慢性肾脏病患者血浆成纤维细胞生长因子23与心血管疾病的关系

Circulation fibroblast growth factor 23 and cardiovascular disease in chronic kidney disease

慢性肾脏病(CKD)患者心血管并发症发生率较普通人群增高,心血管疾病(CVD)是CKD进展的重要危险因子。CKD患者的矿物质与骨代谢异常(MBD)包括血清全段甲状旁腺激素(i PTH)升高、维生素D缺乏及高磷血症等,均为CVD的独立影响因素。成纤维细胞生长因子23(FGF23)能调节体内磷和维生素D代谢水平。血浆FGF23水平在CKD患者早期即进行性升高,一方面是机体对尿毒症状态的适应性变化,另一方面也是骨病与心血管并发症等病理过程的起始因素。血浆FGF23水平与CKD患者的左心室肥厚(LVH)、血管钙化、心血管功能异常及死亡率增加相关。现将FGF23的生理特点及其与CVD的关系、介导CVD的机制等作一综述。

Patients with chronic kidney disease（ CKD） have higher risk of cardiovascular disease（ CVD）. CVD is also an important predictor of CKD progressing. Mineral and bone disorder（ MBD） in CKD patients including increased serum intact parathyroid hormone（ i PTH）,vitamin D deficiency and hyperphosphatemia are attributed as independent risk factors of CVD. FGF23 regulates phosphorus and vitamin D metabolism. Its levels increase progressively in early CKD,partially as adaptive changes to the uremic status but also as primary pathophysiological events that may account for adverse clinical manifestations including bone and cardiovascular complications. Increased plasma FGF23 is associated with left ventricular hypertrophy（ LVH）,vascular calcification,cardiovascular dysfunction,and increased mortality in CKD patients.In this review,the physiology of FGF23,association between plasma FGF23 level and CVD,the mechanism linked FGF23 to CVD,and the clinical intervention options will be discussed.