CAJ | 학술논문

目的：观察慢性肾衰竭患者血液净化治疗前后血清成纤维细胞生长因子23（ FGF23）水平变化。方法选取维持性血液透析3个月以上的慢性肾衰竭患者80例（实验组），根据血液净化模式的不同将实验组患者分为三组：血液透析（ HD）组，每周HD治疗3次；HD＋血液透析滤过（ HDF）组，每周HD 2次、HDF 1次；HD＋血液灌流（ HP）组，每周HD 2次、HD＋HP 1次；血液净化治疗均8周，并于血液净化治疗开始（血液净化治疗前）及治疗8周结束时（血液净化治疗后）空腹抽取静脉血，测定血清FGF23、甲状旁腺激素（PTH）、1，25（OH）2D3及血清肌酐（ SCr）、血尿素氮（ BUN）、钙（ Ca）、磷（ P）。以52例健康体检者作对照（对照组）。结果实验组血液净化治疗前血清FGF23、PTH、SCr、BUN、P水平较对照组升高，1，25（OH）2D3水平降低，两组相比，P均＜0．05；实验组血清FGF23与PTH、BUN、SCr、P水平及透析龄呈正相关（r分别为0．544、0．379、0．318、0．408、0．300，P均＜0．05），血清FGF23水平是PTH、P、BUN水平的独立影响因素，P均＜0．05。 HD＋HDF组、 HD＋HP组治疗前后FGF23、PTH水平相比，P均＜0．05。结论慢性肾衰竭患者体内FGF23水平明显升高，并与PTH、BUN、SCr、P水平及透析龄呈正相关关系， HD＋HDF、HD＋HP两种模式治疗后患者血清FGF23水平降低。
목적：관찰만성신쇠갈환자혈액정화치료전후혈청성섬유세포생장인자23（ FGF23）수평변화。방법선취유지성혈액투석3개월이상적만성신쇠갈환자80례（실험조），근거혈액정화모식적불동장실험조환자분위삼조：혈액투석（ HD）조，매주HD치료3차；HD＋혈액투석려과（ HDF）조，매주HD 2차、HDF 1차；HD＋혈액관류（ HP）조，매주HD 2차、HD＋HP 1차；혈액정화치료균8주，병우혈액정화치료개시（혈액정화치료전）급치료8주결속시（혈액정화치료후）공복추취정맥혈，측정혈청FGF23、갑상방선격소（PTH）、1，25（OH）2D3급혈청기항（ SCr）、혈뇨소담（ BUN）、개（ Ca）、린（ P）。이52례건강체검자작대조（대조조）。결과실험조혈액정화치료전혈청FGF23、PTH、SCr、BUN、P수평교대조조승고，1，25（OH）2D3수평강저，량조상비，P균＜0．05；실험조혈청FGF23여PTH、BUN、SCr、P수평급투석령정정상관（r분별위0．544、0．379、0．318、0．408、0．300，P균＜0．05），혈청FGF23수평시PTH、P、BUN수평적독립영향인소，P균＜0．05。 HD＋HDF조、 HD＋HP조치료전후FGF23、PTH수평상비，P균＜0．05。결론만성신쇠갈환자체내FGF23수평명현승고，병여PTH、BUN、SCr、P수평급투석령정정상관관계， HD＋HDF、HD＋HP량충모식치료후환자혈청FGF23수평강저。
Objective To investigate the changes of FGF 23 levels in patients which chronic renal failure before and after blood purification .Methods 80 patients were recruited with maintenance hemodialysis duration >3 months.Ac-cording to the mode of blood purification treatment , the patients were divided into three groups:which were HD ( three times a week for HD), HD+HDF(twice a week for HD, once a week for HDF), and HD+HP(twice a week for HD, once a week for HD+HP) randomly based on treatment mode of blood purification as eight weeks .FGF23, PTH, 1,25(OH)2D3 and SCr, BUN, Ca, P in fasting venous blood were determined when beginning and finishing the experiment in test group . The above-mentioned indexes were also detected in venous blood collected on empty stomach in control group .Results FGF23, PTH, SCr, BUN, Phosphate in test group before blood purification was obviously higher than the control group , and the level of 1,25(OH)2D3 was lower(P<0.05).FGF23 of the test group had a positive correlation with PTH , BUN, SCr, phosphate and dialysis period(r were 0.544, 0.379, 0.318, 0.408, 0.3, P<0.05).The level of serum FGF23 was that the independent factor which affected the level of P , BUN and PTH, they had statistical significance .Before and after treament, both the group of HD+HDF and HD+HP had statistical significance in the level of FGF 23 and PTH.Con-clusions The level of FGF23 distinctly elevates in the patients with chronic renal failure , and has a positive correlation with PTH, BUN, SCr, phosphate and dialysis period .The high level of FGF23 declines sharply after HD+HDF and HD+HP procedure .