摘要
目的探讨成纤维细胞生长因子23（fibroblast growth factor-23,FGF23）与慢性肾脏病（chronic kidney disease,CKD）患者冠状动脉钙化发生和预后的关系。方法入选2010年4月-12月上海交通大学医学院附属仁济医院肾脏科CKD非透析（CKD 3-5期）、腹膜透析和血液透析患者共150例,分析FGF23浓度与冠脉钙化的关系。并对这些患者进行为期（35±3）个月的随访,记录心血管和死亡事件。结果 CKD中晚期患者血清FGF23水平显著高于健康对照组（P〈0.01）。血清FGF23水平与冠脉钙化分数（CaS）之间呈显著正相关（r=0.177,P〈0.05）。Logistic回归分析显示年龄、透析龄和FGF23水平是CKD中晚期患者发生冠脉钙化的独立危险因素。Kaplan-Meier生存曲线提示FGF23水平较高的患者CVD发生率（P〈0.01）及全因死亡率（P〈0.05）显著高于FGF23水平较低的患者。Cox回归分析显示FGF23≥675.8pg/ml和冠脉明显钙化（冠脉CaS〉400）是患者发生CVD的独立危险因素。而FGF23水平和冠脉明显钙化（冠脉CaS〉400）是患者全因死亡的独立危险因素。结论 CKD中晚期患者的血清FGF23水平较普通人群显著增高,FGF23与CKD中晚期患者的冠脉钙化发生及不良预后可能相关。
Objective To elucidate the relationship between fibroblast growth factor-23（FGF23） and coronary artery calcification,and the prognostic value of FGF23 in chronic kidney disease（CKD） patients at moderate to advanced stage.Methods The relationship between FGF23 and coronary artery calcification was evaluated.Patients were followed up for 35±3 months,and the occurrence of cardiovascular disease（CVD） and death were recorded.Results Serum FGF23 level was significantly higher in CKD patients than in healthy controls（P〈0.01）,Serum FGF23 level was positively correlated with coronary artery calcification score（CaS）（r=0.177,P〈0.05）.Logistic regression analysis showed that age,dialysis duration and FGF23 level were the independent risk factors for coronary artery calcification in CKD patients at moderate to advanced stage.Kaplan-Meier survival curves showed that patients with FGF23 levels≥675.8pg/ml had significantly higher CVD incidence rate（P〈0.01） and all-cause mortality（P〈0.05） than those with FGF23 levels below the cut-off value.Cox regression analysis showed that FGF23≥675.8pg/ml and severe coronary artery calcification（CaS400） were the independent risk factors for CVD in CKD patients,and that FGF23 level and severe coronary artery calcification（CaS400） were the independent risk factors for all-cause mortality in CKD patients.Conclusion Serum FGF23 level in CKD patients at moderate to advanced stage was significantly higher than that in normal population.Serum FGF23 level may relate to coronary artery calcification and adverse clinical outcomes in CKD patients at moderate to advanced stage.
出处
《中国血液净化》
2013年第10期547-551,560,共6页
Chinese Journal of Blood Purification
基金
上海市卫生局基金(2009Y030)
973课题资助(No.2012CB517602)
十二五国家科技支撑计划(2011BAI10B04)
十二五国家科技支撑计划(2011BAI10B08)
上海市科委基础重点项目资金资助(10JC1410100)
关键词
成纤维细胞生长因子23
慢性肾脏病
中晚期
冠状动脉钙化
预后
Fibroblast growth factor-23
Moderate to advanced stage chronic kidney diseases
Coronary artery calcification
Prognosis
