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肾脏病与透析肾移植杂志

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成纤维细胞生长因子23预测重症患者急性肾损伤预后的价值

  

  • 出版日期:2019-10-28 发布日期:2020-01-07

Prognostic value of fibroblast growth factor 23 in critical care patients with acute kidney injury

  • Online:2019-10-28 Published:2020-01-07

摘要: 目的:观察和评估成纤维细胞生长因子(FGF23)能否成为预测重症患者急性肾损伤(AKI)肾功能恢复的生物标志物。
方法:观察2014年6月至2015年7月国家肾脏疾病临床医学研究中心重症监护病房(ICU)收治的AKI患者FGF23水平,并比较AKI肾功能恢复情况与FGF23之间的相关性,采用Logistic回归分析影响AKI预后的危险因素。
结果:纳入104例AKI患者及本中心生物样本库纳入健康对照60例。AKI患者FGF23水平高于健康对照组;AKI患者FGF23升高与高磷血症正相关;出院时肾功能完全恢复、部分恢复以及未恢复分别24例(231%)、50例(481%)和30例(288%)。肾功能未恢复的FGF23水平高于肾功能完全恢复组(P<005)。单因素Logistic回归分析发现出院时肾功能预后不良与高龄、高FGF23、高磷血症、血清肌酐(SCr)高、血Cystatin C高、尿视黄醇结合蛋白高、贫血、脓毒症、慢性肾脏病(CKD)有关联,多因素Logistic回归分析发现出院时肾功能预后不良与FGF23、CKD、年龄与SCr峰值相关,CKD基础是影响AKI肾脏预后的主要因素。FGF23对判断AKI肾功能恢复的诊断阈值为23779 pg/ml。
结论:AKI患者FGF23水平升高,并与高磷血症相关。FGF23可作为预测AKI患者肾功能恢复的生物标志物。

关键词: 急性肾损伤, 成纤维细胞生长因子-23, 高磷血症, 生物标志物

Abstract:

Objective:To observe and evaluate whether fibroblast growth factor 23(FGF23) can be a biomarker for predicting renal function recovery in critical care patients with acute kidney injury (AKI).
Methodology:Patients with AKI admitted to the renal intensive care unit (ICU) of Jinling Hospital from June 2014 to July 2015 were included,to analysis FGF23  level in AKI,and to compare the correlation between renal function recovery and FGF23,and analysis  risk factors affecting  prognosis of AKI.
Results:104 AKI patients were included,and 60 healthy controls were included from the biological sample bank of our center.FGF23 level of AKI patients was higher than that of healthy control group.FGF23 in AKI patients was positively correlated with serum phosphate level.FGF23 level in nonrecovery group was higher than that of complete recovery group (P<005).Single factor Logistic regression analysis found that  poor prognosis of  kidney function at discharge were related with elderly age,higher FGF23,hyperphosphatemia,peak serum creatinine (SCr)   blood cystatin C,urine RBP,anemia,sepsis and chronic kidney disease (CKD).The multifactor Logistic regression analysis found that renal poor prognosis of AKI patients were associated with FGF23,CKD,age and  peak SCr.CKD  history is  the main factor influencing renal prognosis of AKI patients.The diagnostic threshold of FGF23 for judging renal function recovery of AKI was 23779 pg/ml.
Conclusion:FGF23 level was elevated in AKI patients,which was correlated with serum phosphate level.FGF23 could be used as a biomarker to predict renal function recovery in AKI patients.