Department of Pediatrics, Renal Section, Baylor College of Medicine, Houston, TX, 77030, USA.
Pediatr Nephrol. 2011 Jun;26(6):945-51. doi: 10.1007/s00467-011-1822-0. Epub 2011 Feb 27.
Increased mortality of adult chronic hemodialysis (HD) patients is associated with coronary calcifications (CC), increased serum phosphorus (P), use of calcium (Ca)-containing P-binders, and vitamin D deficiency. Serum concentration of fibroblast growth factor 23 (FGF 23) is markedly elevated in adults receiving dialysis and is independently associated with increased mortality. Although coronary calcifications have been described in pediatric and adult HD patients, no significant association between serum FGF 23 and CC has been reported. In our study, 5/16 patients had CC. Patients with CC were older, had longer dialysis vintage and higher serum P. Serum Ca, total PTH, elemental Ca intake, and calcitriol doses were not different for CC patients. Serum FGF 23 levels were markedly elevated in all patients (mean 4,024, range 874-8,253), but significantly higher in patients with CC (4,247 ± 10,35 vs 2,427 ± 11,92, p = 0.01) and positively correlated with Agatston calcification score (r = 0.69, p = 0.003) and serum P (r = 0.49, p = 0.05). Using multivariate analysis, serum FGF 23 and serum P remained the most significant factors associated with Agatston score. This study confirms the occurrence of CC in pediatric HD patients and is the first to show a significant association between CC and elevated serum FGF 23 in children.
在接受透析治疗的成年人中，成纤维细胞生长因子 23（FGF 23）的血清浓度明显升高，并且与死亡率升高独立相关。尽管已经在儿科和成年 HD 患者中描述了冠状动脉钙化（CC），但尚未报道 FGF 23 与 CC 之间存在显著相关性。在我们的研究中，有 5/16 例患者存在 CC。患有 CC 的患者年龄更大，透析时间更长，血清 P 更高。CC 患者的血清 Ca、总 PTH、元素 Ca 摄入量和骨化三醇剂量没有差异。所有患者的血清 FGF 23 水平均明显升高（平均值为 4024，范围为 874-8253），但 CC 患者的水平明显更高（4247 ± 1035 比 2427 ± 1192，p = 0.01），与 Agatston 钙化评分呈正相关（r = 0.69，p = 0.003）和血清 P（r = 0.49，p = 0.05）。使用多元分析，血清 FGF 23 和血清 P 仍然是与 Agatston 评分最显著相关的因素。本研究证实了 CC 在儿科 HD 患者中的发生，并首次显示 CC 与儿童血清 FGF 23 升高之间存在显著相关性。
