原发性醛固酮增多症患者钙磷代谢情况及其与成纤维生长因子23相关性分析

目的比较原发性醛固酮增多症(PA)和原发性高血压(EH)患者钙磷代谢和成纤维生长因子23(FGF23)水平的差异,探讨二者的相关性。方法选择因高血压查因住院确诊的资料完整的病例,按性别、年龄、高血压水平及其病程等匹配原则纳入123例PA患者和123例EH患者,比较两组患者的钙磷代谢指标的差异并分析其与FGF23的关系。结果 (1)PA组的FGF23、PTH水平高于EH组,分别是271.31 pg/m L(173.91,504.34)vs 160.41 pg/m L(118.08,235.60)和74.5 pg/m L(46.5,91.0)vs.43.60 pg/m L(33.75,60.25),其差异具有统计学意义(P0.001),但血钙、血磷水平低于EH组(2.18±0.17 mmol/L vs.2.33±0.17 mmol/L和1.013±0.204 mmol/L vs.1.127±0.190 mmol/L,P0.001)。(2)PA组中FGF23与与血磷水平呈负相关(r=-0.502,P=0.001),与PTH水平呈正相关(r=0.349,P=0.030)。(3)PA组中随着醛固酮水平的递增,FGF23呈上升趋势(P0.05)。结论 PA患者FGF23水平显著上升,FGF23水平与血磷和PTH水平相关,且FGF23与高醛固酮水平相关。

Calcium and phosphorus metabolism in patients with primary aldosteronism and its correlation withfibroblast growth factor 23

Objective To compare calcium and phosphorus metabolism and fibroblast growth factor 23（FGF23）level in patients with primary aldosteronism（PA）and essential hypertension（EH）, and to explore the correlation between them. Methods A total of 123 cases with PA and 123 cases with EH individually matched1：1 by gender, age, blood pressure and duration of hypertension were recruited from in-hospital patients who were hospitalized because of suspicion of secondary hypertension. The differences in calcium and phosphorus metabolism as well as FGF23 were compared between two groups. Result FGF23, PTH levels were higher in PA patient than that of EH patients, 271.31（173.91, 504.34）pg/mL vs. 160.41（118.08, 235.60）pg/mL, 74.5 pg/mL（46.5, 91.0）vs. 43.60（33.75, 60.25）pg/mL, P<0.001. However the levels of serum calcium and blood phosphorus were decreased in PA group, 2.18±0.17 vs. 2.33±0.17 mmol/L and 1.013±0.204 vs. 1.127±0.190 mmol/L, all P values <0.001. In PA group, FGF23 was negatively correlated with the level of serum phosphorus（r=- 0.502, P=0.001）, which was positively correlated with the PTH level（r=0.349, P=0.030）. With the increase of aldosterone level in PA group, FGF23 showed an upward trend（P<0.05）. Conclusion The level of FGF23 was significantly elevated in PA patients, and FGF23 was correlated with serum phosphorus and PTH levels. FGF23 may be associated with high aldosterone level.