维持性血液透析患者血清FGF-23、Klotho蛋白与跟骨骨密度下降的相关性研究

发布时间：2018-05-08 10:22

本文选题：维持性血液透析 + Klotho蛋白　；参考：《西南医科大学》2017年硕士论文

【摘要】：目的:研究维持性血液透析(MHD)患者血清FGF-23、Klotho蛋白水平与跟骨骨密度(BMD)下降的相关性,为MHD患者BMD情况的评估探寻新的标志物,为MHD患者骨质疏松的干预治疗提供新的靶点。方法:(1)纳入69例(男36例,女33例)2016年9月~10月于内江市第二人民医院血液净化中心接受MHD治疗的终末期肾病患者为病例组(A组),采用超声定量法检测MHD患者跟骨BMD的相关指标——骨质指数(BQI)和T值,进一步参照世界卫生组织(WHO)推荐的诊断标准,将MHD患者分为骨量正常组(A1组)、骨量减少组(A2组)、骨质疏松组(A3组);选取36例2016年9月~10月于内江市第二人民医院体检中心行健康体检的,超声定量法检测跟骨BMD正常的健康志愿者为对照组(B组)。(2)收集入选病例组的性别、年龄、透析治疗时间等一般临床资料,检测肌酐、尿素氮、钙、磷及PTH等临床指标。(3)采集A组和B组的血液标本,采用ELISA法检测A、B两组受试者的血清FGF-23、Klotho蛋白、1,25(OH)2D水平。(4)比较A组和B组研究对象的血清FGF-23、Klotho、1,25(OH)2D蛋白水平;分析MHD患者血清FGF-23、Klotho蛋白水平与PTH、1,25(OH)2D、Ca、P等临床指标的相关性;分析MHD患者BMD相关指标——BQI和T值与血清FGF-23、Klotho蛋白水平之间的相关性;分析MHD患者跟骨BMD下降的相关影响因素。结果:(1)69例MHD患者中,跟骨BMD下降的发生率高达78%,包括骨量减少者36例(52%),骨质疏松者18例(26%)。(2)经两独立样本t检验,A组血清Klotho蛋白水平较B组明显降低(P0.001),A组血清FGF-23、1,25(OH)2D水平较B组明显升高(P0.001);进一步采用方差分析,A1组、A2组和A3组血清Klotho蛋白水平均明显低于B组,A1组、A2组和A3组血清FGF-23、1,25(OH)2D水平均明显高于B组,上述差异均有统计意义(P0.001)。(3)A1组、A2组、A3组之间,年龄逐渐增大,Klotho蛋白、BQI逐渐降低,骨密度T值的负值逐渐增大,经方差分析,三组之间年龄、Klotho蛋白、BQI、T值4项指标的差异有统计学意义(P0.05)。(4)经pearson相关性分析:MHD患者血清Klotho蛋白水平与各项血液指标均无相关性(P0.05);血清FGF-23水平与Ca(r=0.43,P0.001)、P(r=0.36,P=0.002)呈正相关。(5)经pearson相关性分析:MHD患者BQI与年龄(r=-0.50,P0.001)、治疗时间(r=-0.29,P=0.016)、Klotho蛋白(r=0.58,P0.001)具有相关性,T值与年龄(r=-0.49,P0.001)、治疗时间(r=-0.28,P=0.017)、Klotho蛋白(r=0.55,P0.001)具有相关性,年龄、治疗时间与跟骨BMD呈负相关,血清Klotho蛋白水平与跟骨BMD呈正相关。(6)采用二分类logisitc回归分析显示:年龄增加是MHD患者跟骨BMD下降的危险因素(OR=1.05,P=0.021),Klotho蛋白降低为MHD患者跟骨BMD下降的危险因素(OR=2.43,P=0.002)。结论:(1)MHD患者跟骨BMD下降的发生率高;(2)MHD患者血清FGF-23与钙磷代谢有关,但本研究未发现MHD患者血清FGF-23水平与跟骨骨密度有相关性;(3)血清Klotho蛋白是MHD患者跟骨BMD下降的保护性因素;(4)年龄增加是MHD患者跟骨BMD下降的危险性因素。
[Abstract]:Objective: to study the relationship between the decrease of serum FGF-23 Klotho protein level and calcaneal bone density (BMD) in patients with maintenance hemodialysis (HD), and to explore a new marker for the evaluation of BMD in patients with MHD, and to provide a new target for the intervention therapy of osteoporosis in MHD patients. Methods 69 cases (36 males) were included in the study. From September to October 2016, patients with end-stage nephropathy treated with MHD in the blood purification center of the second people's Hospital of Neijiang City were selected as group A. Bone mass index (BQI) and T value of calcaneal BMD in MHD patients were measured by ultrasound quantitative method. Referring further to the diagnostic criteria recommended by the World Health Organization (WHO), The patients with MHD were divided into normal bone mass group (group A 1), bone mass reduction group (group A 2) and osteoporosis group (group A 3). 36 patients were selected for health examination from September to October 2016 at the physical examination center of the second people's Hospital of Neijiang City. The healthy volunteers with normal calcaneal BMD were collected gender, age, dialysis treatment time and other general clinical data, and creatinine, urea nitrogen, calcium were detected. Serum FGF-23Klotho protein (FGF-23Klotho protein) was measured by ELISA method. The serum FGF-23Klotho protein level was compared between group A and group B (group