慢性肾病患者血清FGF23和Klotho蛋白与心脏并发症的关系

发布时间：2018-03-21 13:35

本文选题：成纤维细胞生长因子　切入点：Klotho蛋白　出处：《中南大学学报(医学版)》2017年09期 　论文类型：期刊论文

【摘要】：目的:分析维持性血液透析患者血清钙、磷及成纤维细胞生长因子23(fibroblast growth factor,FGF23)、Klotho蛋白水平,探讨慢性肾病矿物质及骨代谢异常(chronic kidney disease-mineral and bone disorder,CKD-MBD)患者血清FGF23、Klotho蛋白水平变化与心血管系统并发症的关系。方法:回顾性分析中南大学湘雅医院CKD-MBD未透析患者(NHD组)、CKD-MBD规律血液透析患者(HD组)及CKD-MBD伴继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)伴腺瘤样增生患者(SHPT组)各60例的MBD及心脏损伤发病情况,比较血液透析对患者病情的影响。同期收集体检中心体检健康的30例对象为对照组,记录其基本情况、收集钙、磷、全段甲状旁腺素(i PTH)等钙磷代谢指标及心脏彩超检查结果。通过酶联免疫吸附试验(enzyme-linked immunosorbent assay,ELISA)检测各组血清FGF23和Klotho蛋白情况,比较各组之间钙磷代谢相关生化指标、左室肥厚、左室扩大及心脏瓣膜异位钙化之间差异,分析上述指标间相关性,明确CKD-MBD患者心血管损伤的相关因素及其与FGF23蛋白和Klotho蛋白水平的关系。结果:维持性血液透析患者尤其是伴有SHPT的血液透析患者血清FGF23水平明显升高,而血清Klotho蛋白水平明显降低(P0.01)。FGF23蛋白水平降低者发生异位钙化风险升高(OR=4.667);Klotho蛋白水平降低者发生心肌肥厚风险升高(OR=3.496)。在慢性肾病患者异位钙化诊断中的血清FGF23蛋白水平ROC曲线下面积为0.778(P0.01);血清Klotho蛋白水平ROC曲线下面积为0.715(P0.01)。结论:血清FGF23增多、Klotho蛋白减少是CKD心脏损伤的危险因素。FGF23和Klotho蛋白可作为诊断和预测CKD-MBD患者心脏异位钙化的临床指标。
[Abstract]:Objective: to analyze the levels of serum calcium, phosphorus and fibroblast growth factor (FGF23) protein in patients with maintenance hemodialysis. To investigate the relationship between the changes of serum FGF23 Klotho protein and cardiovascular system complications in patients with chronic kidney disease-mineral and bone disordern CKD-MBD. Methods: retrospective analysis was made on the changes of CKD-MBD in CKD-MBD patients without dialysis in Xiangya Hospital, Central South University. The incidence of MBD and cardiac injury in 60 patients with regular hemodialysis and 60 patients with secondary hyperparathyroidism and adenomatous hyperplasia. To compare the effect of hemodialysis on the patients' condition. 30 healthy subjects collected from the physical examination center at the same time were taken as the control group, and their basic information was recorded, and calcium and phosphorus were collected. Serum FGF23 and Klotho protein were detected by enzyme linked immunosorbent assay (Elisa), and calcium and phosphorus metabolism indexes were compared between groups, left ventricular hypertrophy, left ventricular hypertrophy (LVH), and left ventricular hypertrophy (LVH) by enzyme linked immunosorbent assay (Elisa). The differences between left ventricular dilatation and cardiac valve ectopic calcification were analyzed. Results: the level of serum FGF23 in maintenance hemodialysis patients, especially in hemodialysis patients with SHPT, was significantly higher than that in patients with SHPT. However, the serum Klotho protein level was significantly decreased in patients with decreased protein level of P0.01U. FGF23. The risk of ectopic calcification was increased. The risk of myocardial hypertrophy was increased in patients with decreased serum Klotho protein level. Serum FGF23 protein hydration in the diagnosis of ectopic calcification in patients with chronic nephropathy. The area under the flat ROC curve was 0.778m P0.01A and the area under the serum Klotho protein level ROC curve was 0.715p0.01.Conclusion: the increase of serum FGF23 and the decrease of Klotho protein are the risk factors of CKD heart injury. FGF23 and Klotho proteins can be used as clinical indexes to diagnose and predict cardiac ectopic calcification in CKD-MBD patients.
【作者单位】：中南大学湘雅医院肾内科;
【基金】：国家自然科学基金(81470933)~~
【分类号】：R54;R692.5

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