Evenepoel P, Naesens M, Claes K, Kuypers D, Vanrenterghem Y
Department of Medicine, Division of Nephrology, University Hospital Leuven, B-3000 Leuven, Belgium.
Am J Transplant. 2007 May;7(5):1193-200. doi: 10.1111/j.1600-6143.2007.01753.x. Epub 2007 Mar 12.
Hypophosphatemia and inappropriately low calcitriol levels are frequently observed following successful renal transplantation. Fibroblast growth factor-23 (FGF-23) is a recently characterized phosphaturic hormone that inhibits renal 1 alpha-hydroxylase activity and may be involved in the pathogenesis of both phenomena. The following hypotheses were tested: pretransplant FGF-23 predicts posttransplant FGF-23, FGF-23 predicts posttransplant hypophosphatemia and FGF-23 is associated with decreased calcitriol levels independent of renal and parathyroid function. Serum biointact parathyroid hormone (PTH), calcidiol, calcitriol, full-length FGF-23, calcium and phosphate were monitored in 41 renal transplant recipients at the time of transplantation (pre) and 3 months thereafter (post). In addition, serum phosphate nadir in each individual patient was identified and urinary fractional excretion of phosphate (FE(PO4)) at month 3 was calculated. High FGF-23(post) levels were independently associated with high FGF-23(pre), low calcitriol(post) and high calcium(post) levels. FGF-23, but none of the other mineral metabolism indices, was an independent predictor of the phosphate nadir in the early posttransplant period. A high FGF-23(post) level was independently associated with a high FE(PO4). High FGF-23(post) and creatinine levels and low PTH(post) levels were independently associated with low calcitriol(post) levels. In conclusion, our data indicate that persistence of FGF-23 contributes to hypophosphatemia and suboptimal calcitriol levels in renal transplant recipients.
肾移植成功后，低磷血症和不适当的低骨化三醇水平经常出现。成纤维细胞生长因子23（FGF-23）是一种最近被鉴定出的排磷激素，它抑制肾脏1α-羟化酶活性，可能参与这两种现象的发病机制。我们检验了以下假设：移植前FGF-23可预测移植后FGF-23，FGF-23可预测移植后低磷血症，且FGF-23与骨化三醇水平降低相关，与肾脏和甲状旁腺功能无关。对41例肾移植受者在移植时（术前）及此后3个月（术后）监测血清生物活性完整甲状旁腺激素（PTH）、骨化二醇、骨化三醇、全长FGF-23、钙和磷。此外，确定每位患者的血清磷最低点，并计算术后3个月的尿磷排泄分数（FE(PO4)）。高FGF-23（术后）水平与高FGF-23（术前）、低骨化三醇（术后）和高钙（术后）水平独立相关。FGF-23是移植后早期磷最低点的独立预测因子，而其他矿物质代谢指标均不是。高FGF-23（术后）水平与高FE(PO4)独立相关。高FGF-23（术后）和肌酐水平以及低PTH（术后）水平与低骨化三醇（术后）水平独立相关。总之，我们的数据表明，FGF-23的持续存在导致肾移植受者出现低磷血症和骨化三醇水平欠佳。
