FGF-23和Klotho蛋白水平在终末期肾病患者中与钙磷代谢及其伴发病的相关性

Relationship between FGF-23 and Klotho protein levels and the calcium and phosphorus metabolism,atherosclerosis and left ventricular hypertrophy in maintenance hemodialysis and peritoneal dialysis patients

目的探讨血清成纤维细胞生长因子23(FGF-23)和Klotho蛋白水平在终末期肾病(ESRD)患者中与钙磷代谢、动脉硬化、左室肥厚的相关性。方法选取2015年1月～2016年4月在大连大学附属中山医院血液净化科进行血液透析(HD)的患者50例为血透组、腹膜透析(PD)患者50例为腹透组,并选取同期在本院体检的健康人群30例为健康对照组。通过整理资料、实验室检测、超声科检查比较不同透析方式对FGF-23和Kloth蛋白水平的影响、同时分析FGF-23和Kloth蛋白水平与钙磷代谢、动脉硬化及左室肥厚的相关性。结果血透、腹透组FGF-23水平明显高于健康对照组,且血透组FGF-23水平也明显高于腹透组,差异有统计学意义(P<0.05);血透组、腹透组Klotho蛋白水平明显低于健康对照组,差异均有统计学意义(P<0.05),血透组与腹透组Klotho蛋白水平相近,差异无统计学意义(P>0.05);FGF-23水平与钙磷代谢呈正相关(r=0.5323、0.5178、0.5178,P<0.05)、与继发性甲状旁腺功能亢进呈正相关(r=0.3038,P<0.05)、与颈动脉硬化呈正相关(r=0.2987,P<0.05);Kloth蛋白与钙磷代谢呈负相关(r=-0.5103、-0.1105、-0.5264,P<0.05)、与继发性甲状旁腺功能亢进呈正相关(r=0.3254,P<0.05)。结论 ESRD透析患者中FGF-23存在高表达,而Klotho蛋白存在低表达,它们与HD、PD患者发生高磷血症、继发性甲状旁腺功能亢进、动脉硬化关系密切。

Objective To explore and analyze the relationship between the serum fibroblast growth factor 23(FGF-23)and Klotho protein levels and the calcium and phosphorus metabolism,atherosclerosis and left ventricular hypertrophy in maintenance hemodialysis(HD)and peritoneal dialysis(PD)patients.Methods Fifty HD patients and fifty PD patients treated in the department of blood purification,Zhongshan Hospital Affiliated to Dalian University from January 2015 to April 2016 were selected as the HD group and the PD group respectively.Another thirty healthy people who received physical examination in our hospital in the same period were selected as the control group.The effects of different dialysis methods on FGF-23 and Klotho protein levels were compared through collating data,laboratory testing and ultrasonography,and the relationship between the FGF-23 and Klotho protein levels and the phosphorus metabolism,arteriosclerosis and left ventricular hypertrophy was analyzed.Results The FGF-23 level in the HD and PD groups was significantly higher than that in the control group,and the FGF-23 level in the HD group was significantly higher than that in the PD group,and the difference was statistically significant(P<0.05).The Klotho protein level in the HD and PD groups was significantly lower than that in the control group,and the difference was statistically significant(P<0.05).The Klotho protein level in the HD group was similar with that in the PD group,and the difference was not statistically significant(P >0.05).FGF-23 level was positively correlated with calcium and phosphorus metabolism(r=0.5323,0.5178,0.5178,P<0.05),was positively correlated with secondary hyperparathyroidism(r=0.3038,P<0.05),and was positively correlated with carotid atherosclerosis(R=0.2987,P<0.05);Klotho protein level was negatively correlated with calcium and phosphorus metabolism(r=-0.5103,-0.1105,-0.5264,P<0.05),and was positively correlated with secondary hyperparathyroidism(r=0.3254,P<0.05).Conclusions There is a high expression of FGF-23 and low expression of Klotho protein in patients with end-stage renal disease(ESRD)dialysis,which are closely related to hyperphosphatemia,secondary hyperparathyroidism and atherosclerosis in HD and PD patients.