血清FGF-2、FGF-23与脓毒症合并急性肾损伤CRRT治疗患者肾功能及预后的关系

Relationship between serum FGF-2 and FGF-23 levels and renal function and its prognosis in sepsis patients with acute kidney injury and treated by continuous renal replacement therapy

目的 分析血清成纤维细胞生长因子(fibroblast growth factor,FGF)-2、FGF-23与接受连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)的脓毒症合并急性肾损伤(acute kidney injury,AKI)患者肾功能和短期预后的关系。方法 选取157例接受CRRT治疗的脓毒症合并AKI患者,比较不同AKI分期患者血清FGF-2、FGF-23水平。根据28天预后情况将其分为生存组和死亡组,比较2组血清FGF-2、FGF-23及肾功能指标水平,并分析其相关性。分析血清FGF-2、FGF-23水平对短期预后的预测价值。结果 AKIⅢ期患者血清FGF-2水平低于AKIⅡ期,血清FGF-23水平高于AKIⅡ期(t=20.149、-8.060,均P<0.001)。死亡组血清FGF-23、肌酐(Scr)、胱抑素C(Cyc-C)水平高于生存组(t=-12.051、-17.462、-5.881,均P<0.001),血清FGF-2、估算肾小球滤过率(estimated glomerular filtration rate,eGFR)低于生存组(t=25.990、15.997,均P<0.001)。Pearson分析显示血清FGF-2与Scr、Cyc-C均呈负相关(r=-0.511、-0.449,P<0.001、0.002),与eGFR呈正相关(r=0.606,P<0.001)。血清FGF-23与Scr、Cyc-C均呈正相关,与eGFR呈负相关(r=0.610、0.522、-0.654,均P<0.001)。FGF-2、FGF-23联合应用的预测价值高于两指标单独应用(Z=2.120、2.034,P=0.034、0.042)。结论 脓毒症合并AKI患者的血清FGF-2水平明显降低、FGF-23水平明显升高,且与患者肾功能下降及短期预后不良有关,二者联合检测对预测脓毒症合并AKI短期预后的价值较高。

Objective To analyze the relationship between serum fibroblast growth factor(FGF)-2 and FGF-23 levels and renal function and its short-term prognosis in sepsis patients with acute kidney injury(AKI)and treated by continuous renal replacement therapy(CRRT).Methods A total of 157 sepsis patients complicated with AKI and treated by CRRT were enrolled in this study.Serum FGF-2 and FGF-23 levels were compared among patients with different AKI stage.Patients were divided into survival group and death group according to the prognosis at day 28.Serum FGF-2 and FGF-23 levels and renal function indexes were compared between the two groups,and the correlations were analyzed.The predictive value of serum FGF-2 and FGF-23 levels for short-term prognosis of AKI was evaluated.Results In patients with AKIⅢ,serum FGF-2 level was lower and serum FGF-23 level was higher,as compared those with AKIⅡ(t=20.149 and-8.060,P<0.001).Serum FGF-23,creatinine(Scr)and cystatin C levels were higher in the death group than in the survival group,while serum FGF-2 and eGFR were lower in the death group than in the survival group(t=-12.051,-17.462,-5.881,25.990 and 15.997 respectively;P<0.001).Pearson correlation analysis showed that serum FGF-2 was negatively correlated with Scr and cystatin C,and positively correlated with eGFR(r=-0.511,-0.449 and 0.606 respectively;P<0.001,0.002 and<0.001 respectively).Serum FGF-23 was positively correlated with Scr and cystatin C,and negatively correlated with eGFR(r=0.610,0.522,-0.654 respectively;P<0.001).The predictive value of combined application of serum FGF-2 and FGF-23 levels was higher than that of the two indicators applied individually(Z=2.120 and 2.034,P=0.034 and 0.042).Conclusion Serum FGF-2 level is significantly reduced and FGF-23 level is significantly increased in sepsis patients with AKI.The lower serum FGF-2 level and higher serum FGF-23 level are associated with the decreased renal function and poor short-term prognosis.Simultaneous use of serum FGF-2 and FGF-23 levels improves the prediction value for short-term prognosis in sepsis patients with AKI.