Inaba M, Okuno S, Imanishi Y, Yamada S, Shioi A, Yamakawa T, Ishimura E, Nishizawa Y
Department of Endocrinology, Metabolism, and Molecular Medicine, Osaka City University Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
Osteoporos Int. 2006 Oct;17(10):1506-13. doi: 10.1007/s00198-006-0154-6. Epub 2006 Aug 5.
Fibroblast growth factor (FGF) 23 is a recently identified circulating factor that regulates phosphate (Pi) metabolism. Since the derangement of Pi control is an important risk factor for vascular calcification, we investigated the importance of plasma FGF-23 in the development of vascular calcification in the aorta and peripheral artery in hemodialysis patients with and without diabetes mellitus (DM).
Male hemodialysis patients with DM (n=32) and without DM (n=56) were examined. Plasma samples were obtained before the start of dialysis sessions, and the FGF-23 levels were determined by enzyme-linked immunosorbent assay. Roentgenography of the aorta and hand artery was performed, and visible vascular calcification was evaluated by one examiner, who was blinded to the patient characteristics.
In the 56 non-DM hemodialysis patients, vascular calcification was found in the hand artery in 5 patients (8.9%) and in the aorta in 23 patients (41.1%). These levels were significantly lower (p<0.05) than in the 32 DM patients, of whom, 19 (59.4%) and 21 (65.6%) had vascular calcification of the hand artery and aorta, respectively. Multiple regression analyses performed separately in the non-DM and DM patients showed that the plasma FGF-23 level, CaxPi product, and body weight are independent factors significantly associated with hand-artery calcification and that diastolic blood pressure is associated with aorta calcification in non-DM patients. In DM patients, the plasma FGF-23 level and hemodialysis duration emerged as independent factors associated with hand-artery calcification and diastolic blood pressure was associated with aorta calcification. The independent association of the plasma FGF-23 level with hand-artery calcification was retained in both non-DM and DM patients when adjusted for the CaxPi product.
Our findings show that the plasma FGF-23 level is an independent factor negatively associated with peripheral vascular calcification in the hand artery, but not in the aorta, in both male non-DM and DM hemodialysis patients, even when adjusted for the CaxPi product. This study raises the possibility that the plasma FGF-23 level may provide a reliable marker for Moenckeberg's medial calcification in male hemodialysis patients, independent of its regulatory effect on Pi metabolism.
成纤维细胞生长因子（FGF）23是最近发现的一种调节磷酸盐（Pi）代谢的循环因子。由于Pi控制紊乱是血管钙化的重要危险因素，我们研究了血浆FGF - 23在有或无糖尿病（DM）的血液透析患者主动脉和外周动脉血管钙化发展中的重要性。
对患有DM的男性血液透析患者（n = 32）和未患DM的男性血液透析患者（n = 56）进行检查。在透析开始前采集血浆样本，通过酶联免疫吸附测定法测定FGF - 23水平。对主动脉和手部动脉进行X线摄影，由一名对患者特征不知情的检查者评估可见的血管钙化情况。
在56例非DM血液透析患者中，手部动脉有5例（8.9%）出现血管钙化，主动脉有23例（41.1%）出现血管钙化。这些水平显著低于（p<0.05）32例DM患者，其中DM患者手部动脉和主动脉血管钙化的分别有19例（59.4%）和21例（65.6%）。在非DM和DM患者中分别进行的多元回归分析表明，血浆FGF - 23水平、钙磷乘积和体重是与手部动脉钙化显著相关的独立因素，舒张压与非DM患者的主动脉钙化相关。在DM患者中，血浆FGF - 23水平和血液透析时长是与手部动脉钙化相关的独立因素，舒张压与主动脉钙化相关。在调整钙磷乘积后，血浆FGF - 23水平与手部动脉钙化的独立关联在非DM和DM患者中均得以保留。
我们的研究结果表明，在男性非DM和DM血液透析患者中，即使调整了钙磷乘积，血浆FGF - 23水平仍是与手部动脉外周血管钙化呈负相关的独立因素，但与主动脉钙化无关。本研究提出了一种可能性，即血浆FGF - 23水平可能为男性血液透析患者的蒙克贝格中膜钙化提供一个可靠的标志物，而与其对Pi代谢的调节作用无关。
