成纤维细胞生长因子23与慢性肾脏病中晚期患者冠状动脉钙化的关系

目的 探讨慢性肾脏病（CKD）中晚期患者血成纤维细胞生长因子23（FGF23）水平与冠状动脉钙化的关系。 方法 2010年4月至12月我院肾脏科病房、腹透中心、血透中心的CKD非透析（CKD 3~5期）、腹膜透析和血液透析患者共150例为对象；年龄、性别匹配的25例健康体检者为对照。收集患者临床和相关生化指标资料。采用酶联免疫法测定血清全段FGF23水平。对入选患者进行冠脉多层螺旋CT（MSCT）检查。分析FGF23水平与CKD中晚期患者冠脉钙化的关系。 结果 CKD中晚期患者血清FGF23水平显著高于健康对照组196.46（83.09，355.02） ng/L比27.17（21.63，51.20） ng/L，P < 0.01]；透析患者的FGF23水平显著高于非透析患者（P < 0.01）；血透患者的FGF23水平显著高于腹透患者6048.29 （1129.08，34807.45） ng/L比1625.80（602.83，7521.78） ng/L，P < 0.01]。CKD中晚期患者冠脉钙化发生率较高（74/130，56.9%），血清FGF23水平与冠脉钙化分数（CaS）呈正相关（r = 0.177，P < 0.05）。Logistic回归分析显示年龄（β = 0.091，OR = 1.095，P < 0.01）、透析龄（β = 2.013，OR = 7.483，P < 0.05）和FGF23水平（β = 0.838，OR = 2.311，P < 0.05）是CKD中晚期患者发生冠脉钙化的独立危险因素。冠状动脉钙化的ROC曲线显示，FGF23曲线下面积为0.705（P < 0.01），当检测的截点为786.73 ng/L时，其敏感度和特异性分别为62.5%和75.9%；碱性磷酸酶（AKP）的曲线下面积为0.626（P = 0.017），当检测的截点为79.75 U/L时，其敏感度和特异性分别为84.5%和41.5%。血磷在诊断冠脉钙化时没有统计学意义。 结论 血清FGF23水平与CKD中晚期患者冠脉钙化发生相关。FGF23作为诊断冠脉钙化的参考指标，其敏感度低于AKP，特异性优于AKP。

Association of fibroblast growth factor 23 with coronary artery calcification in patients with moderate and advanced stage chronic kidney diseases

Objective To elucidate the association of fibroblast growth factor 23 (FGF23) with coronary artery calcification in patients with moderate and advanced stage chronic kidney diseases (CKD). Methods Serum intact FGF23 levels in 150 patients with CKD stage 3 to 5 and 25 age- and sex-matched healthy controls were measured by ELISA. The association between FGF23 and coronary artery calcification was studied. Results Serum FGF23 levels in CKD patients were significantly higher than those in healthy controls 196.46 (83.09, 355.02) ng/L vs 27.17 (21.63, 51.20) ng/L, P<0.01]. The levels of FGF23 were significantly higher in dialyzed patients than those in non-dialyzed patients (P<0.01), and hemodialysis patients had higher levels as compared to peritoneal dialysis ones 6048.29 (1129.08, 34807.45) ng/L vs 1625.80 (602.83, 7521.78) ng/L, P<0.01]. The incidence of coronary artery calcification was relatively high in patients with moderate and advanced stage CKD (74/130, 56.9%). Serum FGF23 level was positively correlated with coronary artery calcification score (CaS) (r=0.177, P<0.05). Logistic regression analysis showed that age (β=0.091, OR=1.095, P<0.01), duration of dialysis (β=2.013, OR=7.483, P<0.05) and FGF23 level (β=0.838, OR=2.311, P<0.05) were independent risk factors for coronary artery calcification in patients with moderate and advanced stage CKD. ROC curve of coronary artery calcification revealed that area under curve (AUC) of FGF23 was 0.705 (P<0.01). With the cut-off value of FGF23 as 786.73 ng/L, the diagnostic sensitivity and specificity in coronary artery calcification were 62.5% and 75.9%. ROC curve of coronary artery calcification showed that AUC of alkaline phosphatase (AKP) was 0.626 (P=0.017). With the cut-off value of AKP as 79.75 U/L, the diagnostic sensitivity and specificity in coronary artery calcification were 84.5% and 41.5%. There was no diagnostic value of serum phosphorus in coronary artery calcification. Conclusions Serum FGF23 level is correlated with coronary artery calcification in patients with moderate and advanced stage CKD. The sensitivity of FGF23 is lower and the specificity is higher than those of AKP for the diagnosis of coronary artery calcification.