Division of Nephrology and Hypertension, Department of Medicine, University of Miami, Miller School of Medicine, Miami, FL 33136, USA.
Clin J Am Soc Nephrol. 2012 Jul;7(7):1155-62. doi: 10.2215/CJN.13281211. Epub 2012 May 3.
Levels of fibroblast growth factor 23 (FGF23) and inflammatory markers are commonly elevated in CKD, and each is associated with adverse clinical outcomes. This study tested the hypothesis that FGF23 is independently associated with inflammation in CKD.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The association between levels of FGF23 and the inflammatory markers IL-6, C-reactive protein (CRP), TNF-α, and fibrinogen was assessed in a cross-sectional analysis of 3879 participants enrolled in the Chronic Renal Insufficiency Cohort (CRIC) study between June 2003 and September 2008.
FGF23 correlated directly with IL-6 (r=0.4), CRP (r=0.2), TNF-α (r=0.4), and fibrinogen (r=0.3; P<0.001 for each). In univariate and multivariable-adjusted linear regression analyses, natural log (ln) transformed FGF23 was significantly associated with lnIL-6, lnCRP, lnTNF-α, and fibrinogen (P<0.001 for each). Each unit higher lnFGF23 was associated with severe inflammation, defined as levels of all inflammatory markers in the highest 25th percentile, in univariate (odds ratio [OR], 2.4 [95% confidence interval (CI), 2.0-2.9]) and multivariable-adjusted (OR, 2.0 [95% CI, 1.6-2.5]) logistic regression analyses. Ascending FGF23 quartiles were independently associated with severe inflammation (OR, 5.6 for the highest versus lowest FGF23 quartile [95% CI, 2.3-13.9]; P for trend < 0.001).
Higher FGF23 levels are independently associated with higher levels of inflammatory markers in patients with CKD and with significantly greater odds of severe inflammation. Future studies should evaluate whether inflammation modifies the association between FGF23 and adverse outcomes in CKD.
成纤维细胞生长因子 23（FGF23）和炎症标志物的水平在 CKD 中通常升高，且每种标志物都与不良临床结局相关。本研究检验了如下假说，即 FGF23 与 CKD 中的炎症独立相关。
设计、设置、参与者和测量：在 2003 年 6 月至 2008 年 9 月间纳入慢性肾功能不全队列（CRIC）研究的 3879 名参与者的横断面分析中，评估了 FGF23 水平与炎症标志物白细胞介素-6（IL-6）、C 反应蛋白（CRP）、肿瘤坏死因子-α（TNF-α）和纤维蛋白原之间的相关性。
FGF23 与 IL-6（r=0.4）、CRP（r=0.2）、TNF-α（r=0.4）和纤维蛋白原（r=0.3；P<0.001）均呈直接相关。在单变量和多变量调整的线性回归分析中，自然对数（ln）转换的 FGF23 与 lnIL-6、lnCRP、lnTNF-α和纤维蛋白原显著相关（P<0.001）。在单变量（比值比[OR]，2.4[95%置信区间（CI），2.0-2.9]）和多变量调整（OR，2.0[95%CI，1.6-2.5]）逻辑回归分析中，每增加一个单位的 lnFGF23 与严重炎症相关，定义为所有炎症标志物中处于最高的 25%分位数的水平。在递增的 FGF23 四分位区间分析中，严重炎症与 FGF23 四分位区间的升高独立相关（最高四分位区间与最低四分位区间相比，OR 为 5.6[95%CI，2.3-13.9]；P<0.001）。
在 CKD 患者中，较高的 FGF23 水平与炎症标志物水平的升高独立相关，且严重炎症的可能性显著增加。未来的研究应评估炎症是否会改变 FGF23 与 CKD 不良结局之间的关系。
