成纤维细胞生长因子23与持续性非卧床腹膜透析患者腹主动脉钙化关系研究
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摘要
目的探讨成纤维细胞生长因子23(fibroblast growth factor-23,FGF23)与持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者腹主动脉钙化之间的相关性。方法收集2013-07-01—2014-03-01在中国医科大学附属第一医院及辽宁省人民医院接受腹膜透析治疗时间>3个月,病情平稳的CAPD患者58例的临床资料及血生化指标,应用酶联免疫吸附试验(ELISA)测定血清中FGF23水平,腹部侧位平片测定腹主动脉钙化(abdominal aortic calcification,AAC)评分情况,采用Pearson相关性分析方法分析FGF23与AAC评分之间的相关性,采用多元线性回归分析FGF23浓度、临床生化指标和AAC之间的关系。以腹主动脉重度钙化(AAC≥16赋值为1)作为因变量,应用Logistic回归分析方法分析CAPD患者发生腹主动脉重度钙化的危险因素。结果 58例CAPD患者中有50例发生腹主动脉钙化,钙化发生率为86.2%。血清FGF23的浓度为(157.89±46.23)ng/L。FGF23与AAC评分呈正相关(r=0.403,P<0.05),与骨特异性碱性磷酸酶(bone-specific alkaline phosphatase,BAP)呈正相关(r=0.71,P<0.05),与血磷、全段甲状旁腺素(iPTH)、血钙、25-羟维生素D无显著相关性。多元线性回归分析显示,FGF23与AAC无相关性(r=-0.47,P=0.96)。Logistic回归分析显示,血清FGF23升高是CAPD患者发生腹主动脉重度钙化的危险因素(β=0.069,OR=1.071,P<0.05)。结论血清FGF23浓度升高是CAPD患者发生腹主动脉重度钙化的危险因素。
Objective To investigate the correlation of fibroblast growth factor-23 with abdominal aortic calcification in patients undergoing continuous ambulatory peritoneal dialysis(CAPD).Methods The clinical and biochemical data of fifty-eight CAPD patients were collected.The levels of serum fibroblast growth factor-23(FGF23) were detected by ELISA.Abdomen lateral plain was used to determine the abdominal aortic calcification score(AAC),a marker of vascular calcification.The relationship between FGF23 and AAC was analyzed by Pearson analysis.The relation between the concentration of FGF23,clinical and biochemical indicators and AAC was analyzed using multiple linear regression analysis.Logistic regression analysis was used to determine the risk factors of abdominal aortic calcification in CAPD patients.Results Fifty patients(86.2%) had abdominal aortic calcification.Mean FGF23 concentration was(157.89±46.23) ng/L.FGF23,age and vitamin D were significantly different among the three groups(P <0.05).FGF23 concentration was positively correlated with AAC and BAP(r=0.403,P <0.05; r=0.71,P <0.05,respectively),but not with serum phosphorus,intact parathyroid hormone,calcium or 25-hydroxy vitamin D.Multiple linear regression analysis showed there was no correlation between FGF23 and AAC(t=-0.4,P =0.96).But multivariate logistic regression analysis showed that FGF23 was an independent risk factor for abdominal aortic calcification(β=0.069,OR=1.071,P <0.05).Conclusion About 86.2% CAPD patients have abdominal aortic calcification.Serum FGF23 level is an independent risk factor for abdominal aortic calcification in CAPD patients.
Objective To investigate the correlation of fibroblast growth factor-23 with abdominal aortic calcification in patients undergoing continuous ambulatory peritoneal dialysis(CAPD).Methods The clinical and biochemical data of fifty-eight CAPD patients were collected.The levels of serum fibroblast growth factor-23(FGF23) were detected by ELISA.Abdomen lateral plain was used to determine the abdominal aortic calcification score(AAC),a marker of vascular calcification.The relationship between FGF23 and AAC was analyzed by Pearson analysis.The relation between the concentration of FGF23,clinical and biochemical indicators and AAC was analyzed using multiple linear regression analysis.Logistic regression analysis was used to determine the risk factors of abdominal aortic calcification in CAPD patients.Results Fifty patients(86.2%) had abdominal aortic calcification.Mean FGF23 concentration was(157.89±46.23) ng/L.FGF23,age and vitamin D were significantly different among the three groups(P <0.05).FGF23 concentration was positively correlated with AAC and BAP(r=0.403,P <0.05; r=0.71,P <0.05,respectively),but not with serum phosphorus,intact parathyroid hormone,calcium or 25-hydroxy vitamin D.Multiple linear regression analysis showed there was no correlation between FGF23 and AAC(t=-0.4,P =0.96).But multivariate logistic regression analysis showed that FGF23 was an independent risk factor for abdominal aortic calcification(β=0.069,OR=1.071,P <0.05).Conclusion About 86.2% CAPD patients have abdominal aortic calcification.Serum FGF23 level is an independent risk factor for abdominal aortic calcification in CAPD patients.
引文
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[2]Nasrallah MM,El-Shehaby AR,Osman NA,et al.The Association between Fibroblast Growth Factor-23 and Vascular Calcification Is Mitigated by Inflammation Markers[J].Nephron Extra,2013,3(1):106-112..
[3]Kwon HY,Lee OH,Kim MJ,et al.The association between mortality and abdominal aortic calcification and relation between its progression and serum calcium concentration in chronic hemodialysis patients[J].Kidney Res Clin Pract,2014,33(2):95-102.
[4]Kraus MA,Kalra PA,Hunter J,et al.The prevalence of vascular calcification in patients with end-stage renal disease on hemodialysis:a cross-sectional observational study[J].Ther Adv Chronic Dis,2015,6(3):84-96.
[5]王质刚.血液透析热点荟萃——终末期糖尿病肾病血液透析并发症的防治[J].中国实用内科杂志,2007,22:1742-1744.
[6]蔡宏,严玉澄,陆任华,等.腹主动脉钙化评分可预估血液透析患者的冠状动脉钙化程度[J].中国血液净化,2013,12:189-194.
[7]Tsuchiya K,Nagano N,Nitta K.Klotho/FGF23 Axis in CKD[J].Contrib Nephrol,2015,185:56-65.
[8]梁剑波,温德良,江丽屏,等.腹膜透析患者心血管病死亡与钙磷代谢关系的回顾性分析[J].中国实用内科杂志,2008,28(S1):103-104.
[9]Jean G,Terrat JC,Vanel T,et al.High levels of serum fibroblast growth factor(FGF)-23 are associated with increased mortality in long haemodialysis patients[J].Nephrol Dial Transplant,2009,24(9):2792-2796.
[10]Wesseling-Perry K,Jüppner H.The osteocyte in CKD:new concepts regarding the role of FGF23 in mineral metabolism and systemic complications[J].Bone,2013,54(2):222-229.