To detect the serum level of FGF23 in CKD subjects with various degree of renal function and analyze the relationship between FGF23 and other biochemical parameters to explore the significance of serum FGF23 on mineral metabolism disorder in patients with CKD. Methodology: Intact serum FCF23 and other biochemical parameters were analyzed in seventy eight patients with various stages of CKD [ eGFR ranged from 4-96 ml/ (min · 1. 73 m2) ] , and 20 health volunteers were regarded as control. Results: (1) The level of serum FGF23 was elevated in all stages of CKD, LogFGF23 and inorganic phosphate (pi) showed significant higher in CKD 3,4 and 5 comparing with that in CKD 1 -2 but also happened in CKD 3,4 and 5 themselves (P < 0. 01), which however did not occurred in CKD 3 with 1 ~ 2 (P > 0. 05 ); LogPTH showed significant differences in all stages while other biochemical parameters had none. (2)LogFGF23 was significantly and positively correlated with Pi(r=0. 54,P< 0.01), LogPTH(r =0. 61 ,P<0. 01) and 1,25(OH)2D3(r =0. 32,/)<0.01) , while negatively correlated with eGFR(r = -0.64,P<0. 01). (3)The difference of LogFGF23 between CKD with secondary hyperparathyroidism (SHPT) (4 372 ±1 997 ng/L) and non-SHPT(2 944 ± 19 814 ng/L) was also significant (P<0.01). The correlation between FGF23 and PTH was significant only in SHPT group(r =0. 569,P<0.01); while significant correlation between FGF23 and 1,25(OH)2D3 was only in non-SHPT group(r =0. 437, P<0.05). The negative correlations between FGF23 and eGFR in two sets were both significant and so were the positive correlations between FGF23 and Pi. (4) Multivariate linerar regression indicated that age, 1,25(OH)2D3, eGFR,serum albumin and "with SHFTwere significant impacting factor to FGF23 (P<0.05). Conclusion: (1) The serum FGF23 was abnormal in early stage of CKD, and increased in parallel with the decline of renal function,which was significantly higher in end-stage renal disease. (2) Serum Pi was increased observably in end-stage of CKD,which stimulated FGF23 more significantly. The high level of serum FGF23 showed relationship to the happening of SHPT. (3) FGF23 can be affected by Age.l ,25(OH)2D3, renal function, nutritional quality and "with SHPT".%目的:观察慢性肾脏病(CKD)不同阶段血成纤维细胞生长因子23( FGF23)水平变化及其与甲状旁腺素(PTH)等生化指标的相关性,初步探讨FGF23在CKD进展中与矿物质代谢相互关系及对机体的影响. 方法:选择78例估算的肾小球滤过率(eGFR)波动在4～96 ml/( min·1.73m2) CKD住院患者及20例健康志愿者,测定外周血FGF23及其他生化指标,分析它们之间的相关性. 结果:(1)各组CKD患者血FGF23水平均高于健康对照组,LogPTH各组间差异性显著(P＜0.05),LogFGF23及血磷在CKD4,5期组中存在显著性差异(P＜0.01),而CKD1 ～2期组与CKD3期组之间无明显差异(P＞0.05)；(2)四组间血磷(r=0.54,P＜0.01)、LogPTH(r =0.61,P＜0.01)及1,25羟维生素D3[1,25 (OH)2 D3](r=0.32,P＜0.0l)与LogFGF23均呈显著正相关,而eGFR(r=-0.64,P＜0.01)与LogFGF23呈显著负相关；(3)FGF23甲旁亢组值(4 372.25±1 996.66 pg/ml)较非甲旁亢组值(2 943.99±1 981.21 pg/ml)明显升高(P＜0.0l),LogFGF23与LogPTH仅在甲旁亢组中显著正相关(r =0.569,P＜0.01),而LogFGF23与1,25(OH)2 D3仅在非甲旁亢组中显示正相关(r=0.437,P＜0.05)；两组中LogFGF23与eGFR均显著负相关,但与血磷间均有正相关性；(4)多元线性回归分析显示多因素(年龄、血清白蛋白、活性维生素D3、eGFR及“有甲旁亢”)与LogFGF23有相关性(P＜0.05). 结论:(1)血FGF23水平在CKD早期已高出正常,并随着肾功能减退不断升高,在终末期异常升高.(2)慢性肾脏病终末期血磷水平显著升高并刺激FGF23生成增加,高FGF23水平与继发性甲旁亢发生相关.(3)年龄、活性维生素D3、肾功能状态、营养状况及有无”甲旁亢”均能影响血FGF23水平.
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