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目的探讨血浆成纤维细胞生长因子23(FGF-23)和B型利钠肽(BNP)水平与肾移植后骨质疏松的关系,为肾移植后骨质疏松的防治提供参考。方法采用回顾性研究方法,选取2011年1月至2012年10月在广州军区广州总医院已行首次肾移植治疗、且术后3年移植肾功能正常的患者45例为研究组,并以同期基线资料匹配的健康查体志愿者30例为对照组。回溯性比较两组血浆FGF-23、BNP水平。计算研究组患者术后随访1年时的骨质疏松发生率,比较有无骨质疏松患者的血浆FGF-23、BNP水平,分析血浆FGF-23、BNP水平与骨质疏松发生率的关系及其对肾移植后骨质疏松发生的预测价值。结果与对照组比较,研究组肾移植术前血浆FGF-23、BNP水平均升高(P均<0.01)。与术前比较,研究组术后1年的血浆FGF-23、BNP水平均降低(P均<0.01)。研究组随访1年时骨质疏松发生率为35.56%。与无骨质疏松患者比较,研究组有骨质疏松患者围术期血浆FGF-23、BNP水平均升高(P均<0.01)。Spearman无条件相关分析结果显示,研究组血浆FGF-23、BNP水平与其肾移植术后骨质疏松发生率均呈正相关(r=0.896,P<0.05;r=0.844,P<0.05)。受试者工作特征曲线(ROC曲线)分析结果显示,研究组围术期血浆FGF-23、BNP水平预测其肾移植术后骨质疏松发生的敏感度、特异度和准确性良好,其中以术后1年时两个指标联合预测的敏感度(93.75%)、特异度(89.66%)和准确性(91.11%)最高。结论血浆FGF-23、BNP水平与肾移植术治疗患者术后骨质疏松均密切相关,且对其术后骨质疏松的预测价值良好。
Objective To investigate the relationship between plasma levels of fibroblast growth factor 23 (FGF-23) and type-B natriuretic peptide (BNP) and osteoporosis after renal transplantation for the prevention and treatment of osteoporosis after renal transplantation. Methods A retrospective study was conducted to select 45 patients with first-line renal transplantation who had been in Guangzhou General Hospital of Guangzhou Military Command from January 2011 to October 2012 and whose renal function was normal after 3-year follow-up. Thirty healthy volunteers who matched baseline data matched the control group. The levels of plasma FGF-23 and BNP were compared retrospectively. Calculate the incidence of osteoporosis in study group one year after follow-up, compare the level of plasma FGF-23 and BNP in patients with or without osteoporosis, and analyze the relationship between plasma FGF-23 and BNP levels and the incidence of osteoporosis Its predictive value of osteoporosis after renal transplantation. Results Compared with the control group, the levels of plasma FGF-23 and BNP in the study group before renal transplantation were significantly increased (all P <0.01). Compared with the preoperative level, the levels of plasma FGF-23 and BNP in the study group decreased after one year (all P <0.01). One year after follow-up, the incidence of osteoporosis in the study group was 35.56%. Compared with those without osteoporosis, the plasma levels of FGF-23 and BNP in perioperative group were higher in study group with osteoporosis (all P <0.01). Spearman unconditional correlation analysis showed that there was a positive correlation between plasma FGF-23 and BNP levels in the study group and the incidence of osteoporosis after renal transplantation (r = 0.896, P <0.05; r = 0.844, P <0.05). The receiver operating characteristic curve (ROC curve) analysis showed that in the study group, the plasma levels of FGF-23 and BNP in the perioperative period predicted the sensitivity, specificity and accuracy of osteoporosis after renal transplantation. Among them, After 1 year, the sensitivity of the two indicators combined prediction (93.75%), the specificity (89.66%) and the accuracy (91.11%) were the highest. Conclusion The plasma levels of FGF-23 and BNP are closely related to the treatment of postoperative osteoporosis in renal transplant patients, and their predictive value of postoperative osteoporosis is good.