血清FGF23-Klotho轴对多发性骨髓瘤患者合并肾损伤的预测价值

Predictive value of serum FGF23-Klotho axis in patients with multiple myeloma complicated with kidney injury

目的:探讨分析血清FGF23-Klotho轴对多发性骨髓瘤(MM)患者合并肾损伤的预测价值。方法:选择我院收治的104例MM患者作为MM组,并根据患者是否存在肾损伤,将其分为肾损伤组(n=34)和非肾损伤组(n=70)。同期选取在我院健康体检的受试者80例作为对照组。检测各组受试者肾功能相关性指标血清胱抑素C(Cys-C)、血肌酐(Scr)、β2微球蛋白(β2-MG)表达,以及血清FGF23以及Klotho表达,并计算FGF23/Klotho比值。采用二元Logistic回归分析血清FGF23、Klotho对MM患者并发肾损伤的影响;采用ROC曲线分析血清FGF23、Klotho对MM合并肾损伤的预测价值;并分析肾损伤组患者血清FGF23、Klotho与Cys-C、Scr、β2-MG相关性。结果:MM组患者血清Cys-C、Scr、β2-MG以及FGF23水平均显著高于对照组,而MM组患者血清Klotho水平显著低于对照组(P<0.05),MM组患者FGF23/Klotho比值显著高于对照组(P<0.05)。在MM患者中,肾损伤组患者血清Cys-C、Scr、β2-MG以及FGF23水平均显著高于非肾损伤组(P<0.05),而肾损伤组患者血清Klotho水平显著低于非肾损伤组(P<0.05)。采用二元Logistic回归分析血清FGF23、Klotho对MM并发肾损伤的影响,结果显示血清FGF23、Klotho均进入回归模型(P<0.05),为影响MM并发肾损伤的重要因素。采用ROC曲线分析血清FGF23、Klotho以及FGF23/Klotho比值对MM合并肾损伤的预测价值,曲线下面积分别为0.839、0.831以及0.962。相关性分析结果显示,肾损伤组患者血清FGF23、FGF23/Klotho比值与Cys-C、Scr、β2-MG呈显著正相关关系(P<0.05),血清Klotho与Cys-C、Scr、β2-MG呈显著负相关关系(P<0.05)。结论:血清FGF23-Klotho轴在多发性骨髓瘤并发肾损伤中具有重要调控价值,与患者肾功能密切相关,对多发性骨髓瘤患者肾损伤的发生具有着重要的预测价值,值得临床进一步深入研究。

Objective:To investigate the predictive value of serum FGF23-Klotho axis in patients with multiple myeloma complicated with kidney injury.Methods:104 MM patients in our hospital were selected as the MM group,and were divided into kidney injury group(n=34) and non-kidney injury group(n=70) according to whether the patients had kidney injury.In the same period,80 healthy subjects in our hospital were selected as the control group.The expression of serum cystatin C( Cys-C),serum creatinine( Scr),β2 microglobulin( β2-mg),and serum FGF23and Klotho were detected.ROC curve was used to analyze the predictive value of serum FGF23 and Klotho on MM combined with kidney injury.The correlation between serum FGF23,Klotho and Cys-C,Scr and β2-MG in renal injury group was analyzed.Re sults:The serum levels of Cys-C,Scr,β2-MG and FGF23 in MM group were significantly higher than those in control group,the serum Klotho level in MM group was significantly lower than that in control group( P < 0.05),and the FGF23/Klotho ratio in MM group was significantly higher than that in control group( P< 0.05).In MM patients,the serum levels of Cys-C,Scr,B2-MG and FGF23 in kidney injury group were significantly higher than those in non-kidney injury group( P < 0.05),while the serum Klotho level in kidney injury group was significantly lower than that in non-kidney injury group( P < 0.05).Logistic regression was used to analyze the effects of serum FGF23 and Klotho on kidney injury in MM patients.Binary Logistic regression was used to analyze the effects of serum FGF23 and Klotho on kidney injury in MM patients,and the results showed that serum FGF23 and Klotho were both entered into the regression model( P < 0.05),which was an important factor affecting kidney injury in MM patients.ROC curve was used to analyze the predictive value of serum FGF23,Klotho and FGF23/Klotho ratio on MM combined kidney injury,and the areas under the curve were 0.839,0.831 and 0.962,respectively.Correlation analysis results showed that serum FGF23,FGF23/Klotho ratio was significantly positively correlated with Cys-C,Scr and β2-MG in renal injury group( P < 0.05),and serum Klotho was significantly negatively correlated with Cys-C,Scr and β2-MG in renal injury group( P < 0.05).Conclusion:Serum FGF23-Klotho axis has important regulatory value in multiple myeloma complicated with kidney injury,which is closely related to the renal function of patients,and has important predictive value in the occurrence of kidney injury in multiple myeloma patients,which is worthy of further clinical research.