A and B). To analyze the correlation between serum FGF-23 Klotho protein level and clinical indexes such as PTHF-23 OH2DX CaP, the correlation between BQI and T values and serum FGF-23 Klotho protein level in patients with MHD, and the influencing factors of BMD decrease in calcaneal bone of MHD patients. Results in 69 patients with MHD, The incidence of decrease of BMD in calcaneus was as high as 78%, including 36 cases of osteopenia and 18 cases of osteoporosis. The serum Klotho protein level of group A was significantly lower than that of group B by t test of two independent samples, and the level of OH2D of group A was significantly higher than that of group B (P 0.001). The levels of serum Klotho protein in group A 1 and group A 3 were significantly lower than those in group B, group A 1 and group A 3, respectively, and the levels of serum FGF-23A 2 and group A 3 were significantly higher than those in group B, and the levels of serum Klotho protein in group A 1 and group A 3 were significantly higher than those in group B. All the above differences were statistically significant. The age of BQI of Klotho protein and the negative value of bone mineral density (BMD) increased between A3 group and A3 group (P 0.001), and the variance analysis showed that the BQI of Klotho protein decreased gradually, and the T value of bone mineral density (BMD) increased gradually by ANOVA. The difference of BQI T value of Klotho protein between the three groups was statistically significant (P 0.05). By pearson correlation analysis, there was no correlation between the serum Klotho protein level and the blood indexes in the patients with pearson. There was no correlation between the serum Klotho protein level and the blood index (P 0.05); the level of serum FGF-23 was positively correlated with the serum Klotho protein level and the serum FGF-23 level was positively correlated with the Cahrrn 0.43P 0.001Pr0.36 P0. 002) by the pearson phase. Correlation analysis showed that BQI was correlated with age (r = -0.50) and age (n = 0.50) P 0.001 (r = 0.29) and Klotho protein (r = 0.58 / P 0.001). There was a correlation between T value and age (r = -0.49 / P 0.001, r = -0.28 / 0. 017P = 0. 05 / P 0. 001), and there was a significant correlation between BQI and age (r = 0. 49 ~ 0. 49 / P ~ 0. 001, r = 0. 05 / P 0. 001). Age and duration of treatment were negatively correlated with calcaneal BMD. Serum Klotho protein level was positively correlated with calcaneal BMD. (6) using two classification logisitc regression analysis, the results showed that age increase was the risk factor of decreased calcaneal BMD in MHD patients. Conclusion the incidence of decreased calcaneal BMD in patients with MHD is higher than that in patients with MHD. Serum FGF-23 is related to calcium and phosphorus metabolism. However, there was no correlation between serum FGF-23 level and calcaneal bone mineral density in patients with MHD. (3) Serum Klotho protein was the protective factor of BMD decrease in MHD patients.
【学位授予单位】：西南医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

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