慢性肾脏疾病肾功能代偿期患者外周血FGF-23水平的变化及其意义

目的 研究基础疾病为原发性肾小球肾炎的慢性肾脏疾病（CKD）代偿期患者外周血成纤维细胞生长因子23（FGF23）水平的变化及其临床意义.方法 选择2011年3月至2012年8月在第三军医大学大坪医院肾内科住院的原发性肾小球肾炎患者139例为研究组和非复杂性尿路感染76例为对照组.两组患者进行以下指标检测：根据身高、体重、年龄、性别和血肌酐计算估算的肾小球滤过率（eGFR）,检测血清钙（Ca）、磷（P）、血清白蛋白、24 h尿蛋白定量,计算钙磷乘积,全段甲状旁腺激素（iPTH）,ELISA法检测外周血FGF23.结果 研究组患者血清FGF23水平显著高于对照组（P=0.003）,而血清Ca、P、iPTH处于正常水平,且与对照组血清Ca、P和iPTH比较,差异无统计学意义（P＞0.05）.对FGF23与24 h尿蛋白量、血清白蛋白、Ca、P、iPTH、eGFR的相关性分析发现,FGF23仅与24 h尿蛋白定量正相关（P＜0.05）、与血清白蛋白负相关（P＜0.05）,而与Ca、P、iPTH和eGFR均无相关性（P＞0.05）.研究组按系膜增生性肾小球肾炎（MSPGN）、膜性肾病（MN）和IgA肾病（IgAN）3个亚组分别与对照组比较,FGF23-C末端水平仍显著高于对照组,差异具有统计学意义（P＜0.05）.CKD2期较CKD1期FGF23水平升高,且差异具有统计学意义（P＜0.05）.结论 CKD肾功能代偿期患者外周血FGF23水平的升高早于Ca和P的变化,且与Ca、P和iPTH的变化无关；外周血FGF23的升高可能作为早期CKD诊断的重要指标之一,并可成为CKD进展的预警指标.

Changes of peripheral blood FGF23 level and its significance in renal compensatory stage of chronic kidney disease

Objective To research the changes of peripheral blood fibroblast growth factor 23 （FGF23） level and it＇s clinical significance in renal compensatory stage of chronic kidney disease （CKD）with primary glomerular nephritis as the basic disease.Methods A total of 139 patients with primary glomerular nephritis at CKD stage 1-2 treated in department of nephrology,Daping Hospital,Third Military Medical University from Mar.2011 to Aug.2012 were enrolled in the study as study group,and 76 patients with uncomplicated urinary tract infection were used as control group.Targets detection in the two group patients were carried out as following：glomerular filtration filter （eGFR） was calculated according to height,weight,age,gender and blood creatinine of the patient,serum calcium （Ca）,phosphor（P）,albumin and 24 hour urinary protein were detected with full automatic biochemical analyzer （Japan）,and calcium phosphorus products were calculated,in the same time,intact parathyroid hormone（iPTH） and FGF-23 levels were determined by enzyme-linked immunosorbent assay （ELISA）.Results Serum FGF23 level in study group was significantly higher than that in control group （P =0.003）,but serum levels of Ca,P and iPTH were still in the normal level,and compared with those in control group,the difference was not statistically significant（P ＞ 0.05）.Correlation analysis between FGF23 and 24 hour urinary protein,serum albumin,serum Ca,serum P,iPTH and eGFR,respectively,displayed that,only positive correlation（P ＜ 0.05） between FGF23 and 24 h proteinuria and significant negative correlation between FGF23 and serum albumin （P ＜ 0.05） were found,but there were no correlations between FGF23 and Ca,P and iPTH,respectively （P ＞ 0.05）.3 subgroups in the study group named mesangial proliferative glomerulonephritis （MSPGN）,membranous nephropathy （MN） and IgA nephropathy （IgAN） respectively compared with control group,showed that FGF23-C terminal level in each subgroup was significantly higher than that in control group（P ＜0.05）.The FGF23-C terminal level in CKD stage 2 was also found obviously increased compared with that in CKD stage 1 （P ＜ 0.05）.Conclusions Peripheral blood FGF23 levels in renal compensatory stage of CKD are elevated before the changes of Ca and P,there were no correlations between FGF23 and Ca,P and iPTH;The change of peripheral blood FGF23 level may be used as one of the important indexes of early CKD diagnosis,and can be used as the warning index to CKD advances.