慢性肾脏病患者血清FGF23、Klotho与钙磷代谢的关系

发布时间：2018-05-18 21:01

本文选题：慢性肾脏病 + 成纤维细胞生长子23　；参考：《大连医科大学》2017年硕士论文

【摘要】：目的:通过酶联免疫吸附实验(enzyme-linked immunosorbent assay,ELISA)检测慢性肾脏病(chronic kidney diseases,CKD)未透析患者血清成纤维细胞生长子23(fibroblast growth factor-23,FGF23)、Klotho的水平,探讨二者与钙磷代谢指标之间的关系。方法:选取2016年1月1日至2016年12月31日在本院肾内科住院的未透析的CKD患者,共90例。根据肾小球滤过率(estimated glomerular filtration rate,e GFR)将患者分为CKD1期16例、CKD2期11例、CKD3期23例、CKD4期25例、CKD5期15例。收集研究对象的一般临床资料。应用全自动生化分析仪检测血钙、血磷、血清肌酐、血清白蛋白、24h尿电解质等;应用免疫化学荧光法检测全段甲状旁腺激素(intact parathyroidhormone,i PTH);应用ELISA法测定血清FGF23、Klotho、1,25-二羟维生素D3(1,25-(OH)2-Vit D3)的浓度;根据所得数据,计算校正钙、钙磷乘积、尿磷排泄分数(fractional excretion of urine phosphate,Fe Pi),并根据EPI公式计算e GFR。所有数据均用Microsoft Office Excel软件预处理后利用R Language version 3.2.2进行统计分析,P0.05表示差异具有统计学意义。结果:1.从整体上来看,CKD未透析患者FGF23的水平随CKD的进展而升高并且方差分析的结果显示,CKD分期对于FGF23水平的影响具有显著的统计学意义(P=0.042)。与FGF23变化趋势相反,Klotho水平随CKD分期升高而显著降低(P0.000)。在反应钙磷代谢的各项指标中,PTH、血磷、钙磷乘积、尿磷排泄分数等指标的水平随CKD的进展而显著升高,而1,25-二羟维生素D3、血钙、24h尿磷等指标的水平随着CKD进展逐渐降低。2.相关分析结果显示,CKD未透析患者FGF23与Klotho(r=-0.22,P0.05)、1,25-二羟维生素D3水平(r=-0.20,P0.05)之间存在负相关。而Klotho与我们关注的钙磷代谢指标、e GFR均存在显著的相关性,其中,Klotho与1,25-二羟维生素D3(r=0.35,P0.01)、血钙(r=0.25,P0.05)、24h尿磷(r=0.23,P0.05),e GFR(r=0.51,P0.01)呈正相关,而与PTH(r=-0.45,P0.01)、血磷(r=-0.34,P0.01)、钙磷乘积(r=-0.32,P0.01)、尿磷排泄分数(r=-0.43,P0.01)呈负相关。对整体数据进行校正后(剔除CKD2期的数据)进行二次分析,结果显示FGF23与各项指标的相关性,都有一定程度的升高,同时除了与Klotho、1,25-二羟维生素D3的负相关外,FGF23与e GFR(r=-0.27,P0.05)之间也表现出显著的负相关。根据数据可视化结果,从整体变化趋势上来看,FGF23随CKD进展的变化趋势,与PTH、血磷、钙磷乘积、尿磷排泄分数一致,与1,25-二羟维生素D3、血钙、24h尿磷、e GFR相反。3.将FGF23和Klotho数据以中位数为标准,划分为高、低两个水平,比较不同水平之间肾脏钙磷代谢指标之间的差异。结果显示,以不同水平FGF23划分的组别中,各项钙磷代谢指标不存在明显差异,而根据Klotho水平划分的组别中,各项钙磷代谢指标均存在显著的差异。4.剔除CKD2期患者的数据,比较CKD1期、3期、4期、5期未透析患者FGF23、Klotho在不同性别之间的差异。结果显示,FGF23水平在CKD1期、3期、4期、5期未透析患者不同性别中均无显著差异,Klotho水平只有在CKD5期中男性明显高于女性,差异有显著性差异。结论:慢性肾脏病未透析患者FGF23水平随CKD进展逐渐升高,Klotho水平随CKD进展逐渐降低,二者变化存在显著负相关。但是从整体上来看,FGF23随CKD进展的变化趋势,与PTH、血磷、钙磷乘积、尿磷排泄分数一致,与1,25-二羟维生素D3、血钙、24h尿磷、e GFR相反。在CKD患者中Klotho水平,与1,25-二羟维生素D3、血钙、24h尿磷,e GFR正相关,与PTH、血磷、钙磷乘积、尿磷排泄分数呈负相关。
[Abstract]:Objective: to detect the relationship between the serum fibroblast growth rate 23 (fibroblast growth factor-23, FGF23) in patients with chronic renal disease (chronic kidney diseases, CKD) by enzyme-linked immunosorbent assay (ELISA), and to explore the relationship between the two and the calcium and phosphorus metabolism index. Method: 1 in 2016. 90 cases of non dialysis CKD patients hospitalized in the Department of Nephrology from 1 to December 31, 2016 were divided into 16 cases of CKD1 phase according to the glomerular filtration rate (estimated glomerular filtration rate, e GFR), 11 cases in CKD2, 23 cases in CKD3, 25 in CKD4 phase, 15 in CKD5 period. The general clinical data of the study subjects were collected. The automatic biochemical score was used. Blood calcium, blood phosphorus, serum creatinine, serum albumin, 24h urine electrolyte, etc. were detected by an analyzer. The total parathyroid hormone (intact parathyroidhormone, I PTH) was detected by immunofluorescence, and the concentration of serum FGF23, Klotho, 1,25- dihydroxyvitamin D3 (1,25- (OH)) was measured by ELISA, and the correction calcium, calcium and phosphorus multiplication were calculated according to the obtained data. Product, fractional excretion of urine phosphate, Fe Pi, and statistical