中心夜间透析和传统透析患者循环成纤维细胞生长因子23水平差异及影响因素

Difference of circulating fibroblast growth factor-23 levels between patients undergoing in-center nocturnal hemodialysis and conventional hemodialysis and the influencing factors

目的比较中心夜间血液透析(INHD)和传统血液透析(CHD)患者循环成纤维细胞生长因子23(FGF23)水平差异并探讨影响患者FGF23水平的因素。方法收集第二军医大学长征医院44例INHD及64例CHD患者空腹静脉血,测定患者钙、磷、全段甲状旁腺素(iPTH)、尿素清除指数(Kt/V)、25-羟维生素D、铁蛋白、血红蛋白、血脂、FGF23等指标并比较两组各指标的差异,采用多重线性回归分析探究FGF23的影响因素,Pearson相关性分析探究FGF23与血钙、血磷、钙磷乘积、iPTH、25-羟维生素D、Kt/V的相关性。结果 INHD患者血磷较CHD患者低(P<0.05),INHD透析充分性明显高于CHD,INHD患者循环FGF23水平低于CHD患者(P<0.05)。FGF23与钙、磷、钙磷乘积相关(P<0.01),与iPTH及Kt/V不相关。结论 INHD比CHD更能有效改善慢性肾脏病-矿物质和骨异常(CKD-MBD)参数。钙磷乘积是血液透析患者FGF23水平的独立影响因素,INHD通过减少钙磷乘积降低血清FGF23水平可能是其改善患者临床预后的机制之一。

Objective To compare the circulating fibroblast growth factor-23 （FGF23） levels between patients undergoing in-center nocturnal hemodialysis （INHD） and conventional hemodialysis （CHD）, and to explore the factors influencing the level of circulating FGF23. Methods Limosis vein blood were collected from 44 patients undergoing INHD and 64 patients undergoing CHD in Changzheng Hospital, Second Military Medical University. Serum calcium, phosphate, intact parathyroid hormone （iPTH）, urea clear index （Kt/V）, 25-hydroxy vitamin D, ferritin, hemoglobin, blood lipid, and FGF23 were measured and compared between the two groups. All the influencing factors of FGF23 were analyzed by multivariate regression analysis. The correlations between FGF23 and serum calcium, phosphate, calcium- phosphate product, iPTH, 25-hydroxy vitamin D and Kt/V were analyzed by Pearson correlation analysis. Results The levels of serum phosphate and FGF23 in patients undergoing INHD were significantly lower than that in patients undergoing CHD （P〈0. 05）. The dialysis adequacy of INHD was significantly higher than that of CHD （P〈0. 05）. Serum FGF23 was related to serum calcium, serum phosphate, and calcium-phosphate product （all P〈0. 01）, but not to iPTH or Kt/V. Conclusion INHD is more effective than CHD in improving the chronic kidney disease-mineral and parameters of bone abnormalities （CKD-MBD）. Calcium-phosphate product is an independent influencing factor of serum FGF23 in patients undergoing IHND. Reducing the serum FGF23 by decreasing calcium-phosphate product may be a mechanism of INHD to improve the clinical prognosis of patients.