腹膜透析患者成纤维细胞生长因子23与骨代谢的关系

Association between fibroblast growth factor 23 and bone metabolism in peritoneal dialysis patients

目的探讨腹膜透析患者成纤维细胞生长因子23（FGF-23）与钙磷代谢及骨密度的关系。方法研究对象为中南大学湘雅医院持续性不卧床腹膜透析（CAPD）患者59例，按照世界卫生组织骨密度评分标准将CAPD患者分为骨质正常、骨质降低、骨质疏松3组，另设健康对照组30例。酶联免疫吸附法检测FGF-23、1，25（OH）2VitD3；免疫化学发光法检测甲状旁腺激素（PTH）；自动生化分析仪测量血钙（Ca）、磷（P）；双能X射线吸收仪测量骨密度（BMD）。结果CAPD患者股骨颈部位的骨质疏松率为23．7％，腰椎部位的骨质疏松率为35．6％。3组问FGF-23水平差异无统计学意义，但CAPD组FGF-23水平显著高于健康对照组（P〈0．01）。Pearson相关分析显示log[FGF-23]与血磷呈正相关（r=0．604，P〈0．01）；与肾小球滤过率（GFR）、1，25（OH）2VitD3呈负相关（r=-0．651，P〈0．01；r=-0．401，P〈0．05）；与PTH、Ca、T值、透析龄无相关。结论CAPD患者血FGF-23显著增高，血磷、肾功能状态、1，25（OH）2VitD3均可调节血FGF-23水平，但FGF-23与骨密度降低无直接关系。

Objective To explore the association between fibroblast growth factor 23 （FGF-23） and calcium （Ca）-phosphorus（P） metabolism and bone mineral density （BMD） in patients on peritoneal dialysis. Methods Fifty-nine patients undergoing continuous ambulatory peritoneal dialysis （CAPD） were enrolled in this study. These patients were divided into three groups as normal, osteopenic and osteoporotic, according to World Health Organization criteria based on bone mineral density T scores. Another 30 healthy people were also enrolled as control group. Levels of serum FGF-23 and 1,25 （OH）2VitD3 were measured by ELISA. Parathyroid horomone （PTH） was detected by immunoradiometric assay. Calcium and phosphorus were assessed with autobiochemistry machine. Bone density was studied by dual-energy X-ray absorptiometry （DEXA）. Results The incidences of osteoporosis at the femur neck and lumbar spine in CAPD patients were 23.7% and 35.6%, respectively. Among three groups of CADP patients, no significant differences were found in the levels of serum FGF-23, while the level of serum FGF-23 in CAPD group was higher than that in control gronp （P〈0.01）. A positive correlation was found between log [FGF-23] and serum phosphorus （r=0.604, P〈0.01）. However, a negative correlation was found between log[FGF-23] and 1,25（OH）2VitD3 and GFR （r=-0.401, P〈0.05; r=-0.651, P〈0.O1）. There were no correlations of log [FGF-23] with PTH, Ca, T scores and the duration of dialysis. Conclusions In CAPD patients, serum FGF-23 increases significantly. Serum phosphorus, renal function and 1,25（OH）zVitD3 may play an important role in adjusting the level of serum FGF-23, while FGF-23 has no direct effect on bone mineralization in CAPD patients.