血液透析患者成纤维细胞生长因子23与左室肥厚的相关性研究

【摘要】目的观察维持性血液透析（nlaintenancehemodialysis，MHD）患者血中成纤维细胞生长因子23（fibroblastgrowthfactor23，FGF23）水平，探讨MIlD患者FOF23的水平及其与左室肥厚之间的关系。方法选取首都医科大学附属复兴医院稳定的MHD患者40例，健康对照20例。应用酶联免疫分析法测定血清FGF23和1，25二羟活性维生素D，（1，25-（0H）2D3）水平，同时测定血清甲状旁腺激素（iPTH）、血钙（Ca2＋）、磷（P^3-）、碱性磷酸酶（ALP）、白蛋白（ALB）等指标。所有患者进行超声心动检测，根据Devereux公式计算左室质量指数（LVMI），根据LVMI值将透析患者分为左室肥厚组及非肥厚组。结果①透析组与对照组血清LogPTtt分别为2．45±0．30与1．66±0．19（P=0．000）、LogFGF23分别为2．76±0．56与1．49±0．08（P=-0．000），差异均有统计学意义，透析组Logl，25-（OH）2D3水平（1．21±0．33）显著低于对照组（1．85±0．28），差异有统计学意义（P=0．000）。②左室肥厚组与非肥厚组LogPTH分别为2．56±0．21与2．41±0．14（P=0．028）、LogFGF23分别为2．94±0．46与2．44±0．53（P=0．006），差异有统计学意义。⑨LVMI与收缩压（r=0．507，P=O．002）、舒张压（r=0．385，P=0．022）、LogFGF23（r=0．415，P=0．013）、LogALP（r=0．367，P=0．030）呈正相关。④逐步多元线性回归分析显示，收缩压（伊0．440，P=0．002）、LogFGF23（β=0．396，P=0．004）和LogALP（β=0．270，P=0．049）是影响左室肥厚的独立影响因素。结论MHD患者血清FGF23明显升高，且FGF23升高和左室肥厚密切相关。

The relationship between serum level of fibroblast growth factor 23 and left ventricular hypertrophy in hemodialysis patients

Objective To determine serum level of fibroblast growth factor 23 （FGF23） in maintenance hemodialysis （MHD） patients, and to explore the relationship between FGF23 and left ventricular hypertrophy （LVH）. Methods Forty MHD patients （patient group） and twenty healthy people with normal renal function （control group） were enrolled in this study. Serum phosphate, calcium and alkaline phosphatase were determined. Serum FGF23 and 1,25-dihydroxycholecalciferol （1,25-（OH）zDa） were determined by ELISA. The MHD pa- tients were further divided into LVH group and non-LVH group according to LVMI. Results @ In the MHD group and control group, LogPTH was 2.45i-0.30 and 1.66=t=0.19 （P =0.000）, respectively, LogFGF23 was 2. 76=t=0.56 and 1.49~0.08 （P =0.000）, respectively, and Log 1,25-（OH）2D3 was 1.21~0.33 and 1.85~-0.28 （P=0. 000）, respectively; （Z） In the LVH group and non-LVH group, LogPTH was 2,56＋0.21 and 2.41＋0.14 （P 〈 0. 05）, respectively, and LogFGF2 was 2.94~0.46 and 2.444-0.53 （P〈0.01）, respectively; @ LVMI was positively correlated with LogFGF23 （r= 0.415, P=-0.013）, LogALP （t=0.367, P=-0.030）, systolic pressure （r=0.507, P=0. 002） and diastolic pressure （r= 0.385, P=-0.022）; @ Multiple linear regression analysis revealed that LogFGF23 （β=0.396, P=-0.004）, LogALP （fl= -0.270, P=-0.049） and systolic pressure （,8=0.440, P=0.002） were the independent factors influencing LVH in MHD patients. Conclusion In MHD patients, serum FGF23 is signifi- cantly increased, and the increase of FGF23 is closely related to LVH.