血液透析患者成纤维细胞生长因子23水平及相关性分析

目的观察维持性血液透析（maintenance hemodialysis,MHD）患者成纤维细胞生长因子23（fibroblast growth factor 23,FGF-23）的水平,分析其与全段甲状旁腺激素（intact parathyroid hormone,iPTH）等生化指标的关系,探讨FGF-23对MHD患者的临床意义。方法选取行MHD治疗的患者41例,健康志愿者12例为对照组,收集一般情况及化验指标,采集血清检测FGF-23,并进行相关性分析。结果①MHD各组与对照组年龄、性别无显著差异,但MHD患者FGF-23显著高于对照组（1077.4±967.46）pg/ml比（73.99±19.58）pg/ml,P〈0.001];②依据甲状旁腺激素（iPTH）不同将MHD分为A组（低iPTH组）、B组（iPTH达标组）、C组（高iPTH组）;FGF-23在3组间有显著性差异,分别为（477.44±2293.53）pg/ml、（176.57±402.39）pg/ml、（1433.1±1984.76）pg/ml,P=0.016];③将MHD患者依据血磷不同水平分组比较,观察到高血磷组与非高血磷组相比,iPTH显著升高（1319.66±1015.96）pg/ml比（583.36±980.81）pg/ml（P=0.012）]、FGF-23也显著升高（1506.83±957.97）pg/ml比（452.31±696.12）pg/ml（P〈0.001）];④相关性分析显示：血钙（r=0.381,P=0.005）、磷（r=0.593,P〈0.001）、钙磷乘积（r=0.656,P〈0.001）、碱性磷酸酶（ALP）（r=0.276,P=0.045）均与FGF-23呈正相关。而iPTH在B组及C组与FGF-23呈正相关（r=0.384,P=0.005）,在A组与FGF-23无相关性。结论 MHD患者中FGF-23与血清钙、磷、钙磷乘积、ALP、iPTH密切相关,在继发性甲状旁腺功能亢进症（secondary hyperparathyroidism,SHPT）的发生中起着重要作用。

To explore the correlation between fibroblast growth factor 23 and different parathyroid hormone levels in maintenance hemodialysis patients

Objective We investigated the significance of fibroblast growth factor 23（FGF23） in maintenance hemodialysis（MHD） patients by measuring serum FGF23 and correlating FGF23 with intact parathyroid hormone levels（iPTH） and other biochemical markers in these patients.Methods Forty-one MHD patients were enrolled in this study,and 12 healthy individuals were used as the control group.Demographic information,serum FGF23 and other laboratory indexes were collected and analyzed.Results ① Serum FGF23 was significantly higher in MHD group than in control group（P〈0.001）.② When MHD patents were sub-grouped into group A（with lower iPTH level）,group B（with normal iPTH level）,and group C（with higher iPTH level）.Serum FGF23 in the group A,B and C was 477.44 ± 2293.53pg/ml,176.57 ± 402.39pg/ml and 1433.1 ± 1984.76pg/ml,respectively,significantly different among the 3 groups（P=0.016）.③ When MHD patients were sub-grouped into hyperphosphatemia group and normal serum phosphate group. Compared to the normal serum phosphorus group,iPTH and FGF23 in the hyperphosphatemia group increased significantly（1319.66±1015.96pg/ml vs.583.36±980.81pg/ml for iPTH,P〈0.05;1506.83±957.97pg/ ml vs.452.31 ± 696.12pg/ml for FGF23,P〈0.001）.④ Serum FGF23 was positively correlated with serum calcium,phosphorus,ALP and calcium-phosphorus product（r=0.381,P〈0.01 for calcium;r=0.593,P〈0.001 for phosphorus;r=0.276,P〈0.05 for ALP;r=0.656,P〈0.001 for calcium-phosphorus product）.iPTH was positively correlated with FGF23 in groups B and C（r=0.384,P〈0.01）,but not in group A.Conclusions In MHD patients,FGF23 was closely related to serum calcium,phosphorus,calcium-phosphorus product,ALP and iPTH.Therefore,FGF23 plays an important role in the presence of secondary hyperparathyroidism.