中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2014年
1期
11-15
,共5页
刘红%常明%刘书馨%刘佳%关美玉
劉紅%常明%劉書馨%劉佳%關美玉
류홍%상명%류서형%류가%관미옥
尿毒症%成纤维细胞生长因子%高通量血液透析%内皮依赖性血管舒张功能
尿毒癥%成纖維細胞生長因子%高通量血液透析%內皮依賴性血管舒張功能
뇨독증%성섬유세포생장인자%고통량혈액투석%내피의뢰성혈관서장공능
Uremia%Fibroblast growth factor%High-flux hemodialysis%Endothelium-dependent vasodilation
目的 研究高通量血液透析(HFD)对维持性血液透析(MHD)患者成纤维细胞生长因子23(FGF-23)水平的影响及其相关的临床意义.方法 60例MHD患者分为高通量血液透析(HFD)组及普通血液透析(HD)组各30例,治疗12个月.采用高分辨彩色多普勒检测两组患者治疗前后肱动脉血流介导的血管扩张功能(FMD)及心脏超声,同时检测同期患者透前的血清FGF-23、钙、磷、25(OH)D3、甲状旁腺激素(PTH)、白介素-6(IL-6)、同型半胱氨酸(Hcy)水平.观察FMD、心脏超声与各临床指标的变化情况并进行相关性分析.结果 两组患者年龄、性别、原发病、透析龄等相匹配.与治疗前相比,HFD组治疗后FGF-23水平显著降低[(56.07±26.63)比(85.53±40.54) ng/L,P＜0.01],同时IL-6[(3.37±2.48)比(5.59±2.53) ng/L,P＜ 0.05]、Hcy[(21.13±6.95)比(29.40± 11.66) μmol/L,P＜0.05]水平降低,25 (OH)D3水平升高[(27.3±10.26)比(23.15±10.73) μg/L,P＜0.05].HD组治疗前后各指标差异无统计学意义.HFD组治疗后FMD升高,HD组治疗前后FMD差异无统计学意义.相关性分析显示基线FMD水平与FGF-23呈负相关(r=-0.413,P＜0.05),与Hcy呈负相关(r=-0.301,P＜0.05);基线LVMI与FGF-23呈正相关(r=0.464,P＜0.05).治疗1年后HFD组FMD变化(△FMD)与FGF-23变化(△FGF-23)呈负相关(r=-0.347,P＜0.05).结论 HFD改善了MHD患者血管内皮功能,降低了心血管疾病的重要危险因素FGF-23水平,对改善患者心血管疾病的预后可能有一定的益处.HFD对MHD患者血管内皮功能的改善可能与FGF-23水平降低有关,而FGF-23对血管内皮功能的影响独立于对血磷水平的调节.
目的 研究高通量血液透析(HFD)對維持性血液透析(MHD)患者成纖維細胞生長因子23(FGF-23)水平的影響及其相關的臨床意義.方法 60例MHD患者分為高通量血液透析(HFD)組及普通血液透析(HD)組各30例,治療12箇月.採用高分辨綵色多普勒檢測兩組患者治療前後肱動脈血流介導的血管擴張功能(FMD)及心髒超聲,同時檢測同期患者透前的血清FGF-23、鈣、燐、25(OH)D3、甲狀徬腺激素(PTH)、白介素-6(IL-6)、同型半胱氨痠(Hcy)水平.觀察FMD、心髒超聲與各臨床指標的變化情況併進行相關性分析.結果 兩組患者年齡、性彆、原髮病、透析齡等相匹配.與治療前相比,HFD組治療後FGF-23水平顯著降低[(56.07±26.63)比(85.53±40.54) ng/L,P＜0.01],同時IL-6[(3.37±2.48)比(5.59±2.53) ng/L,P＜ 0.05]、Hcy[(21.13±6.95)比(29.40± 11.66) μmol/L,P＜0.05]水平降低,25 (OH)D3水平升高[(27.3±10.26)比(23.15±10.73) μg/L,P＜0.05].HD組治療前後各指標差異無統計學意義.HFD組治療後FMD升高,HD組治療前後FMD差異無統計學意義.相關性分析顯示基線FMD水平與FGF-23呈負相關(r=-0.413,P＜0.05),與Hcy呈負相關(r=-0.301,P＜0.05);基線LVMI與FGF-23呈正相關(r=0.464,P＜0.05).治療1年後HFD組FMD變化(△FMD)與FGF-23變化(△FGF-23)呈負相關(r=-0.347,P＜0.05).結論 HFD改善瞭MHD患者血管內皮功能,降低瞭心血管疾病的重要危險因素FGF-23水平,對改善患者心血管疾病的預後可能有一定的益處.HFD對MHD患者血管內皮功能的改善可能與FGF-23水平降低有關,而FGF-23對血管內皮功能的影響獨立于對血燐水平的調節.
