Klotho-FGF23轴与慢性肾脏病5期未透析患者认知功能障碍的相关性研究

Study on correlation between Klotho-FGF23 axis and cognitive dysfunction in patients with chronic kidney disease in stage 5 without dialysis

目的 分析慢性肾脏病(CKD)5期未透析患者血清Klotho蛋白、FGF23蛋白及其他临床指标与认知功能障碍(CI)的相关性,为CKD5期未透析CI患者的早期诊断和治疗提供理论依据。方法 选取右江民族医学院附属医院肾内科住院治疗符合入组标准的97例CKD5期未透析患者,运用中文版蒙特利尔(MoCA)测量认知功能,评分≥26分者为CKD5期未透析无CI组(n=30),评分<26分为CKD5期未透析有CI组(n=67)。记录两组的一般资料,测定所有研究对象血清Klotho蛋白、FGF23蛋白和其他临床指标,分析两组一般资料及各检验指标之间的差异,采用Pearson分析MoCA评分与各指标的相关性,使用ROC曲线分析Klotho、FGF23及Klotho-FGF23对CI的预测价值。结果 (1)97例CKD5期未透析患者中,发生CI有67例,占比69.07%,无CI有30例,占比30.93%。(2)年龄、体重指数(BMI)、性别、民族、吸烟及饮酒在两组中比较差异均无统计学意义(P>0.05),CKD5期未透析无CI组的教育年限大于CKD5期未透析有CI组,差异有统计学意义(P<0.001)。(3)CKD5期未透析无CI组血清Klotho蛋白及MoCA评分均大于CKD5期未透析有CI组,CKD5期未透析无CI组血清FGF23蛋白、磷(P)、全段甲状旁腺激素(iPTH)、血肌酐(Scr)及尿素氮(BUN)均小于CKD5期未透析有CI组,差异均有统计学意义(P<0.001)。两组的Ca2+及VitD3比较差异均无统计学意义(P>0.05)。(4)Pearson分析结果显示,MoCA得分与FGF23蛋白、iPTH、P、Scr、BUN呈负相关,与Klotho蛋白、VitD3呈正相关(P<0.05)。(5)ROC曲线分析结果显示,预测CI时,Klotho、FGF23及Klotho-FGF23的受试者工作曲线下面积分别为0.877、0.863、0.876(P<0.001)。结论 (1)CKD5期未透析患者CI患病率高。(2)Klotho蛋白及FGF23蛋白预测CKD5期未透析患者CI的价值较高,有望成为新的预测指标。

Objective To analyze the correlation of serum Klotho protein,FGF23 protein and other clinical indicators with cognitive impairment(CI)in stage 5 chronic kidney disease(CKD5)patients without dialysis,so as to provide theoretical basis for early diagnosis and treatment of CKD5 patients without dialysis.Methods A total of 97 CKD5 patients without dialysis who were hospitalized in the Department of Nephrology of Affiliated Hospital of Youjiang Medical University for Nationalities and met inclusion criteria were selected.Cognitive function was measured by the Chinese version of Montreal cognitive assessment(MoCA).Those with score≥26 were selected as non-CI group of CKD5 without dialysis(non-CI group,n=30),and those with score<26 were selected as CI group of CKD5 without dialysis(CI group,n=67).And then,general data of the 2 groups were recorded,serum levels of Klotho protein,FGF23 and other clinical markers were determined in all subjects,and differences between the general data and test indexes in the two groups were analyzed.Pearson was used to analyze correlation between MoCA score and each index,and ROC curve was used to analyze the predictive value of Klotho,FGF23 and Klotho-FGF23 for CI.Results(1)Among 97 CKD5 patients without dialysis,67(69.07%)had CI,and 30(30.93%)had no CI.(2)There was no statistically significant difference in age,BMI,gender,ethnicity,smoking and drinking between the two groups(P>0.05),the time of education in non-CI group was longer than that of the CI group,and the difference was statistically significant(P<0.001).(3)The serum Klotho protein and MoCA score in the non-CI group were higher than those of the CI group,and the serum FGF23 protein,P,iPTH,Scr,and BUN in the non-CI group were lower than those in the CI group,and the differences were all statistically significant(P<0.001).There was no statistically significant difference in Ca 2+and VitD 3 between the two groups(P>0.05).(4)Pearson analysis showed that MoCA score was negatively correlated with FGF23 protein,iPTH,P,Scr and BUN,and positively correlated with Klotho protein and VitD 3(P<0.05).(5)ROC curve analysis showed that,when predicting CI,the area under ROC curve of Klotho,FGF23 and Klotho-FGF23 were 0.877,0.863 and 0.876,respectively(P<0.001).Conclusion The prevalence of CI is high in CKD5 patients without dialysis.Kloth and FGF23 had high value in predicting CI in CKD5 patients without dialysis,which are expected to be new predictive indexes.