成纤维细胞生长因子23与血液透析患者血磷和甲状旁腺激素浓度的关系

摘要

目的 观察维持性血液透析患者血中成纤维细胞生长因子23(fibroblast growth factor23,FGF23)浓度,探讨维持性血液透析(maintenance hemodialysis,MHD)患者FGF23的浓度及其与血磷、甲状旁腺激素(parathyroid hormone,PTH)浓度之间的关系.方法 选取稳定MHD患者50例,健康对照30人,透析患者根据PTH浓度分为A1组(PTH<300 pg/mL)、A2组(PTH为300~500 pg/mL)、A3组(PTH>500 pg/mL).应用酶联免疫分析法测定血清FGF23和1,25-二羟活性维生素D3[1,25-dihydroxy-cholecalciferol,1,25-(OH)2D3]浓度,同时测定血清PTH、血钙(Ca2+)、磷(P3-)、碱性磷酸酶(alkaline phosphatase,ALP)、白蛋白(albumin,ALB)等指标.结果①透析患者血清Log FGF23水平显著高于对照组,Log1,25-(OH)2D3水平显著低于对照组,差异有统计学意义.②Log FGF23水平在PTH>500 pg/mL组显著高于PTH<300 pg/mL组.③LogFGF23与Log PTH、血磷、Log ALP呈正相关,与Log 1,25-(OH)2D3呈负相关.④逐步多元线性回归分析显示,血磷、钙磷乘积、Log PTH是影响Log FGF23水平的独立影响因素.结论 维持性血液透析患者血清FGF23升高,且继发性甲状旁腺功能亢进者FGF23明显升高.%Objective To determine the serum level of fibroblast growth factor 23 (FGF23) in maintenance hemodialysis (MHD) patients and explore the relationship between FGF23 and phosphorus and serum parathyroid hormone (PTH). Methods Fifty MHD patients and thirty healthy persons (control group) whose renal functions were normal were enrolled in this study. According to the PTH level, MHD patients were divided into three groups: group A1 (PTH < 300 pg/mL) , group A2 ( PTH 300-500 pg/mL) , group A3 ( PTH > 500 pg/mL). Phosphate, calcium, alkaline phosphatase in their serum were determined too. The level of FGF23 and 1 ,25-(OH)2D3 in serum were detected by the method of ELISA. Results ①The Log FGF23 in MHD group was much higher than that of control, Logl ,25-(OH)2D3 in MHD group was lower than that of control. ②The Log FGF23 in group A3 was much higher than group Al. ③Log FGF23 was positively correlated with serum phosphorus, Log PTH and Log ALP, negatively correlated with Log 1 ,25-(OH)2D3.④ Multiple linear regression analysis revealed that the level of serum level of FGF23 in MHD patients was extremely high. Conclusion The serum level of FGF23 in MHD patients was extremely high.