ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2017, Vol. 26 ›› Issue (4): 312-316.DOI: 10.3969/j.issn.1006-298X.2017.04.003

• 论文 • 上一篇    下一篇

腹膜透析患者腹主动脉钙化与成纤维细胞生长因子23和可溶性Klotho的相关性

  

  • 出版日期:2017-08-28 发布日期:2017-09-04

Relationship between fibroblast growth factor23, soluble Klotho and abdominal aortic calcification in CAPD patients

  • Online:2017-08-28 Published:2017-09-04

摘要:

目的:探讨持续非卧床腹膜透析(CAPD)患者腹主动脉钙化与血清成纤维细胞生长因子23(FGF23)和可溶性Klotho(sKL)水平之间的关系。
方法:收集147例CAPD患者临床资料,采用ELASA法检测血清FGF23和sKL浓度。采用腰椎侧位片评估患者腹主动脉钙化情况,比较腹主动脉非钙化组和腹主动脉钙化组的各项临床指标;用Logistic回归分析法分析患者发生腹主动脉钙化的危险因素;受试者工作特征曲线(ROC)评估FGF23和sKL预测腹主动脉钙化的敏感度及特异度。
结果:147例CAPD患者腹主动脉钙化的发生率为3741%,腹主动脉钙化与FGF23水平、sKL水平、年龄、透析龄、碱性磷酸酶(ALP)、血磷水平、三酰甘油(TG)、超敏C反应蛋白(hsCRP)相关。将单因素分析有统计学意义的变量纳入多因素Logistics回归,FGF23中位水平以上者(>2 77036 pg/ml),其发生腹主动脉钙化的危险度是中位水平及以下者的650倍(OR 650,95%CI 141~2988);年龄每增加1岁,危险度增加7% (OR 107,95%CI 103~111);血磷> 175 mmol/L者,其发生腹主动脉钙化的危险度是血磷≤175 mmol/L者的349倍(OR 349,95%CI 109~1114)。sKL>29653 pg/ml者,其腹主动脉钙化的危险度是sKL≤29653 pg/ml者的025倍(OR 025,95%CI 013~052)。FGF23预测腹主动脉钙化的ROC曲线下面积(AUC)为096(截点为2 04514 pg/ml,其敏感度910%,特异度966%);sKL预测腹主动脉钙化的AUC为095(截点为43478 pg/ml,其敏感度933%,特异度948%)。
结论:CAPD患者腹主动脉钙化与FGF23水平、sKL水平、年龄、透析龄、ALP、血磷水平、TG、hsCRP相关。血清FGF23与sKL水平均有助于预测腹主动脉钙化,高FGF23及低sKL的CAPD患者发生腹主动脉钙化的危险度高。

Abstract:

Objective:To study the relationship between fibroblast growth factor23 (FGF23), soluble Klotho (sKL) and abdominal aortic calcification in patients with continuous ambulatory peritoneal dialysis (CAPD).
Methodology:One hundred forty seven CAPD patients in our dialysis center were enrolled, whose clinical data were recorded. Serum FGF23 and sKL were measured by ELISA. Xray examination of pelvis was applied to evaluate abdominal aortic calcification. The binary logistic regression was used to analysis the risk factors of calcification. The sensitivity, specificity of FGF23 and sKL in prediction of abdominal aortic calcification was evaluated by the receiveroperating characteristic curve (ROC).
Results:1.The incidence of CAPD patients with abdominal aortic calcification was 374% The abdominal aortic calcification were positively correlated to FGF23, age, dialysis vintage, serum phosphate (P), alkaline phosphatase (ALP), triglyceride (TG), high sensitivity Creactive protein (hsCRP) (P<005),  and were negatively correlated to sKL (P<005). 2. Logistic regression showed that the risk of abdominal aortic calcification above the median FGF23 level (2 77036 pg/ml) was 650 times (OR=650, 95%CI 141-2988) than in and under it. The abdominal aortic calcification risk increased by 7% with every 1 year older (OR=107, 95%CI 103-111). The risk of abdominal aortic calcification above the median serum phosphate level (175 mmol/L) was 349 times (OR=349, 95%CI 109-1114) than in and under it. The risk of abdominal aortic calcification above the median sKL level (29653 pg/ml) was 025 times (OR=025, 95%CI  013-052) than in and under it.3. The ROC curve analysis indicated that, the sensitivity, specificity and area under ROC curve of FGF23 levels in abdominal aortic calcification patients were respectively 910%, 966% and 096 (the cut off point: 2 04514 pg/ml). It was 933%, 948% and 095(the cut off point: 43478 pg/ml) for sKL.
Conclusion:The abdominal aortic calcification in CAPD patients was correlated with the levels of FGF23, sKL, age, dialysis vintage, ALP, phosphate, TG and hsCRP. FGF23 and sKL were all contributed to estimating abdominal aortic calcification. The risk of abdominal aortic calcification was higher in patients with high level of FGF23 and low level of sKL than the others.