维持性血液透析患者血清成纤维细胞生长因子23与血管钙化和左心室肥厚的关系

Association of serum FGF23 with the cardiovascular calcification and left ventricular hypertrophy in maintenance hemodialysis patients

目的：观察182例维持性血液透析（MHD）患者的血清成纤维细胞生长因子23（FGF23）水平、影响因素及与血管钙化和左心室肥厚（LVH）的关系. 方法：检测血清全段FGF23水平,钙、磷、全段甲状旁腺素（iPTH）、25羟维生素D及常规实验室指标,记录调节钙磷代谢的用药情况,螺旋CT检测冠脉钙化评分（CACS）,腹部侧位平片检测腹主动脉钙化评分（AACS）,心脏超声检测心脏指标. 结果：所有患者的血清FGF23水平显著升高,根据FGF23水平用四分位法将患者分为四组：组1 FGF23为77.7～1 260.8 pg/ml,组2 FGF23为1 290.9～5 934.6 pg/ml,组3 FGF23为6 969.8～27 219.7 pg/ml,组4 FGF23为27 487.3～234 869.2 pg/ml,随着组间FGF23水平升高,患者年龄更大,踝臂指数更低,血红蛋白更低,血磷更高（P＜0.05）,FGF23与血磷的相关系数为0.435（P＜0.01）.同时,血清25羟维生素D水平呈下降趋势,lgiPTH、活性维生素D的处方率、左心室质量指数（LVMI）、LVH的患病率均呈上升趋势,但无统计学差异.除了AACS≥5的患者随FGF23升高腹主动脉钙化的患病率增加外（P=0.048）,其余各组血管钙化患病率及严重程度有升高趋势,但无统计学差异. 结论：血清FGF23水平在MHD患者中明显升高,与血磷升高正相关.高FGF23水平的患者腹主动脉钙化（AACS≥5）的患病率增加,未发现血清FGF23与冠状动脉钙化、LVH患病率的相关性.

Objective： To determine the serum levels of fibroblast growth factor （FGF23） and to explore the relationships of FGF23 with vascular calcification and left ventricular hypertrophy （LVH） in patients with maintenance hemodialysis （MHD）. Methodology： A cross-sectional observation on one hundred eighty two patients with MHD was performed in this study. The serum intact FGF23, serum calcium and phosphorus, intact parathyroid hormone （iPTH）, 25 hydroxy vitamin D, and routine laboratory examination index were examined. The agents for regulating the metabolism of calcium and phosphorus were recorded. Patients undergone spiral CT to get coronary calcification score （CACS）, abdominal lateral plain film examine to get abdominal aortic calcification score （AACS） , and cardiac ultrasound examine to get cardiac indexs. Results：The levels of serum FGF23 were significantly increased in our patients with MHD. According to the levels of FGF23, the patients were divided into four groups. With the increasing levels of FGF23, the patients were older, ankle brachial index was lower, hemoglobin was lower, and serum phosphorus was higher （P 〈 0.05 ）. The correlation coefficient of serum FGF23 and serum phosphorus was 0. 435 （ P = 0. 001 ）. The levels of serum 25 （ OH ） D showed a decreasing trend, while lgiPTH, prescription of vitamin D, Left ventrieular mass index （LVMI）, the prevalence of left ventricular hypertrophy （LVH） showed an increasing trend, but the difference was not statistically significant. In addition to the patients with AACS ≥ 5, the prevalence of abdominal aortic calcification was increased with FGF23 elevation （P = 0. 048） , the prevalence and severity of vascular calcification of the other groups had a rising trend, but the difference was not statistically significant. Conclusion： The levels of serum FGF23 were increased significantly in patients with, which was related with the increasing levels of serum phosphorus. No relationships of serum FGF23 levels with coronary artery calcification and prevalence of LVH was found, except the patients with abdominal aorta calcification（ AACS ≥ 5）.