不同阶段慢性肾脏病患者血清成纤维细胞生长因子23 与血管钙化的相关性

目的 探讨不同阶段慢性肾脏病（CKD）患者血清成纤维细胞生长因子23（FGF-23）与血管钙化的关系。方法 选取2017 年1 月—2018 年6 月天津医科大学总医院肾内科收治的CKD 患者128 例。分为CKD 1 ～ 2 期组、CKD 3 ～ 4 期组、CKD 5 期组、钙化组及无钙化组，另选取同期健康群众50 例作为对照组。比较各组的FGF-23、尿素氮（BUN）、血清肌酐（Scr）、胱抑素C（Cys C）、肾小球滤过率（GFR）、钙及磷水平，比较不同阶段的CKD 患者的钙化率。分析CKD 患者血清FGF-23 与临床相关指标的相关性，分析FGF-23 的独立影响因素。结果 CKD 5 期组的血清FGF-23、BUN、Scr、Cys C 及磷均高于其他3 组（P <0.05），GFR、钙均低于其他3 组（P <0.05）；CKD 3 ～ 4 期组的血清FGF-23、BUN、Scr、Cys C 均高于CKD 1 ～ 2 期组和对照组（P <0.05），GFR 低于CKD 1 ～ 2 期组和对照组（P <0.05）；CKD 1 ～ 2 期组的血清Scr、Cys C 高于对照组（P <0.05），GFR 低于对照组（P <0.05）。钙化组的血清FGF-23、BUN、Scr、Cys C、磷均高于无钙化组和对照组（P <0.05），GFR 低于无钙化组和对照组（P <0.05）。CKD 患者血清FGF-23 与BUN、Scr、Cys C 及磷呈正相关（P <0.05），与GFR 呈负相关（P <0.05）。经Logistic 回归分析得知，GFR[Ol ^R=0.312（95% CI ：0.200，0.487）] 和磷[Ol ^R=3.714（95% CI ：1.889，7.302）] 是血清FGF-23的影响因素（P <0.05）。结论 CKD 患者血清FGF-23 水平随临床分期增加而升高，且存在血管钙化的患者血清中FGF-23 异常升高，其水平可反映患者的血管钙化情况。

Relationship between serum FGF-23 level and vascularcalcification in patients with chronic kidney diseaseat different stages

Objective To investigate the relationship between serum fibroblast growth factor-23 (FGF-23)levels and vascular calcification in patients with chronic kidney disease (CKD) at different stages. Methods A totalof 128 patients with CKD who were treated in our hospital from January 2017 to June 2018 were enrolled. Amongthem, there were 41 cases in CKD1~2 stage group, 52 cases in CKD3~4 stage group, and 35 cases in CKD5 stagegroup, and there were 43 cases in calcification group and 85 cases in non-calcification group. The other 50 healthyvolunteers in the same period were selected as the control group. The levels of FGF-23, urea nitrogen (BUN),creatinine (Scr), cystatin C (Cys C), glomerular filtration rate (GFR), calcium and phosphorus were compared in eachgroup, and the calcification rate of CKD patients at different stages were compared. The correlation between serumFGF-23 and clinically relevant indicators in patients with CKD were analyzed. The independent influencing factorsof FGF-23 were analyzed. Results The levels of serum FGF-23, BUN, Scr, Cys C and phosphorus in the CKD5stage group were higher than those in the other three groups, and GFR and calcium were lower than the other threegroups (P < 0.05). The serum FGF-23, BUN, Scr and Cys C in the CKD3~4 stage group were higher than those inthe CKD1~2 stage group and the control group, and GFR was lower than CKD1~2 stage group and control group(P < 0.05). The levels of serum Scr and Cys C in the CKD1~2 stage group were higher than those in the controlgroup, and the GFR was lower than that in the control group (P < 0.05). The levels of serum FGF-23, BUN, Scr, CysC and phosphorus in the calcification group were higher than those in the non-calcification group and the controlgroup, and the GFR was lower than that in the non-calcification group and the control group (P < 0.05). The serumFGF-23 was positively correlated with BUN, Scr, Cys C, phosphorus in patients with CKD, and the serum FGF-23was negatively correlated with GFR (P < 0.05). Unconditional logistic multiple regression analysis showed that GFRand phosphorus were significant factors affecting serum FGF-23 (Ol ^R=0.312, 95%CI: 0.200, 0.487), (Ol ^R=3.714,95%CI: 1.889, 7.302). Conclusions The serum FGF-23 level of patients with CKD increases with clinical stage, andit is highly expressed in the serum of patients with vascular calcification, and its expression level can reflect the renalfunction status and vascular calcification of patients.