维持性血液透析患者心脏瓣膜钙化与成纤维细胞生长因子-23及可溶性klotho蛋白水平的关系

Relationship between serum levels of fibroblast growth factor-23 and soluble klotho and cardiac valve calcification in maintenance hemodialysis patients

目的探讨维持性血液透析(maintenance hemodialysis patients,MHD)患者血清成纤维细胞生长因子-23(fibroblast growth factor-23,FGF-23)及可溶性klotho蛋白(soluble Klotho protein,sKL)与心脏瓣膜钙化(cardiac valve calcification,CVC)的关系。方法收集山东第一医科大学附属莱钢医院肾内科透析中心100例维持性血液透析患者的临床资料。采用酶联免疫吸附法测定患者血清FGF-23和sKL浓度,超声心动图评估患者心脏瓣膜钙化情况。结果观察组的CVC比例、FGF-23水平高于对照组,而sKL水平低于对照组(t值分别为8.820,16.642,-2.583,P值分别为<0.001,<0.001,0.012)。多因素Logistic回归分析显示,血清FGF-23水平、血磷升高是MHD患者心脏瓣膜钙化的独立危险因素(OR值分别为2.375,1.642,95%CI值分别为1.527~3.884,1.232~1.912,P值分别为<0.001,0.023),血清sKL水平升高是MHD患者心脏瓣膜钙化的保护因素(OR=0.334,95%CI值为0.044~0.621,P=0.032)。结论血清FGF-23、sKL是MHD患者发生心脏瓣膜钙化的独立影响因素,二者联合检测对MHD患者发生心脏瓣膜钙化具有较高的预测价值。

Objective To explore the relationship between serum levels of fibroblast growth factor-23(FGF-23) and soluble klotho(sKL) and cardiac valve calcification(CVC) in maintenance hemodialysis(MHD) patients. Methods A total of 100 MHD patients treated in the Blood Purification Center of Laigang Hospital were enrolled in this study as the observation group. The serum concentrations of FGF-23 and s KL were measured by enzyme-linked immunosorbent assay. CVC was detected by color Doppler ultrasonography. Results The incidence of CVC and serum level of FGF-23 were higher in observation group than in control group(t=8.820 and 16.642 respectively;P<0.001), while serum level of sKL was lower in observation group than in control group(t=-2.583, P=0.012). The higher levels of serum phosphorus and serum FGF-23 were the independent risk factors for CVC in MHD patients(OR=2.375 and 1.642 respectively;95% CI=1.527~3.884 and 1.232~1.912 respectively;P<0.001 and 0.023 respectively). The higher level of sKL was a protective factor for CVC(OR=0.334, 95% CI=0.044~0.621, P<0.05). Conclusion Serum levels of FGF-23 and s KL were the independent influencing factors for CVC in MHD patients. Therefore, combined detection of serum FGF-23 and s KL can be used to predict CVC in MHD patients.