Bone and Mineral Metabolic Unit, Division of Clinical Chemistry, Department of Clinical and Experimental Medicine, Faculty of Health Sciences at Linköping University, Linköping, Sweden.
Scand J Clin Lab Invest. 2010 Feb;70(1):15-20. doi: 10.3109/00365510903359245.
Fibroblast growth factor-23 (FGF-23) is a novel regulator of phosphate metabolism; however, the clinical knowledge is limited in children with chronic kidney disease (CKD) who are at risk of developing mineral bone disorder.
This prospective study over 2 years investigated the development of bone mass and bone turnover in relation to serum FGF-23 in children with CKD. Thirteen patients, 4-15 years, were included with a median corrected glomerular filtration rate (GFR) of 38 (range 7-74) mL/min/1.73 m(2).
Median FGF-23 was 127 RU/mL at baseline and 70 RU/mL at follow-up. Five patients had FGF-23 levels exceeding the upper reference limit of 141 RU/mL for healthy children. No correlation with age or puberty was found. FGF-23 was inversely correlated with GFR, r = -0.73 (p <0.05). Four of the five patients within CKD stages 4-5 (GFR <30 mL/min/1.73 m(2)) had elevated FGF-23 levels and two patients with end-stage renal disease had markedly high levels of FGF-23 (1333 and 1700 RU/mL). One of these patients was transplanted after 1 year, which normalized FGF-23 to 70 RU/mL at follow-up. FGF-23 was significantly associated with PTH, r = 0.69 (p <0.01). FGF-23 correlated with osteocalcin, but not with other markers of bone turnover. Total body bone mineral density (BMD) was not correlated with FGF-23, however, the lumber spine BMD Z-score correlated with FGF-23 at baseline, r = 0.61 (p <0.05).
Although a small study group, this prospective study suggests that FGF-23 is associated with GFR, PTH, and lumbar spine BMD in pediatric patients with various degrees of CKD.
成纤维细胞生长因子 23（FGF-23）是一种新型的磷代谢调节剂；然而，在有发生矿物质骨异常风险的慢性肾脏病（CKD）患儿中，其临床知识有限。
这项为期 2 年的前瞻性研究调查了 CKD 患儿的骨量和骨转换的发展与血清 FGF-23 的关系。纳入 13 名年龄在 4-15 岁的患者，中位校正肾小球滤过率（GFR）为 38（7-74）mL/min/1.73m(2)。
中位 FGF-23 在基线时为 127 RU/mL，随访时为 70 RU/mL。5 名患者的 FGF-23 水平超过健康儿童的 141 RU/mL 上限参考值。未发现与年龄或青春期相关。FGF-23 与 GFR 呈负相关，r = -0.73（p <0.05）。4 名 CKD 4-5 期（GFR <30 mL/min/1.73 m(2)) 的患者存在升高的 FGF-23 水平，2 名终末期肾病患者的 FGF-23 水平明显升高（1333 和 1700 RU/mL）。其中一名患者在 1 年后接受了移植，随访时 FGF-23 恢复正常至 70 RU/mL。FGF-23 与 PTH 显著相关，r = 0.69（p <0.01）。FGF-23 与骨钙素相关，但与其他骨转换标志物无关。全身骨矿物质密度（BMD）与 FGF-23 无关，但腰椎 BMD Z 评分与 FGF-23 在基线时相关，r = 0.61（p <0.05）。
尽管研究组较小，但这项前瞻性研究表明，FGF-23 与儿科 CKD 患者的 GFR、PTH 和腰椎 BMD 相关。
