摘要
目的探讨慢性肾脏病(chronic kidney disease,CKD)患者血清Klotho水平与肾功能进展的关系,明确血清中Klotho水平是否可以作为CKD患者肾功能进展的预测因子。方法选取261例于2015年3-11月在我院肾内科住院的原发性CKD 3~5期非透析患者,采用ELISA检测患者血清Klotho水平,按血清Klotho水平三分位法将CKD患者分为低水平(<469.26 pg/mL)、中水平(469.26 pg/mL≤Klotho水平<844.55 pg/mL)和高水平(≥844.55 pg/mL)Klotho 3组人群,肾功能进展定义为发生肾脏终点事件,采用Kaplan-Meier生存分析比较各组生存时间,Cox比例风险模型探讨与CKD患者肾功能进展相关的危险因素。结果平均随访42.7个月,总计190例(72.80%)患者发生肾脏终点事件。患者血清Klotho水平与估算的肾小球滤过率(estimated glomerular filtration rate,eGFR)呈显著正相关(r=0.567,P<0.001)。同时,不同血清Klotho水平组患者间的血钙、血磷、甲状旁腺激素和血红蛋白水平差异具有统计学意义(P<0.001)。Kaplan-Meier生存分析发现:血清Klotho水平越低,进展到肾脏终点事件所需时间越短。而Cox回归分析发现:与高血清Klotho水平组相比,低、中Klotho水平组发生肾脏终点事件风险显著增加,其风险分别增加3.3、1.1倍;纳入多个因素进行模型校正后,低血清Klotho水平组发生肾脏终点事件风险仍增加,其风险是高血清Klotho水平组2.401倍。结论 CKD患者血清Klotho水平与肾脏终点事件发生密切相关,血清Klotho水平可作为CKD患者肾功能进展的预测指标。
Objective To investigate the association of serum klotho level with renal function deterioration and whether serum klotho level can be used as a predictor of progression of chronic kidney disease(CKD) into renal end point events. Methods We examined serum klotho protein level using ELISA in 261 patients with primary chronic kidney disease stages 3~5 hospitalized in our department between March and November 2015. Kaplan-Meier survival analysis was used to compare the survival time of the patients with low(<469.26 pg/mL), medium(469.26-844.55 pg/mL) and high(≥844.55 pg/mL) levels of klotho;Cox regression analysis was performed to assess the risk factors associated with the outcomes of the patients. Results During a mean follow-up for 42.7 months, 190(72.80%) out of the 261 patients with CKD developed renal end point events. Serum klotho level showed a significant positive correlation with estimated glomerular filtration rate(eGFR) of the patients(r=0.567, P<0.001). The patients with different serum klotho levels had significant differences in serum levels of calcium, phosphorus, parathyroid hormone(PTH) and hemoglobin(P<0.001). Kaplan-Meier survival analysis showed that a low serum level of klotho was associated with a shorter time for CKD to progress into renal end point events. Cox regression analysis revealed that compared with the patients with a high level of klotho, the patients with low and medium serum levels of klotho had significantly increased risks for developing renal end point events by 3.3 and 1.1 folds, respectively;after adjustment for multiple factors, the risk for renal end point events was still high in low klotho level group(2.401 times that in high klotho level group). Conclusion We confirm that serum klotho level is closely related to the occurrence of renal end point events in CKD patients, and serum klotho level is a predictor of the renal function progression in CKD patients.
作者
杨江信
熊加川
杨可
赵景宏
YANG Jiangxin;XIONG Jiachuan;YANG Ke;ZHAO Jinghong(Department of Nephrology,Chongqing Key Laboratory for Prevention and Treatment of Chronic Kidney Disease,Kidney Disease Center,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037,China)
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2020年第2期154-161,共8页
Journal of Third Military Medical University
基金
国家自然科学基金面上项目(81873605)~~
