成纤维细胞生长因子23与肾脏疾病

Update on fibroblast growth factor 23 in kidney disease

成纤维细胞生长因子23(FGF23)是钙磷代谢平衡研究的热点之一。FGF23主要通过FGF受体(FGFR)及其共受体蛋白klotho作用于肾脏、甲状腺等靶器官,与甲状旁腺激素、1,25(OH)2D3、klotho蛋白之间关系密切,共同调节机体钙磷平衡。在慢性肾脏病(CKD)患者中,FGF23水平明显升高,并与进展为终末期肾病、心血管事件、死亡相关,部分归咎于FGF23通过klotho非依赖途径导致的心脏直接脱靶毒效应。临床上提出了一系列可能降低FGF23水平的措施,这些措施可能改善CKD患者预后。

FGF23 （fibroblast growth factor 23） is a hot topic in regulation of the calcium and phosphate metabolism.The classical effects of FGF23 in the kidney and parathyroid glands are mediated by its binding to FGF receptors （FGFRs） complexed to the co-receptor klotho,maintaining the calcium and phosphate homeostasis with the help of other regulators：PTH,1,25 （OH）2 D3,and klotho.C KD is a clinical condition in which FGF23 levels are most markedly elevated.Elevated FGF23 level may have an ‘ off-target＇ direct toxicity indepondent of klotho in the heart,which may in part explained observations that CKD patients with elevated FGF23 level shown independently association with progression of CKD and development of cardiovascular events and mortality.Therapeutic strategies targeting FGF23 reduction may be helpful in improving outcomes for patients with CKD.