上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (5): 541-.doi: 10.3969/j.issn.1674-8115.2018.05.012

• 论著·临床研究 • 上一篇    下一篇

持续非卧床腹膜透析患者成纤维生长因子 -23及可溶性klotho蛋白水平与心脏瓣膜钙化的关系

付玉玲1，胡坤1，沈艳萍1，施鑫2，乔青1   

  1. 苏州大学附属第一医院 1. 肾内科，2.心超室，苏州 215006
  • 出版日期:2018-05-28 发布日期:2018-05-28
  • 通讯作者: 乔青，电子信箱：qiaoqing72@sina.com。
  • 作者简介:付玉玲（1990—），女，硕士生；电子信箱： 625038109@qq.com。

Research on relationship of FGF-23 and sKL with cardiac valve calcification in CAPD patients

FU Yu-ling1, HU Kun1, SHEN Yan-ping1, SHI Xin2, QIAO Qing1   

  1. 1. Department of Renal Division, The First Affiliated Hospital of Soochow University, Suzhou 215006, China; 2. Department of Cardiac Ultrasound, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
  • Online:2018-05-28 Published:2018-05-28

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摘要： 目的 ·探讨持续非卧床腹膜透析（ continuous ambulatory peritoneal dialysis，CAPD）患者血清成纤维生长因子 -23（fibroblast growth factor-23，FGF-23）及可溶性 klotho蛋白（ soluble klotho，sKL）水平与心脏瓣膜钙化的关系。方法 ·收集苏州大学附属第一医院腹膜透析中心 147例接受 CAPD治疗患者的临床资料。采用酶联免疫吸附法（ enzyme-linked immunosorbent assay，ELISA）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，并将患者分为心脏瓣膜正常组（ A组）与心脏瓣膜钙化组（B组）。使用 SPSS 23.0统计软件对数据进行分析。结果 · 147例 CAPD 患者中，心脏瓣膜钙化发生率为 54.42%。Spearman相关分析显示， CAPD患者心脏瓣膜钙化与年龄、透析龄、血清肌酐、校正钙、血清磷、血清碱性磷酸酶、甲状旁腺激素、 FGF-23水平呈正相关（ P0.045，P0.022，P0.006，P0.024，P0.000，P0.017，P0.022，P0.000），与尿素清除指数、 sKL水平、残余肾功能呈负相关（ P0.045，P0.000，P0.011）。多因素 Logistic回归分析显示， FGF-23水平升高（ OR5.007，95% CI为 1.446～ 17.339， P0.011）、sKL水平降低（ OR0.310，95% CI为 0.108～ 0.891，P0.030）、血磷水平升高（ OR7.433，95% CI为 1.558～ 35.470， P0.012）是腹膜透析患者心脏瓣膜钙化的独立危险因素。受试者工作特征曲线显示， FGF-23及 sKL预测心脏瓣膜钙化的最佳临界值分别为 2 172.64 pg/mL（敏感度 91.3%，特异度 91.0%）及 231.88 pg/mL（敏感度 88.8%，特异度 92.5%）。结论 ·高水平的 FGF-23及低水平的 sKL是 CAPD患者心脏瓣膜钙化的独立危险因素，两者对 CAPD患者心脏瓣膜钙化诊断的准确性均较高。

关键词: 腹膜透析, 心脏瓣膜钙化, 成纤维生长因子 -23, 可溶性 klotho蛋白

Abstract:

Objective · To explore the relationship of fibroblast growth factor-23 (FGF-23) and soluble klotho (sKL) with cardiac valve calcification in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods · 147 CAPD patients the dialysis center of the First Affiliated Hospital of Soochow University were enrolled. The concentrations of FGF-23 and sKL were measuredenzyme-linked immunosorbent assays (ELISA). Echocardiography was applied to evaluate cardiac valve calcification. The patients were divided into normal cardiac valve group (group A) and cardiac valve calcification group (group B). SPSS 23.0 software was used for data analysis. Results · The incidence of cardiac valve calcification in CAPD patients was 54.42%. The risk of cardiac valve calcification showed positive correlation with age, dialysis age, serum creatinine, corrected calcium, serum phosphorus, serum alkaline phosphatase, parathyroid hormone, and the level of FGF-23 (P0.045, P0.022, P0.006, P0.024, P0.000, P0.017, P0.022, P0.000), and negative correlation with urea clearance index, the level of sKL and residual renal function (P0.045, P0.000, P0.011). Multivariate Logistic regression analysis showed that the increase of FGF-23 (OR5.007, 95% CI 1.446-17.339, P0.011) and serum phosphorus (OR7.433, 95% CI 1.558-35.470, P0.012) were two independent risk factors for cardiac valve calcification in CAPD patients, and the decrease of sKL (OR0.310, 95% CI 0.108-0.891, P0.030) was another independent risk factor as well. Receiver operator characteristic curves (ROC) indicated that to predict cardiac valve calcification in patients with CAPD, the optimal cut off points of FGF-23 and sKL were 2 172.64 pg/mL (sensitivity was 91.3%, specificity was 91%) and 231.88 pg/mL (sensitivity was 88.8%, specificity was 92.5%), respectively. Conclusion · The high level of FGF-23 and low level of sKL are two independent risk factors for cardiac valve calcification in CAPD patients. FGF-23 and sKL can be used to diagnose cardiac valve calcification in CAPD patients.

Key words: peritoneal dialysis, cardiac valve calcification, fibroblast growth factor-23 (FGF-23), soluble klotho (sKL)

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