【摘要】目的探讨成纤维细胞生长因子23(fibroblast growth factor-23，FGF-23)水平在终末期肾病(end stage renal disease，ESRD)患者桡动脉钙化(radial artery calcification，RAC)与自体动静脉内瘘(arteriovenous fistula，AVF)失功中的预测价值。方法收集212 例在南京医科大学附属无锡市人民医院行AVF 手术的ESRD 患者的临床资料，采用ELISA 检测患者术前血清FGF-23 水平。采用HE染色法对桡动脉血管进行钙化染色以评估RAC 程度。据随访期间临床及影像学资料将患者分为AVF 失功及AVF 通畅组。比较FGF-23 水平在不同分组中的差异及预测作用。结果212 例患者中有57.8%发生RAC(123/212)。当cut- off 值取FGF- 23＞488.5ng/ml 时，FGF- 23 预测RAC 的敏感性为0.797，特异性为0.921；当cut-off 值取FGF-23＞490.9ng/ml 时，预测AVF 失功的敏感性为0.757，特异性为0.560。结论ESRD 患者RAC的发生率高，FGF-23 可能是预测RAC 及AVF 失功的理想标志物。
【Abstract】Objective To investigate the relationship between serum fibroblast growth factor-23 (FGF-23) level and radial artery calcification (RAC) and arteriovenous fistula (AVF) dysfunction in hemodialysis patients. Methods This prospective study included 212 maintenance hemodialysis (MHD) patients undergoing AVF surgery. Serum FGF-23 level was measured by ELISA. Clinical and biochemical data were collected. RAC was assayed by hematoxylin- eosin staining. Serum FGF- 23 levels were compared between patient groups, and the prediction effect of serum FGF- 23 level was then evaluated. Results The prevalence of RAC was 57.8% (123/212) in the MHD patients. When the cut-off value of serum FGF-23 level was set at 488.5 ng/ml, the sensitivity and specificity for the diagnosis of RAC were 0.797 and 0.921 respectively. When the cut-off value of serum FGF-23 level was set at 490.9 ng/ml, the sensitivity and specificity for the diagnosis of AVF dysfunction were 0.757 and 0.560 respectively. Conclusion Higher prevalence of RAC was found in end-stage renal disease patients. Serum FGF-23 appears to be a sensitive and specific marker of RAC and AVF dysfunction in hemodialysis patients.
[1] Al-Jaishi AA, Oliver MJ, Thomas SM,et al.Patency Rates Of the arteriovernous fistula for hemodialysis:a systematic review and meta-analysis[J].Am J Kidney Did,2014,63(3):464-478
[2] Ramon ROCA-TEY,Ramon BORDES,Román MARTíNEZ-CERCóS,et al.The impact of pre-existing radial artery pathology by histological assessment on the maturation, function and patency of the radiocephalic fistula for hemodialysis[J].International Angiology,2019,38(3):239-249.
[3] Kim SM,Jung IM,Kim D,et al.Effect of Inflow Arterial Calcification on Arteriovenous Fistula Maturation[J].Ann Vasc Surg,2019,58:331-337.
[4] Kumar JS,Sajeev Kumar KS,Arun Thomas ET,et al.Prediction model for successful radiocephalic arteriovenous fistula creation in patients with diabetic nephropathy[J].Saudi J Kidney Dis Transpl, 2019,30(5):1058-1064.
[5] Hu MC,Shiizaki K,Kuro-o M,et al. Fibroblast growth factor 23 and Klotho: physiology and pathophysiology of an endocrine network of mineral metabolism[J]. Annu Rev Physiol,2013,75:503-533.
[6] Hod T, Desilva RN, Patibandla BK, et al.Rumyantzev AS: Factors predicting failure of AV “fistula first” policy in the elderly[J]. Hemodial Int,2014,18(2):507-515.
[7] Prischl FC, Kirchgatterer A, Brandstatter E, rt al. Parameters of prognostic relevance to the patency of vascular access in hemodialysis patients[J]. J Am Soc Nephrol,1995,6(6):1613–1618.
[8] Wong V, Ward R, Taylor J, et al. Factors associated with early failure of arteriovenous fistulae for haemodialysis access[J]. Eur J Vasc Endovasc Surg,1996,12(2):207-213.
[9] Isakova T,Wahl P,Vargas GS,et al.Fibroblast growth factor 23 is elevated before parathyroid hormone and phosphate in chronic kidney disease[J].Kidney Int,2011 ,79(12):1370-1378.
[10] Jimbo R,Kawakami-Mori F,Mu S,et al.Fibroblast growth factor 23 accelerates phosphate-induced vascular calcification in the absence of Klotho deficiency[J]. Kidney Int,2014,85(5):1103-1111.
[11] Yan-Xia Chen,Chong Huang,Zhi-Bing Duan,et al. Klotho/FGF23 axis mediates high phosphate-induced vascular calcification in vascular smooth muscle cells via Wnt7b/β-catenin pathway[J]. Kaohsiung J Med Sci,2019,35(7):393-400.
[12] 郭正勇，赵观进，张慧泽，等。维持血液透析患者腹主动脉钙化与血清FGF-23、Klotho蛋白相关性[J]。实用医学杂志，2018，34（14）：2348-2352.
[13] Zohny SF, El-Fattah MA, Khan JA. Circulating Fibroblast Growth Factor-23 Level and Paraoxonase-1 Lactonase Activity in Chronic Hemodialysis Patients: Their Impact on the Incidence of Native AV Fistula Thrombosis[J].Clin Invest Med, 2016,39(5): E173-E181.
[14] Viecelli AK, Mori TA, Roy-Chaudhury P, et al. The pathogenesis of hemodialysis vascular access failure and systemic therapies for its prevention: Optimism unful filled[J]. Semin Dial, 2018, 31(3): 244-257.
