西那卡塞对血液透析患者血清FGF23及心血管事件的影响

Effect of Cinacalcet on serum FGF23 and cardiovascular diseases in maintenance hemodialysis patients

目的探讨西那卡塞治疗对继发性甲状旁腺功能亢进(SHPT)的维持性血液透析(MHD)患者血成纤维细胞生长因子23(FGF23)及心血管事件的影响。方法我院血全段甲状旁腺素(iPTH)> 300pg/mL的维持性血液透析患者160例,随机分血液透析组和血液透析加西那卡塞治疗组,观察周期12个月,根据血钙及iPTH调整西那卡塞剂量(0～50 mg/d)。ELASA法检测FGF23及Klotho蛋白,化学发光法检测iPTH,生化法检测钙磷水平,B超测量右颈总动脉内膜中层厚度及左心室后壁厚度。观察治疗前后各项指标,记录所有患者在观察期发生心血管事件次数及因上述事件住院次数。结果血液透析组80例和血液透析加西那卡塞治疗组51例患者完成治疗。两组患者治疗前血FGF23水平均明显高于正常,血液透析患者治疗前后血磷、FGF23及PTH差异无统计学意义(P> 0.05),血液透析加西那卡塞治疗后血磷、FGF23及PTH较治疗前明显降低(P <0.05)、Klotho蛋白水平较治疗前增高(P <0.05)。血液透析组治疗期间共死亡10例(12.5%),死亡病例中肿瘤2例(2.55%)、心血管疾病8例(10%),非致死性心血管事件45例次(56.25%)、其中住院23例次(28.75%)。血液透析加西那卡塞治疗组治疗期间共发生死亡2例(3.92%)、均为心血管事件,非致死性心血管事件16例次(31.37%)、其中住院7例次(13.73%),与HD组比较,观察期间,致死性和非致死性心血管事件明显减少(P <0.008)。结论西那卡塞干预治疗可明显降低血液透析患者心血管事件及住院率,降低血FGF23及PTH水平并继发降低血磷水平可能为其机制之一。

Objective To investigate the effect of cinacalcet on serum fibroblast growth factor-23(FGF23) and cardiovascular diseases(CVD)in maintenance hemodialysis patients(MHD)with secondary hyperparathyroid-ism(SHPT).Methods One hundred and sixty MHD patients were divided into two groups:patients treated with HD(group HD,80 cases)and patients treated with HD and cinacalcet(group HD + C,80 cases). FGF23 and Klotho proteins and Parathyroid hormone(PTH)and serum total calcium and serum phosphorus were analyzed before and at 12 months after treatment. Right common carotid artery intima-media thickness(IMT)and left ventric-ular posterior wall thickness(LVPWT)were measured by B-ultrasound. Times of CVD and hospitalization of CVD of all patients were recorded during the study period.Results Eighty patients in group HD and 51 patients in group HD + C received this treatment. FGF23 level in group HD and HD + C was higher than that in the normal population. No significant differences in serum phosphorus and PTH and FGF23 were observed in group HD between before and after treatment. Serum phosphorus and PTH and FGF23 after treatment were lower than those before treatment in group HD + C(P < 0.05,respectively). The level of Klotho protein after treatment was higher than that before treatment in group HD + C(P < 0.05). There were 10 cases of deaths and 45 cases of CVD and 23 cases of hospitalization of CVD in group HD during the study period. Meanwhile,there were 2 cases of deaths and 16 cases of CVD and 7 cases of hospitalization of CVD in group HD + C. The incidence rate of CVD in group HD+C declined 24.88% compared with that in group HD(P < 0.008).Conclusion Cinacalcet reduces the incidence rate of CVD in patients with MHD. The underlying mechanism may be associated with the declined levels of FGF23 and PTH and serum phosphorus.