关键词: 慢性肾脏病, 心率变异性, 继发性甲状旁腺功能亢进, 成纤维细胞生长因子23, 甲状旁腺切除术

Abstract:

Ｏｂｊｅｃｔｉｖｅ：To study the relationship between plasma fibroblast growth factor 23 (FGF23) and heart rate variability (HRV), and to further evaluate the impact of parathyroidectomy (PTX) on plasma FGF23 and HRV in patients with severe secondary hyperparathyroidism (SHPT) in patients with stage 5 chronic kidney disease (CKD).
Ｍｅｔｈｏｄｏｌｏｇｙ：We conducted a crosssectional study by recruiting 164 stage 5 CKD patients and 100 healthy controls, together with a prospective followup study in two PTX subgroups classified as successful PTX (n=39) and persistent SHPT (n=4). Cterminal FGF23 (cFGF23) levels was measured by ELISA and HRV indices were monitored by 24h Holter.
Ｒｅｓｕｌｔｓ：The level of plasma cFGF23 was higher and HRV indices were lower in CKD 5 patients than that in healthy controls. Multivariate stepwise regression analysis revealed that dialysis vintage, levels of serum calcium, phosphorus, alkaline phosphatase (ALP), and intact parathyroid hormone (iPTH) were correlated with levels of plasma cFGF23. The levels of serum iPTH were correlated with mean normaltonormal RR intervals (mean NN), standard deviation of the normaltonormal RR intervals (SDNN) (P<0001), mean heart rate (MHR), and very low frequency (VLF). The levels of plasma FGF23 were correlated with standard deviation of 5min average of normal RR intervals (SDANN), and MHR. Serum ALP was related with rootmean square of differences between adjacent normal RR intervals (rMSSD). The Plasma FGF23 levels were decreased significantly in both successful PTX group [lncFGF23 from (107±16) to (83±13)] and persistent SHPT group [lncFGF23 from (108±17) to (82±20)]. Most HRV indices were increased obviously in SHPT patients after successful PTX, however, no significant changes in persistent SHPT, even though HRV changes were numerically similar in two subgrups.
Ｃｏｎｃｌｕｓｉｏｎ：Compared with healthy controls, CKD patients had higher levels of plasma cFGF23, especially in severe SHPT patients. Mineral and bone disorders were related to lower HRV indices in stage 5 CKD patients, indicating that sympathetic hyperactivity may play an important role in increased risk of CVD because of SHPT. Successful parathyroidectomy could reverse these disorders and have beneficial effects on the cardiovascular system.