analysis of E GFR. all data calculated on the basis of EPI formula for e GFR.. The level of CKD increased and the results of variance analysis showed that the effect of CKD staging on FGF23 level had significant statistical significance (P=0.042). Contrary to the FGF23 trend, Klotho level decreased significantly with the increase of CKD staging (P0.000). In the indicators of calcium and phosphorus metabolites, PTH, blood phosphorus, calcium and phosphorus products, urine phosphorus excretion. The level of scores and other indexes increased significantly with the progress of CKD, while the level of 1,25- dihydroxyvitamin D3, blood calcium, 24h urine phosphorus and so on gradually decreased with the progress of.2. correlation analysis showed that there was a negative correlation between FGF23 and Klotho (r=-0.22, P0.05) and 1,25- dihydroxyvitamin levels in CKD non dialysis patients. There is a significant correlation between E GFR and Klotho and 1,25- dihydroxyvitamin D3 (r=0.35, P0.01), blood calcium (r=0.25, P0.05), 24h urinary phosphorus (r=0.23, P0.05). 01) negative correlation. After the correction of the overall data (excluding the CKD2 period data) for two analysis, the results show that the correlation between FGF23 and various indicators has a certain degree of increase, and in addition to the negative correlation with Klotho, 1,25- dihydroxyvitamin D3, FGF23 and E GFR (R =-0.27, P0.05) also showed significant negative correlation. According to the data, Visual results, from the overall trend of change, FGF23 changes with CKD, and PTH, blood phosphorus, calcium and phosphorus product, urine phosphorus excretion score, and 1,25- dihydroxyvitamin D3, calcium, 24h urine phosphorus, e GFR in the opposite.3., the median of FGF23 and Klotho data is divided into high, low two levels, and the comparison of different levels of kidney calcium and phosphorus between the different levels The difference between metabolic indices showed that there was no significant difference in calcium and phosphorus metabolism in groups with different levels of FGF23, and there were significant differences in calcium and phosphorus metabolism indices according to the Klotho level in groups divided by.4. to eliminate CKD2 patients, compared to CKD1, 3, 4, and 5 stage non dialysis patients FGF23, Klot The difference between ho in different sexes showed that there was no significant difference in FGF23 level in CKD1, 3, 4, and 5 non dialysis patients. The level of Klotho was significantly higher than that of women in the CKD5 stage. The difference was significant. Conclusion: the level of FGF23 in the patients with chronic renal disease was gradually increased with the progression of CKD and Klotho level. As CKD progresses gradually, there is a significant negative correlation between the two changes. But on the whole, the change trend of FGF23 with CKD is the same as PTH, the product of blood phosphorus, calcium and phosphorus, and the opposite of 1,25- dihydroxyvitamin D3, blood calcium, 24h phosphorous, e GFR. R was positively correlated, negatively correlated with PTH, blood phosphorus, calcium phosphorus production and urinary phosphorus excretion fraction.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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