成纤维细胞生长因子23与血液透析患者心血管疾病的关系

Relationship between fibroblast growth factor-23 and cardiovascular disease in hemodialysis patients

目的探讨成纤维细胞生长因子23(FGF-23)与血液透析患者心血管疾病的关系。方法选择维持性血液透析患者共70例为研究组,匹配21例体检者为对照组。研究组又分为心血管病变组(n=24)与非心血管病变组(n=46)。所有研究对象检测采血检测血红蛋白(Hb)、白蛋白(ALB)、肌酐(Cr)、尿素氮(BUN)、尿酸(UA)、钙(Ca)、磷(P)、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、血清全段甲状旁腺激素(iPTH)、FGF-23水平。研究组对象检测C-反应蛋白(CRP)、胱抑素C(CysC)和血浆N末端B型钠尿肽前体(NT-pro BNP)水平。采用彩色多普勒超声仪对研究组患者进行心脏超声检查,计算射血分数(LVEF)和左心室质量指数(LVMI),并比较分析。结果研究组血清Hb、ALB、Ca水平低于对照组,Cr、BUN、UA、P、iPTH、FGF-23水平高于对照组,差异均有显著性(P<0.05),两组TG、TC、HDL-C、LDL-C、FPG水平无显著差异(P>0.05)。心血管病变组FGF-23、CysC、NT-pro BNP、LVMI显著高于非心血管病变组,LVEF显著低于非心血管病变组。对血液透析患者心血管疾病发生的各种检测指标的逐步Logistic回归分析发现,只有FGF-23、NT-pro BNP和CysC进入回归方程,OR分别为3.024、2.783、2.454。结论 FGF-23与维持性血液透析患者心血管病变有着密切的联系,其在预测心血管疾病发生中的价值略优于NT-pro BNP和CysC,对观察维持性血液透析患者心血管病的发生、发展具有重要的意义。

Objective To investigate the relationship between fibroblast growth factor-23（FGF-23）and cardiovascular disease in he-modialysis patients. Methods Seventy cases of maintenance hemodialysis were collected for the study group,and 21 volunteers were matched for the control group. The study group was divided into cardiovascular disease group（n = 24）and non-cardiovascular disease group（n = 46）. Serum levels of blood hemoglobin（ Hb）,albumin（ ALB）,creatinine（ Cr）,blood urea nitrogen（ BUN）,uric acid（ UA）,calcium（ Ca）,phos-phorus（P）,triglycerides（TG）,total cholesterol（TC）,high density lipoprotein cholesterol（HDL -C）,low density lipoprotein cholesterol （LDL-C）,fasting plasma glucose（FPG）,iPTH and FGF-23 were detected in all of the subjects. Detection of C-reactive protein（CRP）, cystatin C（ CysC）and plasma N-terminal B-type natriuretic peptide precursor（ NT-pro BNP）levels were taken in the study group. Color Doppler ultrasound was used in study group to calculate left ventricular ejection fraction（ LVEF）and left ventricular mass index（ LVMI）,and comparative analysis was undertaken. Results Serum levels of Hb,ALB and Ca in the study group were significantly lower than the control group;Cr,BUN,UA,P,iPTH,and FGF-23 were significantly higher than the control group（all P 〈0. 05）. TG,TC,HDL-C,LDL-C, FPG had no significant differences in two groups（all P 〉0. 05）. FGF-23,CysC,NT-pro BNP and LVMI in cardiovascular disease group was significantly higher than non-cardiovascular disease group,and LVEF was significantly lower than non-cardiovascular disease group. On a varie-ty of indicators to detect cardiovascular disease in hemodialysis patients,stepwise logistic regression analysis showed that only FGF-23,NT-pro BNP and CysC entered the regression equation,with OR 3. 024,2. 783 and 2. 454,respectively. Conclusion FGF-23 is closely linked to car-diovascular disease in patients with maintenance hemodialysis,which is slightly better than NT-pro BNP and CysC in predicting the occurrence of cardiovascular disease and has important significance for the observation of occurrence and development of cardiovascular disease in hemodialysis patients.