维持性血液透析患者成纤维细胞生长因子23影响因素探讨

Factors related to the higher serum fibroblast growth factor 23 in maintenance hemodialysis patients

目的检测维持性血液透析(MHD)患者血中成纤维细胞生长因子23(FGF-23)水平,探讨血磷、血钙、甲状旁腺激素及1,25(OH)_2D_3等对FGF-23的影响。方法选择北京市海淀医院MHD患者98例,对照组肾小球过滤率正常共28例,MHD患者根据血磷水平分为低磷组、血磷达标组和高磷组,酶联免疫吸附法测定血中1,25(OH)_2D_3及FGF-23的水平,测定对照组及MHD患者血中碱性磷酸酶、钙、磷水平,同时测定MHD患者全段甲状旁腺激素。结果MHD组血清1,25(OH)_2D_3低于对照组(P<0.001),FGF- 23高于对照组(P<0.001):低磷组、血磷达标组和高磷组FGF-23水平无统计学差别(P=0.804),高磷组甲状旁腺激素明显高于低磷组及血磷达标组(P=0.001,0.010):多元回归分析显示1,25(OH)_2D_3,是MHD患者FGF-23的影响因素(r=0.481,P<0.001)。结论MHD患者血中FGF-23水平明显升高,1,25(OH) _2D_3为MHD患者FGF-23升高的影响因素,血磷不是维持性血液透析患者FGF-23升高的主要影响因素。

Objective We examined serum calcium, phosphate, intact parathyroid hormone and 1,25（OH） 2-D3 as well as serum fibroblast growth factor 23 （FGF-23）, and investigated whether these factors influence serum FGF-23 in maintenance （MHD） hemodialysis patients. Methods We recruited 98 MHD patients and 28 controls with normal renal function in this study. Their serum alkaline phosphatase, calcium, phosphate and intact parathyroid hormone were determined, and their serum 1,25（OH）2-D3 and FGF-23 were measured by ELISA. We then divided the MHD patients into 3 groups： hypophosphatemia group, normal serum phosphate group and hyperphosphatemia group. Results In MHD patients, serum 1,25（OH）2-D3 was lower than that of control group （P 〈0.001）, but FGF-23 was significantly higher than that of control group （P 〈0.001）. Serum FGF-23 had no significant differences among hypophosphatemia group, normal serum phosphate group and hyperphosphatemia group （P = 0.804）. Multiple linear regression analysis revealed that serum 1,25（OH）2-D3 was the factor that influences serum FGF-23 in MHD patients （r =0.481, P 〈0.001 ）. Conclusions In MHD patients, serum FGF-23 increases significantly, and serum 1,25（OH）2-D3 is the factor relating to the increase of serum FGF-23. However, serum phosphate seems to have no impact on the increase of serum FGF-23 in MHD patients.