不同血清成纤维细胞生长因子23水平对腹膜透析患者磷代谢的影响及相关因素分析

目的观察分析不同血清成纤维细胞生长因子（FGF）23水平对腹膜透析患者磷代谢的影响，探讨腹膜透析患者血清FGF23的影响因素。 方法选取重庆医科大学附属成都第二临床学院稳定腹膜透析治疗3个月以上的92例患者，根据患者血清FGF23中位数821 pg/ml，将患者分为低水平组（FGF23<821 pg/ml）和高水平组（FGF23≥821 pg/ml），比较2组患者饮食蛋白质及磷摄入量、血磷水平、腹膜磷清除率、残肾磷清除率、总磷清除率、血清甲状旁腺素（iPTH）水平、残余肾功能（RRF）；根据透析液肌酐浓度/血浆肌酐浓度值，其中32例患者分为A组（高平均转运＋高转运组）和B组（低平均转运＋低转运组），比较A、B组患者腹膜转运功能与FGF23的清除。采用多元逐步回归法分析PD患者血FGF23水平的独立影响因素。 结果FGF23高水平组蛋白质和饮食磷摄入量高于低水平组，差异具有统计学意义（P<0.05）；高水平组血磷、iPTH水平高于低水平组，差异具有统计学意义（P<0.05）；高水平组腹膜磷清除、残肾磷清除率、总磷清除率、尿素清除指数、周肌酐清除率较低水平组更低,差异具有统计学意义（P<0.05）。亚组分析显示A组患者FGF23清除率较B组更低，差异具有统计学意义（P=0.044）。多元逐步回归分析显示血磷水平、总磷清除率、Log（iPTH水平）、残肾功能、透析龄是本研究中血清FGF23升高的独立影响因素。 结论血清FGF23更高水平的腹膜透析患者存在总磷清除率更低，饮食磷摄入和血磷水平更高的临床特征；残肾清除磷与腹膜清除磷均影响腹膜透析患者血清FGF23水平，腹膜转运功能高的腹膜透析患者具更低的腹膜FGF23清除率；血磷水平、总磷清除率、Log（iPTH水平）及残肾功能和透析龄是腹膜透析患者血清FGF23水平的独立影响因素。

Effect of serum fibroblast growth factor-23 on phosphate metabolism and related factors in peritoneal dialysis patients

ObjectiveTo evaluate the effects of serum fibroblast growth factor-23 (FGF23) on phosphate metabolism in peritoneal dialysis (PD) patients, and to identify the factors influencing serum FGF23 in PD patients. MethodsA cross-sectional study was performed in 92 patients with stable PD therapy for more than 3 months at the Chengdu Second Affiliated Hospital of Chongqing Medical University. The patients were divided into two groups according to the median serum FGF23 concentration 821 pg/ml [(476.90-1775.61) pg/ml]: low-level group (<821 pg/ml) and high-level group (≥821 pg/ml). Dietary protein, dietary phosphate, serum phosphate, peritoneal phosphate clearance, residual renal phosphate clearance, total phosphate clearance, serum parathyroid hormone (iPTH), and residual renal function (RFF) were analyzed. Based on dialysate to plasma creatinine ratio (D/Pcr), 32 patients were divided into either subgroup A (high average transport+ high transport) or subgroup B (low average transport+ low transport). ResultsDietary protein and dietary phosphate in the high-level group were significantly higher than those of the low-level group (P<0.05). Serum phosphate, iPTH, and serum calcium were also significantly higher in the high-level group (P<0.05). Peritoneal phosphate clearance, urinary phosphate clearance, total phosphate clearance, Kt/V, and weekly creatinine clearance were significantly lower in the low-level group (P<0.05). The clearance of FGF23 in subgroup A was significantly lower than that of group B (P=0.044). Multiple stepwise regression analysis indicated that serum phosphate level, total phosphate clearance, Log(iPTH), residual kidney function, and dialysis time were independent risk factors for elevated serum FGF23 (P<0.05). ConclusionPD patients with higher levels of serum FGF23 have a lower total phosphate clearance rate, higher dietary phosphate intake, and higher serum phosphate levels. Residual renal clearance of phosphate and peritoneal clearance of phosphate are related to serum FGF23. Patients with relatively high peritoneal transport function have lower peritoneal FGF23 clearance. Serum phosphate, total phosphate clearance, Log(iPTH), residual renal function, and dialysis time are independent risk factors for elevated serum FGF23 levels in PD patients.