血浆成纤维细胞生长因子23和B型利钠肽水平与肾移植后骨质疏松的关系

Association of plasma fibroblast growth factor 23 and B type natriuretic peptide levels with osteoporosis after renal transplantation

目的探讨血浆成纤维细胞生长因子23(FGF-23)和B型利钠肽(BNP)水平与肾移植后骨质疏松的关系,为肾移植后骨质疏松的防治提供参考。方法采用回顾性研究方法,选取2011年1月至2012年10月在广州军区广州总医院已行首次肾移植治疗、且术后3年移植肾功能正常的患者45例为研究组,并以同期基线资料匹配的健康查体志愿者30例为对照组。回溯性比较两组血浆FGF-23、BNP水平。计算研究组患者术后随访1年时的骨质疏松发生率,比较有无骨质疏松患者的血浆FGF-23、BNP水平,分析血浆FGF-23、BNP水平与骨质疏松发生率的关系及其对肾移植后骨质疏松发生的预测价值。结果与对照组比较,研究组肾移植术前血浆FGF-23、BNP水平均升高(P均<0.01)。与术前比较,研究组术后1年的血浆FGF-23、BNP水平均降低(P均<0.01)。研究组随访1年时骨质疏松发生率为35.56%。与无骨质疏松患者比较,研究组有骨质疏松患者围术期血浆FGF-23、BNP水平均升高(P均<0.01)。Spearman无条件相关分析结果显示,研究组血浆FGF-23、BNP水平与其肾移植术后骨质疏松发生率均呈正相关(r=0.896,P<0.05;r=0.844,P<0.05)。受试者工作特征曲线(ROC曲线)分析结果显示,研究组围术期血浆FGF-23、BNP水平预测其肾移植术后骨质疏松发生的敏感度、特异度和准确性良好,其中以术后1年时两个指标联合预测的敏感度(93.75%)、特异度(89.66%)和准确性(91.11%)最高。结论血浆FGF-23、BNP水平与肾移植术治疗患者术后骨质疏松均密切相关,且对其术后骨质疏松的预测价值良好。

Objective To investigate the association of plasma fibroblast growth factor 23 （FGF-23） and B type natriuretic peptide （BNP） levels with osteoporosis after renal transplantation to provide a basis for the prevention and treatment of osteoporosis after renal transplantation. Methods Using a retrospective study method, 45 patients who received the primary renal transplantation in General Hospital of PLA Guangzhou Military Command between January 2011 and October 2012 and had normal transplanted kidney functions 3 years after operation were selected as study group. Thirty healthy volunteers with matched baseline data at the same time were served as control group. The levels of plasma FGF-23 and BNP were retrospectively compared between two groups. The patients in study group were followed for one year to compute the incidence of osteoporosis. The plasma levels of FGF-23 and BNP were compared in patients with osteoporosis and without osteoporosis. The relationship between plasma FGF-23, BNP levels and the incidence of osteoporosis and their predictive values for the occurrence of osteoporosis after renal transplantation were analyzed. Results Compared with control group, the levels of plasma FGF-23 and BNP before renal transplantation significantly increased in study group （all P 〈0.01）. Compared with pre-operation, the levels of plasma FGF-23 and BNP in study group decreased 1 year after operation（ all P 〈0. 01 ）. The incidence of osteoporosis was 35.56% during one year follow-up in study group. Compared with the patients without osteoporosis, the levels of plasma FGF-23 and BNP in patients with osteoporosis significantly increased during perioperative period（ all P 〈0.01 ）. Spearman unconditional correlation analysis showed that the levels of plasma FGF-23 and BNP in study group were positively correlated with the incidence of osteoporosis after renal transplantation （ r = 0. 896, P 〈 0.05 ; r = 0. 844, P 〈 0.05 ）. The receiver operating characteristic curve （ ROC curve） analysis showed that the sensitivity, specificity and accuracy of perioperative plasma levels of FGF-23 and BNP for predicting occurrence of osteoporosis after renal transplantation were well, while the sensitivity, specificity and accuracy of their combination prediction in 1 year after operation were the highest （93.75%, 89.66% ,91.11% ）. Conclusion Plasma levels of FGF-23 and BNP are closely related to postoperative osteoporosis in patients undergoing renal transplantation and have good predictive values for postoperative osteoporosis.