成纤维细胞生长因子-23与慢性肾脏病非透析患者左心室肥厚的关系

The relation between fibroblast growth factor 23 and left ventricular hypertrophy in non dialysis patients with chronic kidney disease

目的：探讨慢性肾脏病（CKD）患者血清成纤维细胞生长因子（FGF）-23与左心室肥厚的关系。方法入选CKD非透析患者124例，其中CKD 1～2期34例（CKD 1～2期组），3～4期50例（CKD 3～4期组），5期40例（CKD 5期组）；另选取健康体检者32例作为对照组。测定血清FGF-23、尿素氮、肌酐、钙、磷、全段甲状旁腺素（iPTH）、血红蛋白；心脏彩超测定左心室舒张末期内径（LVDd）、室间隔厚度（IVST）、左室后壁厚度（LVPWT）、左心室射血分数（LVEF）。根据Devereux校正公式计算左心室质量指数（LVMI），LVMI男≥125 g/m2，女≥110 g/m2可诊断为左心室肥厚。分析FGF-23与左心室肥厚的关系。结果 CKD患者中左心室肥厚46例（肥厚组），左心室不肥厚78例（非肥厚组），CKD患者左心室肥厚发生率为37.1%（46/124）。肥厚组lgFGF-23、lgiPTH、磷明显高于非肥厚组[1.69±0.33比1.50±0.27、1.98±0.45比1.74±0.32、（1.50±0.59） mmol/L比（1.27±0.39）mmol/L]，钙、白蛋白、血红蛋白和LVEF明显低于非肥厚组[（2.06±0.24） mmol/L 比（2.17±0.20）mmol/L、（35.76±4.18）g/L 比（39.74±5.73）g/L、（96.65±22.66）g/L 比（117.15±27.67）g/L、（59.62±12.02）%比（67.76±6.69）%]，差异有统计学意义（P＜0.01或＜0.05）；肥厚组与非肥厚组收缩压和舒张压比较差异无统计学意义（P＞0.05）。CKD 1～2期组、CKD 3～4期组、CKD 5期组左心室肥厚发生率和LVMI明显高于对照组[11.8%（4/34）、36.0%（18/50）、60.0%（24/40）比3.1%（1/32），（91.18±16.17）、（111.25±27.89）、（124.82±24.80）g/m2比（84.41±13.77）g/m2]，CKD 3～4期组、CKD 5期组明显高于CKD 1～2期组，CKD 5期组明显高于CKD 3～4期组，差异有统计学意义（P＜0.01或＜0.05）。CKD患者LVMI与lgFGF-23、lgiPTH、高血压病史呈正相关（r＝0.297、0.327、0.229，P＝0.019、0.009、0.026），与钙、血红蛋白、LVEF呈负相关（r＝-0.280、-0.432、-0.432，P＝0.028、0.000、0.000），与磷、收缩压、舒张压、性别、年龄无相关性（P＞0.05）。多元线性回归分析结果显示，LVMI（Y）与血红蛋白（X1）和LVEF（X2）呈负相关，回归方程：Y＝255.201-0.424 X1-1.092 X2。结论 CKD非透析患者随着肾功能减退，左心室肥厚发生率逐渐增高。CKD非透析患者FGF-23与左心室肥厚、LVMI升高相关，且与心力衰竭严重程度相关。贫血和心功能状态与CKD非透析患者左心室肥厚密切相关。

Objective To investigate the relation between serum level of fibroblast growth factor （FGF）-23 and left ventricular hypertrophy in non dialysis patients with chronic kidney disease （CKD）. Methods One hundred and twenty-four non dialysis patients with CKD were selected. Among them 34 cases were CKD 1-2 stage （CKD 1-2 stage group）, 50 cases were CKD 3-4 stage （CKD 3-4 stage group）, and 40 cases were CKD 5 stage （CKD 5 stage group）. Thirty-two subjects of healthy people were selected as control group. The serum FGF-23, urea nitrogen, creatinine, calcium, phosphorus, intact＆amp;nbsp;parathyroid hormone （iPTH） and hemoglobulin levels were measured. The cardiac structural parameters were assessed by Doppler echocardiography, which included left ventricular end-diastolic diameter （LVDd）, interventricular septum thickness （IVST）, left ventricular posterior wall thickness （LVPWT） and left ventricular ejection fraction （LVEF）. Left ventricular mass index （LVMI） was calculated by Devereux formula. The patients were diagnosed as left ventricular hypertrophy according to LVMI （male ≥ 125 g/m2, female ≥ 110 g/m2）. The relation between FGF-23 and left ventricular hypertrophy was analyzed. Results Among the patients with CKD, left ventricular hypertrophy was in 46 cases （hypertrophy group）, non left ventricular hypertrophy was in 78 cases （hypertrophy group）, and the incidence of left ventricular hypertrophy in patients with CKD was 37.1% （46/124）. The lgFGF- 23, lgiPTH and phosphorus levels in hypertrophy group were significantly higher than those in non hypertrophy group：1.69 ± 0.33 vs. 1.50 ± 0.27, 1.98 ± 0.45 vs. 1.74 ± 0.32 and （1.50 ± 0.59） mmol/L vs. （1.27 ± 0.39） mmol/L, the calcium, albumin, hemoglobulin and LVEF levels were significantly lower than those in non hypertrophy group：（2.06 ± 0.24） mmol/L vs. （2.17 ± 0.20） mmol/L, （35.76 ± 4.18） g/L vs. （39.74 ± 5.73） g/L, （96.65 ± 22.66） g/L vs. （117.15 ± 27.67） g/L and （59.62 ± 12.02）%vs. （67.76 ± 6.69）%, and there were statistical differences （P〈0.01 or〈0.05）. There were no statistical differences in systolic blood pressure and diastolic blood pressure between hypertrophy group and non hypertrophy group （P〉0.05）. The incidences of left ventricular hypertrophy and LVMI in CKD 1-2 stage group, CKD 3-4 stage group and CKD 5 stage group were significantly higher than those in control group：11.8%（4/34）, 36.0%（18/50） and 60.0% （24/40） vs. 3.1% （1/32）, （91.18 ± 16.17）, （111.25 ± 27.89） and （124.82 ± 24.80） g/m2 vs. （84.41 ± 13.77） g/m2, those indexes in CKD 3-4 stage group, CKD 5 stage group were significantly higher those in CKD 1-2 stage group, and those indexes in CKD 5 stage group were significantly higher than those in CKD 3-4 stage group, and there were statistical differences （P〈0.01 or〈0.05）. The LVMI was positively correlated with lgFGF-23, lgiPTH and history of hypertension in CKD patients （r=0.297, 0.327 and 0.229; P = 0.019, 0.009 and 0.026）. The LVMI had negative correlation with calcium, hemoglobulin and LVEF （r=-0.280,-0.432 and-0.432;P=0.028, 0.000 and 0.000）. The LVMI had no correlation with phosphorus, systolic blood pressure, diastolic blood pressure, gender and age （P〉0.05）. Multiple linear regression analysis result showed that LVMI （Y） was negatively correlated with hemoglobulin （X1） and LVEF （X2）, and the regression equation was Y = 255.201- 0.424 X1- 1.092 X2. Conclusions The incidence of left ventricular hypertrophy increases gradually with the decline of renal function in non dialysis patients with CKD. The serum level of FGF-23 is related to left ventricular hypertrophy and the degree of heart failure in non dialysis patients with CKD. Anemia and cardiac function state are closely related to left ventricular hypertrophy in non dialysis patients with CKD.