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目的探讨慢性肾脏病(CKD)患者随着肾功能的变化,血清成纤维细胞生长因子23(FGF23)水平与钙磷代谢的关系。方法将69例CKD 1~5期患者设为观察组,另选取年龄、性别匹配的20例健康体检者设为对照组。检测各组患者的临床相关生化指标:酶联免疫吸附测定法(ELISA)检测FGF23、25羟基维生素D3[25(OH)D3]。全自动生化分析仪测定其血钙(Ca)、磷(P)、碱性磷酸酶(ALP)、血肌酐(SCr)、尿素氮(BUN)、肾小球滤过率(GFR)、白蛋白(Alb)水平,二氧化碳结合力(CO2CP)、血脂、尿酸。免疫放射法测定甲状旁腺激素(iPTH)水平。对入选患者进行颈动脉、椎动脉、心脏、冠状动脉、腹部侧位。记录患者血压、心率、心电图(EKG)、心血管事件。结果血清FGF23、iPTH、P水平的变化随着患者GFR的下降而升高,特别是在CKD 4、5期明显,与对照组比较差异有统计学意义(P<0.05)。血25(OH)D3较对照组有明显下降,但随肾功能状态的变化差异无统计学意义(P>0.05)。同时Ca具有一定的下降趋势,直至CKD 5期(2.03±0.21)mmol/L与对照组(2.15±0.11)mmol/L比较差异有统计学意义(P<0.05)。血清FGF23、iPTH水平的相关因素在CKD 1~5期呈正态分布,此时FGF23为自变量,CKD 1~5期FGF23的水平与iPTH、P、SCr呈正比例关系(P<0.05),与GFR、25(OH)D3呈反比例关系(P<0.05),与Ca无相关关系。结论随着肾功能的减退,血清FGF23、P、iPTH水平会逐渐升高,25(OH)D3较对照组有明显下降,但随肾功能状态的变化无统计学意义。CKD患者FGF23的水平与iPTH、P、SCr呈正比例关系,与GFR、25(OH)D3呈反比例关系。
Objective To investigate the relationship between the level of serum fibroblast growth factor 23 (FGF23) and the metabolism of calcium and phosphorus in patients with chronic kidney disease (CKD) as a function of renal function. Methods 69 cases of CKD patients from stage 1 to stage 5 were selected as the observation group. 20 healthy subjects of the same age and sex matched were selected as the control group. The clinically relevant biochemical indexes of each group were detected: enzyme-linked immunosorbent assay (ELISA) was used to detect FGF23,25 hydroxyl vitamin D3 [25 (OH) D3]. The levels of serum Ca, P, ALP, SCr, BUN, GFR and albumin were measured by automatic biochemical analyzer. (Alb), carbon dioxide binding (CO2CP), lipids, uric acid. Immuno Radiological Determination of Parathyroid Hormone (iPTH) Level. Selected patients were carotid, vertebral artery, heart, coronary artery, lateral abdominal position. Patient blood pressure, heart rate, electrocardiogram (EKG), and cardiovascular events were recorded. Results The changes of serum FGF23, iPTH, P levels increased with the decrease of GFR in patients, especially at stage 4 and 5 of CKD. The difference was statistically significant (P <0.05) compared with the control group. Blood 25 (OH) D3 was significantly lower than the control group, but with no significant difference in the changes of renal function status (P> 0.05). At the same time, Ca had a downward trend until the CKD phase 5 (2.03 ± 0.21) mmol / L and the control group (2.15 ± 0.11) mmol / L difference was statistically significant (P <0.05). Serum levels of FGF23 and iPTH correlated positively with stage 1 to 5 of CKD. FGF23 was an independent variable at this time. The levels of FGF23 in stages 1-5 of CKD were positively correlated with iPTH, P and SCr (P <0.05), and GFR, 25 (OH) D3 was inversely proportional relationship (P <0.05), no correlation with Ca. Conclusion With the decline of renal function, serum FGF23, P, iPTH levels will gradually increase, 25 (OH) D3 significantly decreased compared with the control group, but with no statistical significance of renal function. The level of FGF23 in CKD patients is directly proportional to iPTH, P and SCr, and inversely proportional to GFR and 25 (OH) D3.