Savica V, Calò L A, Granata A, Caldarera R, Cavaleri A, Santoro D, Monardo P, Savica R, Muraca U, Bellinghieri G
University of Messina, Italy.
Clin Nephrol. 2007 Oct;68(4):216-21.
Hyperphosphoremia, main contributor to cardiovascular calcifications, has a major impact on the morbidity and mortality of chronic renal failure (CRF) patients. Phosphate binders and dietary phosphate limitation are not effective enough to abolish hyperphosphoremia-induced cardiovascular abnormalities, therefore, the identification of other and more timely approaches for serum phosphorous reduction is necessary. Salivary fluid contains phosphate which, if related to the daily salivary secretion (1,000 - 1,800 ml), deserves attention as a marker for an earlier start of pharmacologic treatment for phosphorous removal. In ESRD patients under dialysis we have shown increased salivary phosphate closely to be related with serum phosphorous and interpreted as compensatory. This study evaluates salivary phosphate secretion in 77 nondialyzed CRF compared with healthy subjects and its relationship with renal function.
Saxon's test confirmed normal salivary function in patients and controls. Serum phosphorous, creatinine and GFR were also measured.
Salivary phosphorous was significantly higher in CRF patients compared with controls: 38.60 mg/dl (range 12.20 - 95.60) vs 16.30 (10.30 - 27.10), p < 0.0001; serum phosphate was also significantly higher: 3.70 (2.10 - 6.80) vs 3.50 (2.3 4.6), p = 0.013. In CRF patients, salivary phosphorous positively correlated with serum phosphorous (r - 0.45, p < 0.0001) and with serum creatinine (r = 0.72, p < 0.0001), while negatively correlated with GFR (r = -0.72, p < 0.0001).
The results of our study show also in CRF patients increased salivary phosphate secretion, which is related with renal function. On this basis the use of salivary phosphate secretion as a marker for an earlier start of the abnormal phosphate, metabolism pharmacologic treatment could be proposed.
高磷血症是心血管钙化的主要促成因素，对慢性肾衰竭（CRF）患者的发病率和死亡率有重大影响。磷酸盐结合剂和饮食中磷的限制不足以消除高磷血症引起的心血管异常，因此，有必要确定其他更及时的降低血清磷的方法。唾液中含有磷，如果与每日唾液分泌量（1000 - 1800毫升）相关，作为更早开始药物除磷治疗的标志物值得关注。在接受透析的终末期肾病（ESRD）患者中，我们发现唾液磷增加与血清磷密切相关，并将其解释为一种代偿现象。本研究评估了77例未透析的CRF患者与健康受试者的唾液磷分泌情况及其与肾功能的关系。
萨克森试验证实患者和对照组的唾液功能正常。还测量了血清磷、肌酐和肾小球滤过率（GFR）。
CRF患者的唾液磷显著高于对照组：38.60毫克/分升（范围12.20 - 95.60） vs 16.30（10.30 - 27.10），p < 0.0001；血清磷酸盐也显著更高：3.70（2.10 - 6.80） vs 3.50（2.3 - 4.6），p = 0.013。在CRF患者中，唾液磷与血清磷呈正相关（r = 0.45，p < 0.0001），与血清肌酐呈正相关（r = 0.72，p < 0.0001），而与GFR呈负相关（r = -0.72，p < 0.0001）。
我们的研究结果表明，CRF患者的唾液磷分泌也增加，这与肾功能有关。在此基础上，可以提出将唾液磷分泌作为更早开始异常磷代谢药物治疗的标志物。
