血清FGF-23、Klotho水平与维持性血液透析患者腰椎骨密度的关系

Relationship between serum FGF-23,Klotho levels and lumbar bone mineral density in maintenance hemodialysis patients

目的 研究血清FGF-23、Klotho水平与维持性血液透析(maintenance hemodialysis,MHD)患者腰椎骨密度的关系。方法 选择本院2017年9月~2020年9月收治的100例MHD患者作为研究对象,根据腰椎骨密度将患者分为正常组(T≥-1SD),骨量减少组(-2.5 SD0.05);正常组的女性占比显著低于骨质疏松组,透析时间显著短于骨量减少组和骨质疏松组,血红蛋白、总蛋白量显著高于骨质疏松组,肾肌酐清除率显著高于骨量减少组和骨质疏松组(P<0.05)。正常组的PTH、TRAP、BALP、BGP、FGF-23显著低于骨量减少组和骨质疏松组,Klotho显著高于骨量减少组和骨质疏松组(P<0.05);三组的血磷、血钙比较,差异均无统计学意义(P>0.05)。经Pearson直线相关法分析,透析时间、PTH、TRAP、BALP、BGP、FGF-23与MHD患者腰椎骨密度均呈负相关(P<0.05),Klotho与MHD患者腰椎骨密度呈正相关(P<0.05);血红蛋白、总蛋白量、肾肌酐清除率与MHD患者腰椎骨密度均无相关性(P>0.05)。结论 高FGF-23水平和低Klotho水平是预测MHD患者腰椎骨密度降低的重要指标,临床可根据FGF-23、Klotho水平对MHD患者骨质疏松症进行防治。

Objective To study the relationship between serum FGF-23,Klotho levels and lumbar bone mineral density in maintenance hemodialysis(MHD)patients.Methods A total of 100 patients with MHD from September 2017 to September 2020 in our hospital were selected as the study subjects.They were divided into the normal group(T≥-1SD),the osteopenia group(-2.5SD<T≤-1.0SD),and the osteoporosis group(T≤-2.5SD)according to the lumbar bone mineral density.The general data and serum indicators of the three groups were compared.Results Among 100 patients,38 cases had T≥-1SD,32 cases had T≤-2.5SD,and 32 cases had T≤-2.5SD.The comparison of age,hypertension,diabetes,24 h urine volume among the three groups,and the comparison of gender,hemoglobin and total protein volume between the normal group and the osteopenia group,had no statistically significant differences(P>0.05).The female rate of the normal group was significantly lower than that of the osteoporosis group,the dialysis time was significantly lower than that of the osteopenia group and the osteoporosis group,the amount of hemoglobin and total protein were significantly higher than that of the osteoporosis group,and the renal creatinine clearance rate was significantly higher than that of bone mass reduction group and the osteoporosis group,and the differences were statistically significant(P<0.05).The PTH,TRAP,BALP,BGP and FGF-23 of the normal group were significantly lower than those of the osteopenia group and the osteoporosis group,and Klotho was significantly higher than the osteopenia group and the osteoporosis group,and the differences were statistically significant(P<0.05).There were no statistically significant differences in blood phosphorus and blood calcium among the three groups(P>0.05).Analysis by Pearson linear correlation method showed that dialysis time,PTH,TRAP,BALP,BGP,FGF-23 were negatively correlated with lumbar bone mineral density in patients with MHD(P<0.05).Klotho was positively correlated with lumbar bone mineral density in patients with MHD(P<0.05).There was no correlation between hemoglobin,total protein,renal creatinine clearance and lumbar bone mineral density in MHD patients(P>0.05).Conclusion High FGF-23 levels and low Klotho levels are important indicators for predicting the reduction of lumbar bone mineral density in MHD patients.Clinically,FGF-23 and Klotho levels can be used to prevent and treat osteoporosis in MHD patients.