Centre de Référence des Maladies Rénales Rares, Hôpital Femme Mère Enfant, Boulevard Pinel, 69677 Bron Cedex, France.
J Clin Endocrinol Metab. 2010 Apr;95(4):1741-8. doi: 10.1210/jc.2009-1576. Epub 2010 Feb 15.
Fibroblast growth factor 23 (FGF23) is a phosphaturic factor and a suppressor of 1alpha-hydroxylase activity in the kidney. Although its importance in chronic kidney disease (CKD) has been demonstrated in adults, there is little information in pediatric patients.
The aims of this study were: 1) to determine reference values for FGF23 serum levels according to glomerular filtration rate (GFR) (measured by the reference standard, inulin clearance), gender, and age; and 2) to evaluate the effects of different etiologies and treatments on FGF23 serum levels in a prospective single-center cohort of 227 CKD children (119 boys).
Age, body weight, height, and GFR (mean +/- sd) values were: 11.3 +/- 4.1 yr, 37 +/- 16 kg, 140 +/- 20 cm, and 98 +/- 34 ml/min per 1.73 m(2), respectively. Calcium, phosphate, PTH, 25 hydroxyvitamin D, 1,25 dihydroxyvitamin D, C-terminal FGF23, and intact FGF23 (mean +/- sd) levels were: 2.43 +/- 0.11 mmol/liter, 1.41 +/- 0.22 mmol/liter, 41 +/- 23 pg/ml, 24 +/- 10 ng/ml, 152 +/- 72 pmol/liter, 76 +/- 134 relative units/ml, and 44 +/- 37 pg/ml, respectively. There was a wide range of FGF23 serum levels, but FGF23 levels increased when GFR decreased. FGF23 serum levels were not modified by gender, but they increased with age. In univariate analysis, corticosteroid therapy seemed to be associated with increased FGF23 serum levels. A multivariate linear regression analysis found a significant impact of GFR, body mass index, and solid organ transplantation on FGF23 serum levels.
Age, GFR, body mass index, and solid organ transplantation seem to influence FGF23 serum levels in a pediatric population. The impact of corticosteroids on FGF23 metabolism should be further investigated; further longitudinal studies will also help to better define the prognostic impact of FGF23 serum levels in pediatric CKD in terms of disease progression, cardiovascular morbidities, and bone disabilities.
成纤维细胞生长因子 23（FGF23）是一种磷调节因子，也是肾脏中 1α-羟化酶活性的抑制剂。尽管其在成人慢性肾脏病（CKD）中的重要性已得到证实，但在儿科患者中相关信息较少。
本研究的目的是：1）根据肾小球滤过率（通过参考标准，菊粉清除率测量）、性别和年龄确定 FGF23 血清水平的参考值；2）评估不同病因和治疗方法对 227 例 CKD 儿童（男 119 例）前瞻性单中心队列中 FGF23 血清水平的影响。
年龄、体重、身高和肾小球滤过率（平均值±标准差）值分别为 11.3±4.1 岁、37±16kg、140±20cm 和 98±34ml/min/1.73m2。钙、磷、甲状旁腺激素、25 羟维生素 D、1,25 二羟维生素 D、C 端 FGF23 和完整 FGF23（平均值±标准差）水平分别为 2.43±0.11mmol/L、1.41±0.22mmol/L、41±23pg/ml、24±10ng/ml、152±72pmol/L、76±134 相对单位/ml 和 44±37pg/ml。FGF23 血清水平范围较宽，但随着肾小球滤过率的降低而升高。FGF23 血清水平不受性别影响，但随年龄增长而增加。单因素分析发现，皮质类固醇治疗似乎与 FGF23 血清水平升高有关。多变量线性回归分析发现，肾小球滤过率、体重指数和实体器官移植对 FGF23 血清水平有显著影响。
年龄、肾小球滤过率、体重指数和实体器官移植似乎会影响儿科人群的 FGF23 血清水平。皮质类固醇对 FGF23 代谢的影响需要进一步研究；进一步的纵向研究也将有助于更好地定义 FGF23 血清水平在儿科 CKD 中的预后影响，包括疾病进展、心血管并发症和骨骼残疾。
