成纤维细胞生长因子-23与慢性肾病患者钙磷代谢的相关性研究

目的：检测CKD3～5期患者血中成纤维细胞生长因子23（FGF-23）水平,探讨FGF-23与钙磷代谢的关系。方法：采用酶联免疫分析法（ELISA）对108例CKD3～5慢性肾脏疾病患者及20例健康志愿者进行血清全段FGF-23测定,同时测定血清25（OH）D3、iPTH、血清肌酐（Scr）、血钙（Ca2＋）、磷（P3-）、碱性磷酸酶（ALP）、血红蛋白（Hb）、白蛋白（Alb）、C反应蛋白等指标。观察各期患者以上指标的变化,及其与FGF-23的关系。结果：（1）CKD各组患者血清FGF-23水平均显著高于对照组。CKD各期FGF-23水平逐步升高,组间差异有统计学意义。（2）Pearson相关分析结果显示：非透析组血清FGF-23水平与肌酐清除率、血红蛋白、校正血钙、血磷存在显著负相关关系（P〈0.01）;与钙磷乘积、全段甲状旁腺激素（P〈0.01）和白蛋白（P〈0.05）存在直线正相关关系。透析组血清FGF-23水平与全段甲状旁腺激素及C-反应蛋白（P〈0.01）存在正相关关系。（3）非透析组多元回归结果显示：血磷、iPTH、肌酐清除率是血清FGF-23水平的独立相关因素,其回归方程为：Y（FGF-23）=1.700＋0.106（P）＋0.048（LogPTH）-0.003（Ccr）。透析组PTH、CRP是影响FGF-23的主要变量。结论：CKD患者血FGF-23明显升高,血磷和甲状旁腺激素可能是CKD患者血FGF-23水平的调节因子。

The Relationship Between Serum Level of Fibroblast Growth Factor 23 and Phosphorus and Calcium Metabolism in CKD Patients

Objective：To determine the serum level of fibroblast growth factor 23（FGF-23）in CKD patients and explore the relationship bewteen FGF-23 and phosphorus and calcium metabloism.Methods：Serum FGF-23 level was determined by enzyme-linked immunosorbent assay（ELISA）in CKD patients and twenty healthy controls.The levels of serum iPTH and 25（OH）D3 were measured by radioimmunology.At the same time,some other paremeters including serum creatinine,calcium,phosphorus,albumin,hemoglobin and c-reactive protein were measured in patients and healthy volunteers.Results：（1）The levels of serum FGF-23 in CKD group were significantly higher than that in normal controls（P0.01）.（2）In non-dialysis group,the level of serum FGF-23 by Pearson relativity analysis was significantly correlated positively with intact parathormone（r=0.619,P0.01）,calcium-phosphorus product product（r=0.533,P0.01）,albumin（r=0.312,P0.05）and c-reactive protein（r=0.306,P0.05）.The level of serum FGF-23 by Pearson relativity analysis was significantly correlated negatively with serum phosphorus（r=-0.621,P0.01）,corrected calcium（r=-0.415,P0.01）,eGFR（r=-0.602,P0.01）and hemoglobin（r=-0.628,P0.01）in non-dialysis group.In MHD group,the level of serum FGF-23 by Pearson relativity analysis was significantly correlated positively with intact parathormone（r=0.390,P0.01）and c-reactive protein（r=0.458,P0.01）.In non-dialysis group,serum phosphorus,intact parathormone and creatinine clearance rate were found to be three variables independently that influence the level of serum FGF-23 by multiple regression model.（3）The regression equation is as follow：Y（FGF-23）=1.700＋0.106（P）＋0.048（LogPTH）-0.003（Ccr）.In MHD group,intact parathormone and c-reactive protein were significant variables that influenced the level of serum FGF-23 in multiple regression model.Conclusion：FGF-23 concentrations were significantly elevated in patients with CKD group compared with control group.In non-dialysis group,Serum phosphorus,intact PTH and eGFR are the major regulators that influence FGF-23.