【摘要】目的探讨维持性血液透析(maintenance hemodialysis patients，MHD)患者血清成纤维细胞生长因子-23(fibroblast growth factor-23，FGF-23)及可溶性klotho 蛋白(soluble Klotho protein，sKL)与心脏瓣膜钙化(cardiac valve calcification，CVC)的关系。方法收集山东第一医科大学附属莱钢医院肾内科透析中心100 例维持性血液透析患者的临床资料。采用酶联免疫吸附法测定患者血清FGF-23 和sKL 浓度，超声心动图评估患者心脏瓣膜钙化情况。结果观察组的CVC 比例、FGF-23水平高于对照组，而sKL 水平低于对照组(t 值分别为8.820, 16.642, - 2.583, P 值分别为＜0.001,＜0.001, 0.012)。多因素Logistic 回归分析显示，血清FGF-23 水平、血磷升高是MHD 患者心脏瓣膜钙化的独立危险因素(OR 值分别为2.375，1.642，95%CI 值分别为1.527～3.884，1.232～1.912，P 值分别为＜0.001, 0.023)，血清sKL 水平升高是MHD 患者心脏瓣膜钙化的保护因素(OR=0.334, 95%CI 值为0.044～0.621, P=0.032)。结论血清FGF-23、sKL 是MHD 患者发生心脏瓣膜钙化的独立影响因素,二者联合检测对MHD患者发生心脏瓣膜钙化具有较高的预测价值。
【Abstract】Objective To explore the relationship between serum levels of fibroblast growth factor- 23(FGF- 23) and soluble klotho (sKL) and cardiac valve calcification (CVC) in maintenance hemodialysis (MHD) patients. Methods A total of 100 MHD patients treated in the Blood Purification Center of Laigang Hospital were enrolled in this study as the observation group. The serum concentrations of FGF-23 and sKL were measured by enzyme-linked immunosorbent assay. CVC was detected by color Doppler ultrasonography. Results The incidence of CVC and serum level of FGF-23 were higher in observation group than in control group (t=8.820 and 16.642 respectively; P<0.001), while serum level of sKL was lower in observation group than in control group (t= -2.583, P=0.012). The higher levels of serum phosphorus and serum FGF-23 were the independent risk factors for CVC in MHD patients (OR = 2.375 and 1.642 respectively; 95% CI = 1.527 ～ 3.884 and 1.232 ~ 1.912 respectively; P<0.001 and 0.023 respectively). The higher level of sKL was a protective factor for CVC (OR=0.334, 95% CI=0.044~0.621, P＜0.05). Conclusion Serum levels of FGF-23 and sKL were the independent influencing factors for CVC in MHD patients. Therefore, combined detection
of serum FGF-23 and sKL can be used to predict CVC in MHD patients.
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