成纤维细胞生长因子23与慢性肾脏病钙磷代谢相关性研究

Correlation of fibroblast growth factor 23 with calcium and phosphorus metabolism in patients with chronic kidney disease

目的研究血清钙(Ca)、磷(P)、甲状旁腺激素(iPTH)、1,25(OH)2D3以及肾功能与成纤维细胞生长因子23(FGF23)的关系。方法将2009年9月至2010年2月中国医科大学附属第一医院住院的慢性肾脏病(CKD)患者58例分为3组,另设对照组20例。采用免疫酶联吸附(ELISA)法测定FGF23及1,25(OH)2D3浓度。全自动生化分析仪测定血清Ca、P、肌酐(Scr)、尿素氮(BUN)浓度,化学免疫发光法测定全段iPTH。结果 FGF23在CKD血清中的质量浓度均高于健康对照组,且随肾小球滤过率(GFR)的降低逐渐升高,在CKD 4,5期FGF23升高明显,与CKD 3期比较差异有统计学意义(P<0.05),1,25(OH)2D3显著下降,与对照组差异有统计学意义(P<0.01)。随着GFR的降低,血清Scr、P、iPTH逐渐升高。Pearson相关分析显示,CKD 3～5期logFGF23与logiPTH、Scr、P呈正相关(r=0.516,P<0.01;r=0.397,P<0.01;r=0.344,P<0.01),与GFR,1,25(OH)2D3呈负相关(r=-0.491,P<0.01;r=-0.413,P<0.01)。结论血清FGF23、iPTH、P随着GFR降低逐渐升高,1,25(OH)2D3逐渐降低,尤以CKD 4～5期明显。当GFR<30时FGF23质量浓度与GFR、血清iPTH、P、1,25(OH)2D3等因素有关。

Objective To evaluate the effects of serum calcium, phosphorus, parathyroid hormone 1,25 （OH） 2 D3 and kidney function on fibroblast growth factor 23 （FGF23）. Methods 58 cases with chronic kidney disease （CKD） registered to Division of Nephrology,the First Affiliated Hospital of China Medical University be- tween September 2009 and February 2010 were enrolled and divided into 3 groups according to their glomerular filtration rate. Another 20 healthy subjects were recruited as controls. Serum samples obtained from all subjects were determined for concentrations of FGF23, parathyroid hormone 1,25 （OH）2 D3 by ELISA, for serum levels of calcium （Ca）, phosphorus （P）, Scr and BUN by automatic biochemistry analyzer, and for intact parathyroid hor- mone （iPTH） by chemiluminescence immunoassay. Results Concentration of serum FGF23 was higher in patients with chronic kidney disease patients than in healthy controls, and was noted to increase along with lower glomerular filtration rate with a significantly higher level in stages 4 and 5 compared with the findings in stage 3 CKD. The level of 1,25（OH）2D3 in CKD patients was significantly lower than that in the controls （P 〈0. 001 ）. The serum levels Scr, P and iPTH increased along with lower glomerular filtration rate. Pearson correlation analysis revealed that logFGF23 in stages 3 -5 CKD was positively correlated with logiFFH, Scr and P （r = 0. 516, P 〈0. 01 ;r =0. 379, P 〈0. 01 ; r = 0. 344, P 〈 0.01 ） but negatively correlated with GFR, 1,25 （ OH）2D3 （ r = -0.491,P〈0. 01;r= -0.413,P〈0.01）. Conclusion Levels of serum FGF23,iPTH and P increase and 1, 25 （OH）2D3 decreases with the decline of GFR,especially in stages 4 - 5 CKD. Given a GFR below 30 ,the level of FGF23 is correlated with GFR,iPTH,P and [ ,25（OH）2D3.