成纤维细胞生长因子23在血液透析患者磷和维生素D代谢中的作用

目的 探讨成纤维细胞生长因子23（FGF-23）在维持性血液透析（MHD）患者磷和维生素D代谢中的作用及相关调控机制。 方法 采用酶联免疫分析法（ELISA）对59例MHD患者（血透组）及20例健康志愿者（对照组）进行血清全段FGF-23测定，同时应用放免法测定血清1，25-二羟维生素D（1,25(OH)2VitD）水平。血透组患者测定血清白蛋白（Alb）、血红蛋白（Hb）、血肌酐（Scr）、尿素氮（BUN）、钙（Ca）、磷（P）及全段甲状旁腺激素（iPTH）等指标。 结果 血透组血清FGF-23水平明显高于对照组[（215.23±123.55）比（28.72±11.49） ng/L，P < 0.01]，而血清1,25(OH)2VitD水平明显低于对照组[（13.25±8.73）比（42.24±12.45） μg/L，P < 0.01]。Pearson相关分析显示，血透组血清FGF-23水平与血清P、Scr、Ca、iPTH及透析疗程时间呈正相关（P < 0.05）；与血清1,25(OH)2VitD水平和年龄呈负相关（P < 0.05）；而与性别、血压、血清Alb、Hb、BUN等指标无相关。多元回归分析显示，血清P、Ca、Scr、iPTH和1,25(OH)2VitD是影响血清FGF-23的主要变量，5者组成的模型解释了总变异的约62%（R2=0.623，P < 0.01）。 结论 MHD患者血清全段FGF-23水平明显增高，而1,25(OH)2VitD水平明显降低。FGF-23的调控是由复杂的多种因素共同作用的结果，血清P、Ca、Scr、iPTH和1,25(OH)2VitD是影响血清FGF-23水平的主要调控因子。

Role of fibroblast growth factor-23 in phosphorus and vitamin D metabolism of maintenance hemodialysis patients

Objective To explore the role of fibroblast growth factor-23（FGF-23） in phosphorus and vitamin D metabolism of maintenance hemodialysis (MHD) patients. Methods Intact FGF-23 serum level was detected by enzyme-linked immunosorbent assay (ELISA) in 59 MHD patients (MHD group) and twenty healthy people (control group). The level of serum 1, 25-dihydroxy vitamin D [1,25(OH)2VitD] was measured by radioimmunology. At the same time, some other parameters including serum albumin, hemoglobin, creatinine, urea nitrogen, calcium, phosphorus and intact PTH were measured in MHD patients. Results Serum FGF-23 was significantly higher in MHD group than that in control group [(215.23±123.55） vs （28.72±11.49） ng/L, P<0.01]. Moreover, the level of serum 1,25(OH)2VitD was remarkably lower in MHD patients than that in control group [（13.25±8.73） vs（42.24±12.45） μg/L, P<0.01]. By Pearson relativity analysis, serum FGF-23 level was positively correlated with serum phosphorus, calcium, creatinine, intact PTH and duration of hemodialysis (all P<0.05). FGF-23 level was also negatively correlated with age and 1,25(OH)2VitD (P<0.05). No correlations of FGF-23 with gender, blood pressure, albumin, hemoglobin and urea nitrogen were found. Serum phosphorus, calcium, creatinine, intact PTH and 1, 25(OH)2VitD were found to be five independent variables that influenced FGF-23 serum level by multiple regression model. The model accounted for 62% of total variance. (R2= 0.623，P< 0.01). Conclusions The level of serum FGF-23 is significantly higher in MHD patients. Serum phosphorus, calcium, creatinine, intact PTH and 1,25(OH)2VitD are the major regulators that influence FGF-23.