慢性肾脏病患者血清Klotho水平及其与肾功能关系初探

目的 检测慢性肾脏病（CKD）3～5期患者血清Klotho水平,探讨其与肾功能进展的关系.方法 选择29例CKD 3～5期患者（CKD组）,年龄匹配的非CKD患者10例（对照组）,采用酶联免疫吸附技术测定血清Klotho和成纤维生长因子23 （FGF23）水平.结果 对照组血清Klotho水平为（1 125.50±126.96） ng/L,CKD组为（670.07±146.22） ng/L,两组比较差异有统计学意义（P＜0.01）.对照组血清FGF23水平为（10.48±8.93） ng/L,CKD组为（48.89±44.28） ng/L,两组比较差异有统计学意义（P＜0.01）.Pearson相关分析显示,CKD患者血清Klotho水平与估计的肾小球滤过率（eGFR）和血红蛋白呈正相关,与log尿素氮、log肌酐、log FGF23以及血磷呈负相关.多元逐步回归分析显示log FGF23和血磷是影响CKD患者血清Klotho水平的独立因素.根据eGFR每年下降率将CKD患者分为肾功能快速进展组（10例）和肾功能稳定组（19例）.肾功能快速进展组血清Klotho水平更低（580.27±162.15）ng/L比（717.33±115.22）ng/L],血尿酸和尿蛋白水平更高（448.00±65.21） mmol/L比（368.32±78.80） mmol/L、（1.99±1.57） g/d比（0.60±1.00） g/d],差异均有统计学意义（P＜0.05）.结论 CKD 3～5期患者血清Klotho水平随肾功能下降而降低,血磷和FGF23是其独立影响因素.血清Klotho可能成为预测CKD患者肾功能进展的指标.

The level of serum Klotho in patients with chronic kidney disease and its relationship with renal function

Objective To detect the level of serum Klotho in chronic kidney disease （CKD） 3-5 stage patients and explore its relationship with the progress of renal function.Methods Twenty-nine patients with CKD 3-5 stage （CKD group） and 10 cases of age-matched non-CKD patients （control group） were enrolled in the study.The level of serum Klotho and fibroblast growth factor 23 （FGF23） were measured by enzyme-linked immunosorbent assay.Results The level of serum Klotho in CKD group was significantly lower than that in control group （670.07 ± 146.22） ng/L vs.（1 125.50 ± 126.96） ng/L] （P 〈 0.01）.The level of serum FGF23 in CKD group was significantly higher than that in control group（48.89 ± 44.28） ng/L vs.（10.48 ± 8.93） ng/L] （P 〈 0.01）.Pearson correlation analysis showed that the level of Klotho in CKD patients was positively correlated with estimated glomerular filtration rate （eGFR） and hemoglobin,and Klotho was negatively correlated with log urea nitrogen,log serum creatinine,log FGF23 and phosphate.Multiple regression analysis showed that log FGF23 and serum phosphorus were independent factors for serum Klotho level in patients with CKD.CKD patients were divided into rapid progression of renal function group （10 cases） and renal stability group （19 cases） according to annual rate of eGFR dechne.The patients in rapid progression of renal function group with lower serum Klotho （580.27 ± 162.15） ng/L vs.（717.33 ± 115.22） ng/L],higher uric acid and more severe proteinuria （448.00 ±65.21） mmol/L vs.（368.32 ±78.80） mmol/L,（1.99 ± 1.57） g/d vs.（0.60 ± 1.00） g/d] （P 〈0.05）.Conclusions Serum Klotho level of CKD 3-5 stage patients decreases with the decline in renal function.Serum phosphate and FGF23 are the independent factors for serum Klotho.Serum Klotho may become the prediction index of renal function progress for patients with CKD.