomarkers for negatively early diagnosis of diabetic nephropathy.