目的 探讨老年终末期肾病(end-stage renal disease，ESRD)血液透析患者血清成纤维细胞生长因子23(fibroblast growth factor-23,FGF-23)、可溶性生长刺激表达基因2蛋白(soluble growth stimulation expressed gene2，sST2)水平变化及对心脏瓣膜钙化的预测价值。 方法 选取2018年6月～2021年6月新疆医科大学第七附属医院收治的106例老年ESRD血液透析患者为观察组，选取同期106例健康体检者为对照组。对比2组血清FGF-23、sST2水平，观察组随访至2022年1月，统计心脏瓣膜钙化发生率，分析心脏瓣膜钙化的影响因素及FGF-23、sST2在心脏瓣膜钙化中的交互作用，评估FGF-23、sST2预测心脏瓣膜钙化的价值。 结果 观察组血清FGF-23(t=35.539，P＜0.001)、sST2水平(t=45.748，P＜0.001)高于对照组；FGF-23及sST2高表达会增加心脏瓣膜钙化风险(OR=4.539、4.265，95% CI：2.527～8.154、2.008～9.057，均P＜0.001)；调整混杂因素后，FGF-23、sST2对心脏瓣膜钙化的发生存在正向交互作用，协同效应为二者单独存在产生效应之和的2.631倍(SI=2.631)；FGF-23、sST2联合预测心脏瓣膜钙化的AUC大于单一指标(AUC=0.851，95% CI：0.767～0.913，P＜0.001)。 结论 老年ESRD血液透析患者血清FGF-23、sST2水平呈异常高表达，二者在心脏瓣膜钙化中有协同作用，二者联合可有效提升预测效能。
Objective To explore serum levels of fibroblast growth factor-23 (FGF-23) and soluble growth stimulation expressed gene 2 (sST2) in the prediction of heart valve calcification in elderly patients with end-stage renal disease (ESRD) on hemodialysis. Methods A total of 106 elderly ESRD patients on hemodialysis admitted to the Seventh Affiliated Hospital of Xinjiang Medical University from June 2018 to June 2021 were recruited as the observation group, and a total of 106 healthy individuals for physical check-up were recruited as the control group. Serum FGF-23 and sST2 levels were compared between the two groups. The observation group was followed up until January 2022, and the incidence of heart valve calcification in this group was then calculated. The influencing factors for heart valve calcification and the interaction of FGF-23 and sST2 in the pathogenesis of heart valve calcification were analyzed. The values of FGF-23 and sST2 in predicting heart valve calcification were then evaluated. Results Serum FGF-23 and sST2 levels were higher in the observation group than in the control group (t=35.539 and 45.748, P＜0.001). Higher expressions of FGF-23 and sST2 increased the risk of heart valve calcification (OR=4.539 and 4.265, 95% CI：2.527~8.154 and 2.008~9.057, P＜0.001). After adjusting for confounding factors, there was a positive interaction between FGF-23 and sST2 on the occurrence of cardiac valve calcification. The synergistic effect was 2.631 times higher than the sum of the effects of the two individually (SI=2.631). The area under the curve (AUC) of combined FGF-23 and sST2 was greater than that of FGF-23 or sST2 for the prediction of heart valve calcification (AUC=0.851, 95% CI：0.767~0.913, P＜0.001). Conclusion Serum FGF-23 and sST2 levels abnormally increased in elderly ESRD patients on hemodialysis. The effects of FGF-23 and sST2 were synergistic in the pathogenesis of heart valve calcification, and combination of the two can efficiently improve the prediction of heart valve calcification.
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