血透患者成纤维细胞生长因子23与甲状旁腺激素相关性分析

发布时间：2018-02-28 09:06

本文关键词： 血液透析成纤维细胞生长因子23 甲状旁腺激素　出处：《山西医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：目的：观察慢性肾衰竭维持性血液透析（maintenance hemodialysis,MHD）患者血清成纤维细胞生长因子23（fibroblast growth factor23,FGF-23）及全段甲状旁腺激素(intact parathyroid hormone,iPTH)的水平，分析FGF23水平与iPTH等影响因素的相关性，探讨FGF-23对慢性肾衰竭SHPT患者的临床意义，为MHD患者甲状旁腺功能异常的早期防治探索一种更有效、更安全的方法。方法：选取2012年6月至2013年6月在中日友好医院规律血液透析（每周透析3次，每次4小时）≥3个月，年龄在18岁-70岁的血液透析患者41名，另选择健康志愿者12名为对照组，记录一般情况及生化指标，采集血清检测FGF-23及iPTH并行相关分析。结果：（1）慢性肾衰竭MHD各组与对照组在年龄及性别均无显著差异，但MHD患者FGF-23显著高于对照组（1077.4±967.46pg/ml比73.99±19.58pg/ml，P0.001）；（2）依据iPTH不同将MHD分为A组(低iPTH组)、B组(iPTH达标组)、C组(高iPTH组)，FGF-23在三组间有显著性差异（分别为477.44±2293.53pg/ml、176.57±402.39pg/ml、1433.1±1984.76pg/ml，P=0.016）；（3）高iPTH组按是否有面部骨骼畸形分为两个亚组即C1组（单纯高iPTH组）及C2组（高iPTH伴骨骼畸形组），两组间FGF23无显著性差异（P0.05）；（4）MHD患者根据血磷水平不同再次进行分组，高血磷组与非高血磷组相比，iPTH水平显著升高1319.66±1015.96pg/ml比583.36±980.81pg/m（lP=0.012）、相同地FGF-23也明显升高1506.83±957.97pg/ml比452.31±696.12pg/m（lP0.001）；(5)行相关性分析显示：FGF-23与iPTH在B组、C组呈正相关（r=0.736，P=0.005），而在A组无相关性；FGF-23与血钙（r=0.381，P=0.005）、磷（r=0.749，P0.001）、钙磷乘积（r=0.656，P0.001）及碱性磷酸酶（Alkaline phosphatase，ALP）（r=0.276，P=0.045）均呈正相关。结论：MHD患者血FGF-23较健康志愿者明显增高，与SHPT患者的iPTH相关，，并与血钙、血磷、钙磷乘积、ALP相关，其中与血磷的关系最为密切。FGF-23可能在SHPT的发生、发展中起着重要作用，并有可能成为慢性肾衰竭SHPT新的诊断及治疗靶点。
[Abstract]:Objective: to observe the levels of serum fibroblast growth factor 23 (FGF-23) and total parathyroid hormone (PTH) in maintenance hemodialysis patients with chronic renal failure (CRF), and to analyze the correlation between FGF23 level and iPTH. To explore the clinical significance of FGF-23 in SHPT patients with chronic renal failure and to explore a more effective and safe method for the early prevention and treatment of parathyroid dysfunction in MHD patients. Methods: from June 2012 to June 2013, 41 hemodialysis patients aged from 18 to 70 years were selected for hemodialysis (3 times a week, 4 hours per week) in China-Japan Friendship Hospital. In addition, 12 healthy volunteers were selected as the control group. The general situation and biochemical indexes were recorded, and the serum samples were collected to detect FGF-23 and iPTH. Results (1) there was no significant difference in age and sex between MHD group and control group. But the FGF-23 of MHD patients was significantly higher than that of control group (1077.4 卤967.46 PG / ml vs 73.99 卤19.58 PG / ml P 0.001g / ml). According to iPTH, the patients with MHD were divided into A group (low iPTH group and B group). (high iPTH group FGF-23 had significant difference between the three groups (477.44 卤2293.53 PG / ml 176.57 卤402.39pgml1433.1 卤1984.76pg / ml P 0.016).). The patients were divided into two subgroups: C1 group (simple high iPTH group) and C2 group (high iPTH with bone deformity group). There was no significant difference in FGF23 between the two groups. The level of FGF-23 in hyperphosphorous group was significantly higher than that in non-hyperphosphorous group (1319.66 卤1015.96 PG / ml vs 583.36 卤980.81 PG / ml vs 583.36 卤980.81pg / ml 0.012g / ml), and the FGF-23 was also significantly increased by 1506.83 卤957.97pggml / ml / 452.31 卤696.12pgmlP0.001g / ml (452.31 卤696.12pgP0.001g / ml). The correlation analysis showed that there was a positive correlation between FGF-23 and iPTH in group B (0.736P0.005), but there was no correlation between FGF-23 and serum calcium (0.381g / g / ml). There was a positive correlation between Ca ~ (2 +) ~ (P ~ (2 +)) and Alkaline phosphatase (ALP ~ (0.276) P ~ (0.045)). Conclusion the blood FGF-23 of the patients with SHPT is significantly higher than that of the healthy volunteers, and is related to the iPTH of the patients with SHPT, and to the serum calcium, phosphorus, calcium and phosphorus products. FGF-23 may play an important role in the occurrence and development of SHPT. And may become a new diagnosis and treatment target of chronic renal failure (SHPT).
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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