中心夜间透析和传统透析患者循环成纤维细胞生长因子23水平差异及影响因素

目的 比较中心夜间血液透析(INHD)和传统血液透析(CHD)患者循环成纤维细胞生长因子23(FGF23)水平差异并探讨影响患者FGF23水平的因素.方法 收集第二军医大学长征医院44例INHD及64例CHD患者空腹静脉血,测定患者钙、磷、全段甲状旁腺素(iPTH)、尿素清除指数(Kt/V)、25-羟维生素D、铁蛋白、血红蛋白、血脂、FGF23等指标并比较两组各指标的差异,采用多重线性回归分析探究FGF23的影响因素,Pearson相关性分析探究FGF23与血钙、血磷、钙磷乘积、iPTH、25-羟维生素D、Kt/V的相关性.结果 INHD患者血磷较CHD患者低(P＜0.05),INHD透析充分性明显高于CHD,INHD患者循环FGF23水平低于CHD患者(P＜0.05).FGF23与钙、磷、钙磷乘积相关(P＜0.01),与iPTH及Kt/V不相关.结论 INHD比CHD更能有效改善慢性肾脏病-矿物质和骨异常(CKD-MBD)参数.钙磷乘积是血液透析患者FGF23水平的独立影响因素,INHD通过减少钙磷乘积降低血清FGF23水平可能是其改善患者临床预后的机制之一.

Difference of circulating fibroblast growth factor-23 levels between patients undergoing in-center nocturnal hemodialysis and conventional hemodialysis and the influencing factors

Objective To compare the difference of serum FGF23 level in two cohorts undergoing in-center nocturnal hemodialysis(INHD) or conventional hemodialysis(CHD)and explore the regulatory factors of circulating FGF23. Methods Limosis vein blood of patients was collected. Serum calcium, phosphate, intact PTH, KT/V, 25(OH)D, ferritin, hemoglobin, lipid, serum FGF23 were measured and compared. All the regulatory factors of FGF23 were analyzed by multivariate regression analyses. Results The serum phosphate and FGF23 of INHD patients were significantly lower than that of CHD patients. The dialysis adequacy of INHD was higher than that of CHD. Serum FGF23 were associated with serum calcium, serum phosphate, calcium-phosphate product but not with intact PTH or KT/V. Conclusions INHD can improve the parameters of CKD-MBD. Calcium-phosphate product is independent regulatory factor of serum FGF23. Reduction of FGF23 levels in INHD patients due to modified calcium-phosphate product might contribute to improvement of clinical prognosis.