血清FGF-23水平变化与慢性肾病维持性血液透析患者冠状动脉钙化的相关性及其临床意义

Study on the relevance and clinical significance of the level changes of serum FGF-23 with the coronary artery calcification in patients with chronic renal disease and maintenance hemodialysis

目的探讨血清成纤维细胞生长因子-23(FGF-23)水平变化与慢性肾病维持性血液透析患者冠状动脉钙化的相关性。方法前瞻性选取西安市长安医院2015年10月至2017年11月经维持性血液透析治疗的慢性肾病患者106例设为研究组(无钙化34例,轻度钙化24例,中度钙化23例,重度钙化25例),另选取同期健康体检者106例设为对照组。统计记录研究组透析龄,并抽取所有受检者空腹静脉血,测定血磷、血清FGF-23水平。观察研究组与对照组血清FGF-23水平、研究组不同钙化程度患者一般指标(年龄、透析龄、血磷、血清FGF-23)水平、冠状动脉钙化危险因素,并统计分析冠状动脉钙化危险因素与冠状动脉钙化相关性。结果研究组血清FGF-23水平高于对照组(P<0.05);研究组不同钙化程度患者间年龄、透析龄、血磷、血清FGF-23水平间存在明显差异(P<0.05),多重比较,随着钙化程度加重,年龄、透析龄不断增大,血磷、血清FGF-23水平不断增高(P<0.05);血磷、血清FGF-23水平增高为慢性肾病维持性血液透析患者冠状动脉钙化重要危险因素(P<0.05);Person检验可知,血磷(r=0.279)、血清FGF-23(r=0.311)水平与冠状动脉钙化存在正相关关系(P<0.05)。结论慢性肾病维持性血液透析患者血清FGF-23水平及血磷水平异常增高,且其为冠状动脉钙化发生的重要危险因素,其表达水平随钙化程度加剧而不断增高,两者间存在正相关关系。临床可通过动态监测血清FGF-23水平评估患者冠状动脉钙化程度,以此制定、调整有针对性干预方案,对改善临床疗效及预后具有积极意义。

Objective To investigate the relevance of the level changes of serum fibroblast growth factor-23（FGF-23） with the coronary artery calcification in patients with chronic renal disease and maintenance hemodialysis. Methods A total of 106 patients with chronic kidney disease who received maintenance hemodialysis in our hospital from October 2015 to November 2017 were selected as the study group（no calcification in 34 cases,mild calcification in 24 cases,moderate calcification in 23 cases,severe calcification in 25 cases）. In addition,106 cases performing physical examination in our hospital were selected as the control group. The dialysis age in the study group were statistically recorded.The fasting venous blood of all the subjects was extracted and the levels of serum phosphorus and serum FGF-23 were measured. The levels of serum FGF-23 between the study groups and the control group,and the general indicators（age,dialysis age,blood phosphorus,serum FGF-23）of patients with different degrees of calcification of the study group and the risk factors of coronary artery calcification were compared. The correlation between the risk factors of coronary artery calcification and coronary artery calcification was statistically analyzed. Results The level of serum FGF-23 of the study group was higher than that of the control group（P〈0. 05）. There were significant differences in the age,the age of dialysis,the blood phosphorus and the level of serum FGF-23 among the patients with different calcification levels in the study group（P〈0. 05）.In multiple comparison,with the increase of the degrees of calcification,the age and age of dialysis,the level of serum phosphorus and serum FGF-23 increased（P〈0. 05）. The increase of serum phosphorus and serum FGF-23 was an important risk factor for coronary artery calcification in patients with chronic renal disease and maintenance hemodialysis（P〈0. 05）. There was positive correlation between the blood phosphorus（r= 0. 279）,serum FGF-23（r = 0. 311） and coronary artery calcification（P〈0. 05）. Conclusion The levels of serum FGF-23 and blood phosphorus in patients with chronic renal disease and maintenance hemodialysis are abnormally high. And they are the important risk factors for coronary artery calcification. Their expression levels increase with the degrees of calcification. There is a positive correlation between them. The clinical assessment of the degree of coronary artery calcification can be made by dynamic monitoring of the levels of serum FGF-23,in order to formulate and adjust the targeted intervention program. It is of positive significance to improve the clinical effect and prognosis.