目的 探讨腹膜透析患者成纤维细胞生长因子23(fibroblast growth factor -23,FGF-23)与股动脉内中膜厚度(intima-media thickness,IMT)的关系。方法 将82例持续性非卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者根据股动脉壁最大内膜厚度不同分组,观察CAPD患者组间FGF-23与IMT的关系。结果 CAPD患者中股动脉IMT增厚的检出率为45.12%,IMT增厚组患者的年龄、血磷、糖化血红蛋白、甲状旁腺激素、FGF-23水平明显高于IMT正常组,差异具有统计学意义(P<0.05),以患者IMT值作为因变量进行多元回归分析,结果显示CAPD患者的血磷、iPTH、FGF-23与患者股动脉IMT增厚独立相关(P<0.05)。结论 FGF-23是慢性肾衰竭(chronic kidney disease, CKD)患者钙磷代谢紊乱、血管钙化等事件的重要生物标志物,是CAPD患者血管钙化的早期重要预警指标。
Abstract
Objective To observe the correlations between fibroblast growth factor-23(FGF-23) and femoral artery intima- media thickness(IMT) in peritoneal dialysis patients.Methods Patients on continuous ambulatory peritoneal dialysis(CAPD) were divided into different groups according the femoral artery IMT. The relationships between FGF-23 and femoral artery IMT in different CAPD groups were analyzed.Results The incidence of increased femoral artery IMT in CAPD patients was 45.12%. Age, and levels of serum phosphorous、HbA1c、intact parathyroid hormone( iPTH) and FGF-23 of the increased IMT group were significantly above those of the normal IMT group (P<0.05). According to multiple logistic regression analysis ,the levels of serum phosphorous、iPTH and a high FGF-23 concentration were significant independent risk factors for increased IMT in CAPD patients(P<0.05).Conclusions These results suggest that a high level of FGF-23 is an important indicator of calcium-phosphorus metabolism and vascular calcification in CKD patients, and maybe an important early warning signal of vascular calcification in CAPD patients.
关键词
腹膜透析 /
成纤维细胞生长因子23 /
股动脉 /
内中膜厚度
Key words
peritoneal dialysis /
fibroblast growth factor- 23 /
femoral artery /
intima- media thickness
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参考文献
[1] 高 德,史昌乾,高 峰,等.腹膜透析患者下肢动脉病变与钙磷代谢的相关性[J]. 武警医学,2014,25(5):484-486.
[2] Yamada S, Tsuruya K, Tokumoto M, et al. Fibroblast growth factor 23, but notparathyroid hormone, is associated with urinary phosphate regulation in patients on peritoneal dialysis: phosphaturic effect of FGF-23 in PD[J]. Ther Apher Dial,2015, 19(1): 73-80.
[3] Komaba H,Fukagawa M. FGF-23-parathyroid interaction: implications in chronic kidney disease[J]. Kidney Int,2010,77(4):292-298.
[4] Wolf M. Forging forward with 10 burning questions on FGF-23 in kidney disease[J]. J Am Soc Nephrol, 2010, 21(9):1427-1435.
[5] Rhee Y, Bivi N, Farrow E, et al. Parathyroid hormone receptor signaling in osteocytes increases the expression of fibroblast growth factor-23 in vitro and in vivo[J]. Bone, 2011, 49(4): 636-643.
[6] Tsai W C,Wu H Y,Peng Y S,et al.Effects of lower versus higher phosphate diets on fibroblast growth factor-23 levels in patients with chronic kidney disease: a systematic review and meta-analysis[J]. Nephrol Dial Transplant,2018,33(11): 1977-1983.
[7] Hagstrom E. Parathyroid hormone and calcium are independently associated with subclinical vascular disease in a community-based cohort[J]. Atherosclerosis, 2015,238(2): 420-426.
[8] Lee X Y,Ng H Y,Chiu T T,et al. Association of bone-derived biomarkers with vascular calcification in chronic hemodialysis patients[J].Clin Clim Acta,2016,452(15):38-43.
[9] 郑明楠,吴 华,金 实.FGF-23和Kiotho蛋白水平在终末期肾病患者中与钙磷代谢及其伴发病的相关性[J]. 西部医学,2019, 31(2):190-192.
[10] Ix J H,Shlipak M G,Wassel C L,et al.Fibroblast growth factor-23 and early decrements in kidney function:The Heart and Soul Study[J].Nephrol Dial Transplant,2010,25(3):993-997.
[11] 黄泳璋,肖 洁.成纤维细胞生长因子23 与慢性肾脏病患者肾功能及钙磷代谢的关系[J].中国实用医药,2017, 12(10):41-42.
[12] 闫奇奇,郝 丽,张 森.FGF-23 与CKD 患者钙磷代谢及心血管疾病关系研究进展[J].安徽医科大学学报,2019,54(1):158-162.
[13] 朱冬燕,陈 向,曹亚南,等. 慢性肾脏病骨矿物质代谢紊乱FGF-23 的血管钙化机制[J]. 武警医学,2018,29(4):409-411.