维持性血液透析患者外周血成纤维细胞生长因子23水平与血管钙化关系的研究

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)水平与血管钙化的关系。方法选择慢性肾脏(chronickidney disease,CKD)5期MHD患者22例(透析时间在3年以上),透析通路为自体桡动脉-头静脉内瘘,在动静脉内瘘重建过程中,取失功动静脉内瘘动脉段作为试验组标本,同龄人群(取材于尸体肾供者)腹主动脉作为对照组(10例)。以von Kossa染色法对血管钙化进行定性检测,甲酚酞络合酮化学法对血管钙化进行定量检测,磷酸苯二钠法测定血管组织碱性磷酸酶(alkaline phosphatase,ALP)活性;酶联免疫吸附法检测外周血FGF-23水平;并对桡动脉血管平滑肌细胞(vascular smooth muscle cells,VSMCs)钙含量和ALP活性与FGF-23的表达进行相关分析。结果与对照组比较,MHD患者VSMCs钙含量、ALP活性和外周血FGF-23水平均显著增加(P<0.01)。MHD组外周血FGF-23水平与VSMCs钙含量和ALP活性均呈显著正相关(P<0.01)。结论 MHD患者血管钙化广泛存在,外周血FGF-23水平的显著升高,FGF-23与血管钙化显著正相关。FGF-23不仅参与了MHD患者血管钙化的发生机制,而且是MHD患者血管钙化的重要预警指标之一。

Relationship between fibroblast growth factor-23 in peripheral blood and vascular calcification in maintenance hemodialysis patients

Objective To study the relationship between plasma FGF-23 level and peripheral vascular calcification（VC） in patients treated with maintenance hemodialysis（MHD）.Methods A total of 22 patients treated with maintenance hemodialysisfor for more than 3 years with a wrist primary radial artery-cephalic vein arteriovenous fistula（AVF） as the vascular access were included in this study（MHD group）.Samples of radial artery were collected from these patients during the reconstruction of the inadequate AVF.Ten abdominal aorta samples collected from cadaveric kidney donors were used as controls（control group）.Von Kossa histochemistry served as the qualitative indicator of VC,and cresolphthalein complexone chemical method served as the quantification of VC. Alkaline phosphatase（ALP） activity assay was performed following the manual of the assay kit,and FGF-23 level was determined by enzyme-linked immunosorbent assay.The relationship between FGF-23 and VC in MHD patients was analyzed.Results Calcium content in vascular smooth muscle cells（VSMCs）,ALP activity and FGF- 23 level in peripheral blood were significantly higher in MHD group than in control group（P0.01）.In MHD group, FGF-23 level in peripheral blood was positively correlated to calcium content in VMSCs and ALP activity（P0.01）. Conclusion VC is extensively presented in MHD patients,accompanied by the increase of serum FGF-23.FGF23 level is positively correlated to VC in MHD patients.These results imply that the increase of plasma FGF-23 may be involved in the pathogenesis of VC,and may be an important early warning indicator to MHD patients.