目的：探讨慢性肾脏病（ CKD）患者不同分期骨-肾-甲状旁腺轴相关因子水平及相关影响因素。方法选择2012年10月-2013年3月于广西医科大学第一附属医院就诊的符合研究标准的137例CKD非透析患者及35例健康对照者，根据估算肾小球滤过率（ eGFR）将CKD组再分为4组：CKD 1~2期组、CKD 3期组、CKD 4期组、CKD 5期组，比较各组血清成纤维生长因子23（FGF23）、klotho蛋白、1，25-二羟维生素D3〔1，25-（OH）2D3〕、全段甲状旁腺激素（ iPTH ）、血钙、血磷、血碱性磷酸酶（ ALP ）等水平；对 FGF23与各临床指标的相关性行Spearman相关分析，采用多元逐步线性回归分析FGF23的影响因素。结果与对照组比较， CKD 3~5期组FGF23、iPTH、ALP升高，1，25-（OH）2D3降低（P﹤0.05）；与对照组比较，CKD 4~5期组血磷及klotho蛋白升高，血钙降低（P﹤0.05）。FGF23与血磷（r＝0.432，P﹤0.001）、iPTH（r＝0.409，P﹤0.001）、ALP（r＝0.372，P﹤0.001）、klotho蛋白（r＝0.383，P﹤0.001）、平均动脉压（MAP）（r＝0.276，P﹤0.001）呈正相关；与eGFR（r＝-0.600， P﹤0.001）、血钙（r＝-0.192，P＝0.012）、1，25-（OH）2D3（r ＝-0.228，P ＝0.003）、高密度脂蛋白（HDL）（r＝-0.252，P＝0.001）、清蛋白（r＝-0.273，P﹤0.001）、血红蛋白（r＝-0.449，P﹤0.001）呈负相关。多元逐步线性回归显示，eGFR、血磷、klotho 蛋白、HDL对 FGF23的影响有统计学意义。结论 CKD 患者 FGF23、iPTH、ALP、1，25-（OH）2D3水平改变早于血钙、血磷、klotho蛋白；eGFR、血磷、klotho蛋白、HDL是FGF23的独立影响因素。%Objective To investigate the bone-kidney-parathyroid axes related cytokines and its influencing factors in patients with chromic kidney disease( CKD)at different stages. Methods A total of 137 eligible patients at different stages of CKD and 35 healthy subjects visiting this hospital from October 2012 to March 2013 were divided,according to estimated glo-merular filtration rate(eGFR),into groups A(CKD stage 1 ~2),B(CKD stage 3),C(CKD stage 4),D(CKD stage 5). The levels of serum fibroblast growth factor 23(FGF23),klotho protein,1,25-(OH)2D3,intact parathyroid hormone ( iPTH),calcium,phosphorus,serum alkaline phosphatase( ALP)were compared between 4 groups. Spearman regression a-nalysis was used to analyze the correlation of FGF23 with varying clinical indicators,multiple stepwise linear regression analysis to analyze the influencing factors of FGF23. Results FGF23,iPTH,ALP were higher,1,25-(OH)2D3 was lower in groups B,C,D than in control group(P﹤0. 05),serum phosphorus,klotho protein higher,calcium lower in groups C,D than in control group(P﹤0. 05). FGF23 was positively correlated with phosphorus(r=0. 432,P﹤0. 001),iPTH(r=0. 409,P﹤0. 001),ALP(r =0. 372,P ﹤0. 01),klotho protein(r =0. 383,P ﹤0. 001),MAP(r =0. 276,P ﹤0. 001),and negatively with eGFR(r= -0. 600,P﹤0. 001),calcium(r= -0. 192,P=0. 012),1,25-(OH)2D3(r= -0. 228, P=0. 003),HDL(r = -0. 252,P =0. 001),albumin(r = -0. 273,P ﹤0. 001),hemoglobin(r = -0. 449,P ﹤0. 001). Multiple stepwise linear regression analysis that eGFR,phosphorus,klotho protein,HDL were independent influen-cing factors of FGF23. Conclusion The changes of FGF23,iPTH,ALP,1,25(OH)2D3 are earlier than those of calcium, phosphorus,klotho protein;eGFR,phosphorus,klotho protein,HDL are independent influencing factors of FGF23.
展开▼
