慢性肾脏病患者成纤维细胞生长因子23与肾功能及钙磷代谢的关系

目的 探讨慢性肾脏病（CKD）患者随着肾功能的变化，其成纤维细胞生长因子23（FGF23）与钙磷代谢的关系。 方法 研究对象为2008年8月至2009年4月在上海交通大学附属第一人民医院肾内科住院的初诊CKD患者72例，按照肾小球滤过率（GFR）水平分为5组，另设健康对照组20例。抽取受试者静脉血并分离血清，以酶联免疫法检测FGF23、25（OH）VitD3、1，25（OH）2VitD3；全自动生化分析仪测量钙（Ca）、磷（P）、血肌酐（Scr）、尿素氮（BUN）、白蛋白（Alb）水平；免疫放射法测定全段甲状旁腺激素（iPTH）。 结果 CKD患者血清FGF23水平随GFR降低逐渐升高，在CKD4期和5期时，血FGF23、P、iPTH上升明显，1，25（OH）2VitD3显著下降，与CKD1期差异有统计学意义（均P < 0.05）。CKD2~3期与CKD1期的FGF23、P、Ca、iPTH、活性维生素D水平差异均无统计学意义。血Ca、25（OH）VitD3随着肾功能下降有降低趋势，但各期间差异均无统计学意义。Pearson相关分析显示，CKD1~5期logFGF23与P、logiPTH呈正相关（r = 0.653，P < 0.01；r = 0.800，P < 0.01），与GFR、1，25（OH）2VitD3呈负相关（r = -0.753，P < 0.01；r = -0.265，P < 0.05)，与Ca、25（OH）VitD3无相关。CKD1~3期logFGF23与logiPTH呈正相关(r = 0.374，P < 0.05)，而与Ca、P、25（OH）VitD3、1，25（OH）2VitD3、GFR均无相关。CKD4~5期log FGF23与P、logiPTH呈正相关（r = 0.381，P < 0.05；r = 0.515，P < 0.01），与GFR呈负相关（r = -0.654，P < 0.01），与Ca、25（OH）VitD3、1，25（OH）2VitD3无相关。 结论 随着肾功能减退，血清FGF23、P、iPTH水平逐渐升高，活性维生素D水平逐渐下降，尤以CKD4~5期明显。在肾脏病早期阶段（CKD1~3期）血iPTH水平与FGF23有关。当GFR<30 ml/min时，肾功能状态、血磷、血iPTH均可影响血FGF23水平。

Association of fibroblast growth factor 23 with calcium-phosphorus metabolism and renal function in patients with chronic kidney disease

Objective To study the association of fibroblast growth factor 23(FGF23)with calcium(Ca)-phosphorus(P)metabolism and renal function in patients with chronic kidney disease(CKD).Methods Serum samples of 20 healthy people and 72 CKD patients were collected.Patients were divided into five groups according to renal function.Levels of FGF23,25 (OH)VitD_3,and 1,25(OH)_2VitD_3 were measured by ELISA.Intact parathyroid hormone(iPTH)was detected by immunoradiometric assay.Scr,BUN,calcium(C),phosphorus(P)and albumin were assessed by autobiochemistry machine.Results Levels of serum FGF23,P,iPTH increased gradually and 1,25(OH)_2VitD_3 decreased with the decline of renal function,especially in stages 4-5 of CKD,whose differences were significant.Pearson correlation analysis revealed,during CKD1-5 stages,logFGF23 was correlated with P,logiPTH,GFR,1,25(OH)_2VitD_3(r=0.653,P＜0.01;r=0.800,P＜0.01;r=-0.753,P＜0.01;r=-0.265,P＜0.05).During CKD1-3 stage,logFGF23 was positively correlated with logiPTH(r=0.374,P＜0.05)and not correlated with P,GFR,1,25(OH)2VitD3.During CKD4-5 stages,logFGF23 was positively correlated with P,logiPTH(r=0.381,P＜0.05;r=0.515,P＜0.01)and negatively correlated with GFR(r=-0.654,P＜0.01).There were no correlations of logFGF23 with 25(OH)VitD_3 and Ca.Conclusions Levels of serum FGF23,P,iPTH increase and 1,25(OH)_2VitD_3 decreases with the decline of renal function,especially during CKD4-5 stages.The level of FGF23 is associated with iPTH during CKD1-3 stage.When GFR＜30 ml/min,FGF23 level is affected by renal function,phosphorus and iPTH.