中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (10): 547-551.doi: 10.3969/j.issn.1671-4091.2013.09.00

• 临床研究 • 上一篇    下一篇

成纤维细胞生长因子23可预测慢性肾脏病中晚期患者冠脉钙化的发生及不良预后

  

  1. 1. 上海交通大学医学院附属仁济医院肾脏科
    2. 上海交通大学附属仁济医院
  • 收稿日期:2013-08-12 出版日期:2013-10-12 发布日期:2013-10-12
  • 通讯作者: 倪兆慧 profnizh@126.com E-mail:profnizhao@126.com
  • 基金资助:

    上海市卫生局基金(2009Y030)，973课题资助(No. 2012CB517602)，十二五国家科技支撑计划(2011BAI10B04)，十二五国家科技支撑计划(2011BAI10B08)，上海市科委基础重点项目资金资助 (10JC1410100)

Fibroblast growth factor-23 may predict coronary artery calcification and adverse clinical outcome in chronic kidney disease patients at moderate to advanced stage

  • Received:2013-08-12 Online:2013-10-12 Published:2013-10-12

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摘要： 【摘要】目的探讨成纤维细胞生长因子23(fibroblast growth factor-23,FGF23)与慢性肾脏病(chronic kidney disease, CKD)患者冠状动脉钙化发生和预后的关系。方法入选2010年4月～12月我院肾脏科CKD非透析（CKD 3~5期）、腹膜透析和血液透析患者共150例，采用酶联免疫吸附法测定血清全段FGF23水平，分析FGF23浓度与冠脉钙化的关系。并对这些患者进行为期(35±3)个月的随访，记录心血管和死亡事件。结果 CKD中晚期患者血清FGF23水平显著高于健康对照组（P400)是患者发生CVD的独立危险因素。而FGF23水平和冠脉明显钙化(冠脉CaS>400)是患者全因死亡的独立危险因素。结论CKD中晚期患者的血清FGF23水平较普通人群显著增高，FGF23与CKD中晚期患者的冠脉钙化发生及不良预后可能相关。

关键词: 成纤维细胞生长因子23, 慢性肾脏病, 中晚期, 冠状动脉钙化, 预后

Abstract: Objective To elucidate the relationship between fibroblast growth factor-23 (FGF23) and coronary artery calcification, and the prognostic value of FGF23 in chronic kidney disease (CKD) patients at moderate to advanced stage. Methods Serum intact FGF23 was measured by using ELISA in 150 CKD patients at stages 3-5. The relationship between FGF23 and coronary artery calcification was evaluated. Patients were followed up for 35±3 months, and the occurrence of cardiovascular disease (CVD) and death were recorded. Results Serum FGF23 level was significantly higher in CKD patients than in healthy controls (P＜0.01), and was much higher in dialyzed patients than non-dialyzed patients (P＜0.01), especially higher in hemodialysis patients. Serum FGF23 level was positively correlated with coronary artery calcification score (CaS) (r=0.177, P＜0.05). Logistic regression analysis showed that age, dialysis duration and FGF23 level were the independent risk factors for coronary artery calcification in CKD patients at moderate to advanced stage. During the follow-up, CVD in 21 (14%) patients and death in 13 (8.7%) patients were recorded. Patients were then stratified to two groups by the median FGF23 level (675.8pg/ml). Kaplan-Meier survival curves showed that patients with FGF23 levels ≥675.8pg/ml had significantly higher CVD incidence rate (P＜0.01) and all-cause mortality (P＜0.05) than those with FGF23 levels below the cut-off value. Cox regression analysis showed that FGF23 ≥675.8pg/ml and severe coronary artery calcification (CaS ＞400) were the independent risk factors for CVD in CKD patients, and that FGF23 level and severe coronary artery calcification (CaS ＞400) were the independent risk factors for all-cause mortality in CKD patients. Conclusion Serum FGF23 level in CKD patients at moderate to advanced stage was significantly higher than that in normal population. Serum FGF23 level may relate to coronary artery calcification and adverse clinical outcomes in CKD patients at moderate to advanced stage.

Key words: Fibroblast growth factor-23, Moderate to advanced stage chronic kidney diseases, Coronary artery calcification, Prognosis