慢性肾脏病患者血清成纤维细胞生长因子23与肾功能及钙磷代谢的关系

目的 了解慢性肾脏病(CKD)患者不同分期血中成纤维细胞生长因子23(FGF-23)的变化,探讨FGF-23与CKD患者肾功能及钙磷代谢的关系。方法 选择CKD患者124例,健康对照组32例,测定患者的血清FGF-23、血钙、血磷、甲状旁腺激素(iPTH)、血清尿素氮(BUN)和肌酐(SCr),按照CKD-EPI公式计算肾小球滤过率(eGFR),分析FGF-23与肾功能及钙磷代谢的关系。结果 CKD患者血FGF-23水平较对照组显著升高(P<0.01)。随着肾功能减退,CKD患者血FGF-23和iPTH水平逐渐增高,在CKD3～4期与对照组比较差异有统计学意义(均P<0.01),在CKD5期明显高于对照组、CKD1～2期、CKD3～4期。随着肾功能减退血钙水平逐渐降低、血磷水平逐渐增高,CKD患者在CKD5期与对照组、CKD1～2期、CKD3～4期比较差异有显著统计学意义(均P<0.01)。相关分析显示,LogFGF-23与血磷、LogiPTH、BUN、SCr呈正相关,与eGFR呈负相关。多元线性回归表明,FGF-23与CKD患者BUN、SCr呈正相关。结论 CKD患者血清FGF-23在CKD3～4期就显著增高,变化早于血磷的增高。肾功能状态、血磷、iPTH与FGF-23相关。肾功能状态可能是CKD患者血FGF-23升高的主要影响因素。

Association of fibroblast growth factor 23 with renal function and calcium-phosphorus metabolism in patients with chronic kidney disease

Objective To investigate the change of fibroblast growth factor 23(FGF-23) in patients with different stages of chronic kidney disease(CKD); To analyze the association of FGF-23 with renal function and calcium-phosphorus metabolism.Methods A total of 124 CKD patients were selected, and 32 healthy people were studied as control group. The levels of FGF-23, serum calcium, serum phosphorus, intact parathyroid hormone(iPTH),blood urea nitrogen(BUN) and serum creatinine(SCr) were measured in all subjects. The glomerular filtration rate(eGFR) was estimated according to CKD-EPI formula. The association of FGF-23 with renal function and calcium-phosphorus metabolism were analyzed.Results The serum FGF-23 in CKD patients increased more significantly than that in control group(P<0.01). The levels of serum FGF-23 and iPTH increased gradually with the decline of renal function. There were significant difference in FGF-23 and iPTH between CKD3-4 stages and control group (all P<0.01). The levels of serum FGF-23 and iPTH in CKD 5 stage increased more significantly than those in control group,CKD1-2 stages and CKD3-4 stages. With the decline of renal function,the level of serum calcium reduced gradually in CKD patients, serum phosphorus increased gradually in CKD patients. There were significant difference in serum calcium, serum phosphorus between CKD5 stage and control group,CKD1-2 stages,CKD3-4 stages (all P<0.01).The correlations showed that LogFGF-23 was positively correlated with serum phosphorus, LogiPTH, BUN and SCr.FGF-23 was negatively correlated with eGFR. Multiple linear regression analysis indicated that FGF-23 was positively correlated with BUN and SCr.Conclusion Serum FGF-23 increases significantly in CKD3-4 stages. FGF-23 increases earlier than serum phosphorus. FGF-23 is correlated significantly with renal function, serum phosphorus and iPTH. Renal function is an independent influence factor for FGF-23 increase in CKD patients.