慢性肾脏病患者血浆成纤维细胞生长因子23水平与骨矿物质代谢的相关性分析

Analysis of the correlation between plasma fibroblast growth factor 23 level and bone mineral metabolism in patients with chronic kidney disease

目的观察分析血浆成纤维细胞生长因子23(FGF-23)水平与慢性肾脏病(CKD)患者骨矿物质代谢的相关性。方法选择2015年1月至2017年6月经实验室、影像学等检查确诊为CKD的患者105例作为CKD组,按照肾小球滤过率估计值(eGFR)分为1~5期;选择同期就诊于体检中心且性别、年龄相当的健康体检者30例作为健康组。比较分析两组血红蛋白(Hb)、血浆白蛋白(ALB)、血浆FGF-23、肾小球滤过率(GFR)情况及不同CKD分期患者间血钙、血磷、碱性磷酸酶(ALP)、甲状旁腺激素(PTH)水平,利用Spearman相关分析探讨CKD患者血浆FGF-23水平与血钙、血磷、ALP等指标之间的关系。结果 CKD组的FGF-23显著高于健康组(P<0.05),而Hb、GFR显著低于健康组(P<0.05),并且存在钙磷代谢紊乱、低白蛋白血症。不同CKD分期患者间血磷及血清ALP水平随肾功能的下降有增高趋势,但差异无统计学意义(P>0.05);血钙随GFR下降有下降趋势,但差异无明显统计学意义(P>0.05);PTH水平随CKD分期增高而增高,FGF-23水平随肾功能的降低而增加(P<0.05)。以FGF-23为因变量,以血钙、血磷、ALP、PTH为自变量进行Spearman相关分析。结果显示,FGF-23与血钙(r=-0.77,P<0.05)呈负相关,FGF-23与血磷(r=0.21,P<0.05)、ALP(r=0.85,P<0.01)、PTH(r=0.675,P<0.05)呈正相关。结论 CKD患者外周血FGF-23水平与骨矿物质代谢有一定的相关性。血清FGF-23与血清中钙、磷、PTH具有一定的关系。正常人的血液循环中有FGF-23表达不高,但在高磷饮食、使用活性维生素D过程中,患者血清FGF-23水平也明显升高。FGF-23的调控可能是维生素D、钙、磷、iPTH等多种因素共同作用的结果。通过早期检测血清中FGF-23与钙、磷、ALP的水平,可为患者赢取更多的治疗时间,为患者获益。

Objective To observe the correlation between plasma fibroblast growth factor 23(FGF-23)level and bone mineral metabolism in patients with chronic kidney disease(CKD).Methods From January 2015 to June 2017,105 patients with CKD confirmed by laboratory and imaging examinations were selected as CKD group.According to the glomerular filtration rate,CKD patients were selected as stage 1-5,and 30 healthy people with the same sex and age were selected as healthy group.The levels of hemoglobin(Hb),plasma albumin(ALB),plasma fibroblast growth factor-23(FGF-23)and glomerular filtration rate(GFR)were compared between the two groups,and the levels of serum calcium(Ca),phosphorus(P),alkaline phosphatase(ALP),parathyroid hormone(PTH),and glomeurlar filtration rate were compared between patients with different CKD stages.Spearman correlation analysis was used to explore the levels of plasma FGF-23 and calcium and glomerular filtration rate in patients with chronic kidney disease.The relationship between phosphorus,ALP and other indicators.Results Compared with healthy group,FGF-23 in CKD group was significantly higher than that in healthy group,while Hb and glomerular filtration rate were significantly lower than those in healthy group(P<0.05),and there were disorders of calcium and phosphorus metabolism and hypoalbuminemia.Serum phosphorus and ALP levels increased with the decrease of renal function in patients with different CKD stages,but there was no statistical significance(P>0.05).Serum calcium decreased with the decrease of glomerular filtration rate,but there was no significant difference(P>0.05),parathyroid hormone levels increased with the increase of CKD stages(P<0.05),and FGF-23 levels increased with the decrease of renal function.There were significant differences among the groups(P<0.05).FGF-23 was used as dependent variable and seaim calcium,phosphorus,ALP and PTH were used as independent variables for Spearman correlation analysis.The results showed that FGF-23 was negatively correlated with serum calcium(r=-0.77,P<0.05),while FGF-23 was positively correlated with serum phosphorus(r=0.21,P<0.05),ALP(r=0.85,P<0.01),PTH(r=0.675,P<0.05).Conclusions There is a certain correlation between the level of fibroblast growth factor-23 in peripheral blood and bone mineral metabolism in patients with chronic kidney disease.Serum FGF-23 has a certain relationship with serum calcium,phosphorus and PTH.The expression of FGF-233 is not high in the blood circulation of normal people,but the level of serum FGF-23 is also significantly increased in the process of high phosphoius diet and active vitamin D use.The regulation of FGF-23 may be the result of vitamin D,calcium,phosphorus,iPTH and other factors.By early detection of serum FGF-23 and serum calcium,phosphorus and ALP,as well as the interaction between them,patients can win more treatment time and benefit patients.