CAJ | 학술논문

目的探讨慢性肾脏病(CKD)患者随着肾功能的变化,其成纤维细胞生长因子23(FGF23)与钙磷代谢的关系.方法研究对象为2008年8月至2009年4月在上海交通大学附属第一人民医院肾内科住院的初诊CKD患者72例,按照肾小球滤过率(GFR)水平分为5组,另设健康对照组20例.抽取受试者静脉血并分离血清,以酶联免疫法检测FGF23、25(OH)VitD_3、1,25(OH)2VitD3;全自动生化分析仪测量钙(Ca)、磷(P)、血肌酐(Scr)、尿素氮(BUN)、白蛋白(Alb)水平;免疫放射法测定全段甲状旁腺激素(iPTH).结果 CKD患者血清FGF23水平随GFR降低逐渐升高,在CKD4期和5期时,血FGF23、P、iPTH上升明显.1,25(OH)2VitD3显著下降,与CKD1期差异有统计学意义(均P＜0.05).CKD2～3期与CKD1期的FGF23、P、Ca、iPTH、活性维生素D水平差异均无统计学意义.血Ca、25(OH)VitD_3随着肾功能下降有降低趋势,但各期间差异均无统计学意义.Pearson相关分析显示,CKD1～5期logFGF23与P、logiPTH呈正相关(r=0.653,P＜0.01;r=0.800.P＜0.01).与GFR、1,25(OH)_2VitD_3呈负相关(r=-0.753,P＜0.01;r=-0.265,P＜0.05),与Ca、25(OH)VitD_3无相关.CKD1～3期logFGF23与logiPTH呈正相关(r=0.374,P＜0.05),而与Ca、P、25(OH)VitD3、1,25(OH)2VitD3、GFR均无相关.CKD4～5期log FGF23与P、logiPTH呈正相关(r=0.381,P＜0.05;r=0.515,P＜0.01),与GFR呈负相关(r=-0.654,P＜0.01),与Ca、25(OH)VitD3、1,25(OH)2VitD3无相关.结论随着肾功能减退,血清FGF23、P、iPTH水平逐渐升高,活性维生素D水平逐渐下降,尤以CKD4～5期明显.在肾脏病早期阶段(CKD1～3期)血iPTH水平与FGF23有关.当GFR＜30 ml/min时,肾功能状态、血磷、血iPTH均可影响血FGF23水平.
목적 탐토만성신장병(CKD)환자수착신공능적변화,기성섬유세포생장인자23(FGF23)여개린대사적관계.방법 연구대상위2008년8월지2009년4월재상해교통대학부속제일인민의원신내과주원적초진CKD환자72례,안조신소구려과솔(GFR)수평분위5조,령설건강대조조20례.추취수시자정맥혈병분리혈청,이매련면역법검측FGF23、25(OH)VitD_3、1,25(OH)2VitD3;전자동생화분석의측량개(Ca)、린(P)、혈기항(Scr)、뇨소담(BUN)、백단백(Alb)수평;면역방사법측정전단갑상방선격소(iPTH).결과 CKD환자혈청FGF23수평수GFR강저축점승고,재CKD4기화5기시,혈FGF23、P、iPTH상승명현.1,25(OH)2VitD3현저하강,여CKD1기차이유통계학의의(균P＜0.05).CKD2～3기여CKD1기적FGF23、P、Ca、iPTH、활성유생소D수평차이균무통계학의의.혈Ca、25(OH)VitD_3수착신공능하강유강저추세,단각기간차이균무통계학의의.Pearson상관분석현시,CKD1～5기logFGF23여P、logiPTH정정상관(r=0.653,P＜0.01;r=0.800.P＜0.01).여GFR、1,25(OH)_2VitD_3정부상관(r=-0.753,P＜0.01;r=-0.265,P＜0.05),여Ca、25(OH)VitD_3무상관.CKD1～3기logFGF23여logiPTH정정상관(r=0.374,P＜0.05),이여Ca、P、25(OH)VitD3、1,25(OH)2VitD3、GFR균무상관.CKD4～5기log FGF23여P、logiPTH정정상관(r=0.381,P＜0.05;r=0.515,P＜0.01),여GFR정부상관(r=-0.654,P＜0.01),여Ca、25(OH)VitD3、1,25(OH)2VitD3무상관.결론 수착신공능감퇴,혈청FGF23、P、iPTH수평축점승고,활성유생소D수평축점하강,우이CKD4～5기명현.재신장병조기계단(CKD1～3기)혈iPTH수평여FGF23유관.당GFR＜30 ml/min시,신공능상태、혈린、혈iPTH균가영향혈FGF23수평.
Objective To study the association of fibroblast growth factor 23(FGF23)with calcium(Ca)-phosphorus(P)metabolism and renal function in patients with chronic kidney disease(CKD).Methods Serum samples of 20 healthy people and 72 CKD patients were collected.Patients were divided into five groups according to renal function.Levels of FGF23,25 (OH)VitD_3,and 1,25(OH)_2VitD_3 were measured by ELISA.Intact parathyroid hormone(iPTH)was detected by immunoradiometric assay.Scr,BUN,calcium(C),phosphorus(P)and albumin were assessed by autobiochemistry machine.Results Levels of serum FGF23,P,iPTH increased gradually and 1,25(OH)_2VitD_3 decreased with the decline of renal function,especially in stages 4-5 of CKD,whose differences were significant.Pearson correlation analysis revealed,during CKD1-5 stages,logFGF23 was correlated with P,logiPTH,GFR,1,25(OH)_2VitD_3(r=0.653,P＜0.01;r=0.800,P＜0.01;r=-0.753,P＜0.01;r=-0.265,P＜0.05).During CKD1-3 stage,logFGF23 was positively correlated with logiPTH(r=0.374,P＜0.05)and not correlated with P,GFR,1,25(OH)2VitD3.During CKD4-5 stages,logFGF23 was positively correlated with P,logiPTH(r=0.381,P＜0.05;r=0.515,P＜0.01)and negatively correlated with GFR(r=-0.654,P＜0.01).There were no correlations of logFGF23 with 25(OH)VitD_3 and Ca.Conclusions Levels of serum FGF23,P,iPTH increase and 1,25(OH)_2VitD_3 decreases with the decline of renal function,especially during CKD4-5 stages.The level of FGF23 is associated with iPTH during CKD1-3 stage.When GFR＜30 ml/min,FGF23 level is affected by renal function,phosphorus and iPTH.