高通量透析对成纤维细胞生长因子-23的影响及其临床意义

Effects of high- flux hemodialysis on fibroblast growth factor- 23 and its clinical significance

目的研究高通量血液透析（HFD）对维持性血液透析（MHD）患者成纤维细胞生长因子23（FGF．23）水平的影响及其相关的临床意义。方法60例MHD患者分为高通量血液透析（HFD）组及普通血液透析（HD）组各30例，治疗12个月。采用高分辨彩色多普勒检测两组患者治疗前后肱动脉血流介导的血管扩张功能（FMD）及心脏超声，同时检测同期患者透前的血清FGF-23、钙、磷、25（OH）D，、甲状旁腺激素（PTH）、白介素-6（IL-6）、同型半胱氨酸（Hcy）水平。观察FMD、心脏超声与各临床指标的变化情况并进行相关性分析。结果两组患者年龄、性别、原发病、透析龄等相匹配。与治疗前相比，HFD组治疗后FGF-23水平显著降低[（56．07±26．63）比（85．53±40．54）ng／L，P〈0．01】，同时IL-6[（3．37±2．48）比（5．59±2．53）ng／L，P〈0．05】、Hcy[（21．13±6．95）比（29．40±11．66）μmol／L，P〈0．05]水平降低，25（OH）D，水平升高[（27．3±10．26）比（23．15±10．73）}μg／L，P〈0．05]。HD组治疗前后各指标差异无统计学意义。HFD组治疗后FMD升高，HD组治疗前后FMD差异无统计学意义。相关性分析显示基线FMD水平与FGF．23呈负相关（r=0．413，P〈0．05），与Hey呈负相关（r=-0．301，P〈0．05）；基线LVMI与FGF．23呈正相关（r=0．464，P〈0．05）。治疗1年后HFD组FMD变化（aFMD）与FGF．23变化（aFGF．23）呈负相关（r=-0．347，P〈0．05）。结论HFD改善了MHD患者血管内皮功能，降低了心血管疾病的重要危险因素FGF．23水平，对改善患者心血管疾病的预后可能有-定的益处。HFD对MHD患者血管内皮功能的改善可能与FGF-23水平降低有关，而FGF-23对血管内皮功能的影响独立于对血磷水平的调节。

Objective To investigate the effects of high-flux hemodialysis （HFD） on fibroblast growth factor- 23 （FGF- 23） levels in maintenance hemodialysis （MHD） patients and its clinical significance. Methods Sixty uremia patients were divided into HFD group and hemodialysis （HD） group and observed for 12 months. Flow mediated dilation （FMD）, cardiac ultrasonography, levels of FGF- 23, serum phosphorus, serum calcium, 25- （OH）D3, parathyroid hormone （PTH）, homocysteine （Hcy） and interleukin-6 （IL-6） were tested in all patients before and after treatment. The correlation of above indexes were analyzed. Results No statistical difference were found in primary disease, age and duration of dialysis in two groups. The levels of FGF-23 [（56.07±26.63） vs （85.53±40.54） ng/L, P 〈 0.01], IL-6 [（3.37±2.48） vs （5.59±2.53） ng/L, P 〈 0.05] and Hcy [（21.13±6.95） vs （29.40±11.66） μmol/L,P 〈 0.05] decreased and FMD, 25-（OH）D3 [（27.3±10.26） vs （23.15±10.73） μg/L, P 〈 0.05] increased significantly after the treatment of HFD. There were no significant changes in the HD group. The baseline FMD was negatively correlated with FGF-23 （r = -0.413, P 〈 0.05） and Hcy （r = -0.301, P 〈 0.05）. The baseline LVMI was correlated with FGF-23 （r = 0.464 P 〈 0.05）. After one year＇s trearmeat of HFD, the changes of FMD（A FMD） was negatively correlated with the changes of FGF-23 （A FGF- 23）（r =-0.347, P 〈 0.05）. Conehlsions HFD can improve FMD and decrease FGF-23 levels. The improvement of FMD may be related to the decreased level of FGF-23. The effect of FGF-23 on FMD should be independent of serum phosphate.