목적 연구고통량혈액투석(HFD)대유지성혈액투석(MHD)환자성섬유세포생장인자23(FGF-23)수평적영향급기상관적림상의의.방법 60례MHD환자분위고통량혈액투석(HFD)조급보통혈액투석(HD)조각30례,치료12개월.채용고분변채색다보륵검측량조환자치료전후굉동맥혈류개도적혈관확장공능(FMD)급심장초성,동시검측동기환자투전적혈청FGF-23、개、린、25(OH)D3、갑상방선격소(PTH)、백개소-6(IL-6)、동형반광안산(Hcy)수평.관찰FMD、심장초성여각림상지표적변화정황병진행상관성분석.결과 량조환자년령、성별、원발병、투석령등상필배.여치료전상비,HFD조치료후FGF-23수평현저강저[(56.07±26.63)비(85.53±40.54) ng/L,P＜0.01],동시IL-6[(3.37±2.48)비(5.59±2.53) ng/L,P＜ 0.05]、Hcy[(21.13±6.95)비(29.40± 11.66) μmol/L,P＜0.05]수평강저,25 (OH)D3수평승고[(27.3±10.26)비(23.15±10.73) μg/L,P＜0.05].HD조치료전후각지표차이무통계학의의.HFD조치료후FMD승고,HD조치료전후FMD차이무통계학의의.상관성분석현시기선FMD수평여FGF-23정부상관(r=-0.413,P＜0.05),여Hcy정부상관(r=-0.301,P＜0.05);기선LVMI여FGF-23정정상관(r=0.464,P＜0.05).치료1년후HFD조FMD변화(△FMD)여FGF-23변화(△FGF-23)정부상관(r=-0.347,P＜0.05).결론 HFD개선료MHD환자혈관내피공능,강저료심혈관질병적중요위험인소FGF-23수평,대개선환자심혈관질병적예후가능유일정적익처.HFD대MHD환자혈관내피공능적개선가능여FGF-23수평강저유관,이FGF-23대혈관내피공능적영향독립우대혈린수평적조절.
Objective To investigate the effects of high-flux hemodialysis (HFD) on fibroblast growth factor-23 (FGF-23) levels in maintenance hemodialysis (MHD) patients and its clinical significance.Methods Sixty uremia patients were divided into HFD group and hemodialysis (HD)group and observed for 12 months.Flow mediated dilation (FMD),cardiac ultrasonography,levels of FGF-23,serum phosphorus,serum calcium,25-(OH)D3,parathyroid hormone (PTH),homocysteine (Hcy) and interleukin-6 (IL-6) were tested in all patients before and after treatment.The correlation of above indexes were analyzed.Results No statistical difference were found in primary disease,age and duration of dialysis in two groups.The levels of FGF-23 [(56.07±26.63) vs (85.53±40.54) ng/L,P ＜0.01],IL-6 [(3.37±2.48) vs (5.59±2.53) ng/L,P ＜ 0.05] and Hcy [(21.13±6.95) vs (29.40±11.66) μmol/L,P ＜ 0.05] decreased and FMD,25-(OH)D3 [(27.3± 10.26) vs (23.15± 10.73) μg/L,P ＜ 0.05] increased significantly after the treatment of HFD.There were no significant changes in the HD group.The baseline FMD was negatively correlated with FGF-23 (r =-0.413,P ＜ 0.05) and Hcy (r =-0.301,P ＜0.05).The baseline LVMI was correlated with FGF-23 (r =0.464 P ＜ 0.05).After one year's trearmeat of HFD,the changes of FMD(/△ FMD) was negatively correlated with the changes of FGF-23 (/△ FGF-23)(r =-0.347,P ＜ 0.05).Conclusions HFD can improve FMD and decrease FGF-23 levels.The improvement of FMD may be related to the decreased level of FGF-23.The effect of FGF-23 on FMD should be independent of serum phosphate.
