维持性血液透析患者左心室肥大与FGF-23及钙磷代谢的相关性研究

Correlation study on left ventricular hypertrophy and fibroblast growth factor 23,calcium-phosphorus metabolism in maintenance hemodialysis patients

目的:探讨维持性血液透析(MHD)患者左心室肥大(LVH)与血清成纤维细胞生长因子23(FGF-23)、血钙、血磷、全段甲状旁腺激素(iPTH)等临床指标的相关性。方法:按照研究需要随机选取弋矶山医院血液净化中心80例病情相对稳定的MHD患者,所有患者血清FGF-23水平采用酶联免疫吸附ELISA法测定,其他需测定指标有血清钙、磷、iPTH等,所有入选患者检查超声心动图,依据Devereux公式计算左心室质量指数(LVMI)后根据LVH的诊断标准将研究对象分为2组,即LVH组59例和N-LVH组21例。结果:单因素分析显示,LVH组在透析龄、磷、钙磷乘积、胆固醇、收缩压、舒张压、LVMI、FGF-23和iPTH上均高于N-LVH组(P<0.05),而LVH组在高密度脂蛋白和血红蛋白上均低于N-LVH组(P<0.05);LVMI与透析龄(r=0.840)、磷(r=0.900)、FGF-23(r=0.953)和收缩压(r=0.687)均呈正相关(P<0.05);多因素分析显示,FGF-23、透析龄、收缩压和磷指标的升高是影响LVMI升高的重要因素。结论:MHD患者LVH与血清FGF-23、血磷等升高密切相关。

Objective:To investigate the correlation of left ventricular hypertrophy(LVH)with the level of serum fibroblast growth factor 23(FGF-23),serum calcium,phosphate,intact parathyroid hormone(iPTH)and other clinical parameters in patients undergoing maintenance hemodialysis(MHD).Methods:Eighty patients undergoing MHD at relatively stable stage were randomly recruited in Hemopurification Center of Yijishan Hospital.Serum FGF-23 level was measured using enzyme linked immunosorbent assay(ELISA),and other indexes,including the level of serum calcium and serum phosphate and iPTH were determined in all patients.All subjects included underwent echocardiography,and were allocated to left ventricular hyperthopy(LVH)group(n=59)and non-left ventricular hrpertrophy(N-LVH)group(n=21)after calculation of the left ventricular mass index(LVMI)by Devereux formula.Results:Univariate analysis showed that dialysis age,levels of serum phosphorus,calcium-phosphorus product,cholesterol,systolic blood pressure,diastolic blood pressure,LVMI,FGF-23 and iPTH were higher in the LVH group than in the N-LVH group(P<0.05),yet the level of high density lipoprotein cholesterol and hemoglobin levels were lower in LVH group than in N-LVH group(P<0.05).LVMI was positively correlated with dialysis age(r=0.840),level of serum phosphorus(r=0.900),FGF-23(r=0.953)and systolic blood pressure(r=0.687)(P<0.05).Multivariate analysis showed that FGF-23,dialysis age,systolic blood pressure and serum phosphorus level were the important risk factors for LVMI.Conclusion:The level of FGF-23 is significantly elevated in MHD patients,and closely related to LVH and blood phosphorus.