成纤维细胞生长因子 23、矿物质代谢与老年男性死亡率（瑞典 MrOs 研究）
Fibroblast growth factor 23, mineral metabolism and mortality among elderly men (Swedish MrOs).
机构信息
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
出版信息
BMC Nephrol. 2013 Apr 15;14:85. doi: 10.1186/1471-2369-14-85.
BACKGROUND
Fibroblast growth factor 23 (FGF23) is the earliest marker of disturbed mineral metabolism as renal function decreases. Its serum levels are associated with mortality in dialysis patients, persons with chronic kidney disease (CKD) and prevalent cardiovascular disease (CVD), and it is associated with atherosclerosis, endothelial dysfunction and left ventricular hypertrophy in the general population. The primary aim of this study is to examine the association between FGF23 and mortality, in relation to renal function in the community. A secondary aim is to examine the association between FGF23 and CVD related death.
METHODS
The population-based cohort of MrOS Sweden included 3014 men (age 69-81 years). At inclusion intact FGF23, intact parathyroid hormone (PTH), 25 hydroxyl vitamin D (25D), calcium and phosphate were measured. Mortality data were collected after an average of 4.5 years follow-up. 352 deaths occurred, 132 of CVD. Association between FGF23 and mortality was analyzed in quartiles of FGF23. Kaplan-Meier curves and Log-rank test were used to examine time to events. Cox proportional hazards regression was used to examine the association between FGF23, in quartiles and as a continuous variable, with mortality. The associations were also analyzed in the sub-cohort with estimated glomerular filtration rate (eGFR) above 60 ml/min/1.73 m(2).
RESULTS
There was no association between FGF23 and all-cause mortality, Hazard ratio (HR) 95% confidence interval (CI): 1.02 (0.89-1.17). For CVD death the HR (95% CI) was 1.26 (0.99 - 1.59)/(1-SD) increase in log(10)FGF23 after adjustment for eGFR, and other confounders. In the sub-cohort with eGFR > 60 ml/min/1.73 m(2) the HR (95% CI) for CVD death was 55% (13-111)/(1-SD) increase in log(10)FGF23.
CONCLUSIONS
FGF23 is not associated with mortality of all-cause in elderly community living men, but there is a weak association with CVD death, even after adjustment for eGFR and the other confounders. The association with CVD death is noticeable only in the sub-cohort with preserved renal function.
背景
成纤维细胞生长因子 23（FGF23）是肾功能下降时矿物质代谢紊乱的最早标志物。其血清水平与透析患者、慢性肾脏病（CKD）和常见心血管疾病（CVD）患者的死亡率相关，并且与普通人群中的动脉粥样硬化、内皮功能障碍和左心室肥厚相关。本研究的主要目的是在社区中检查 FGF23 与肾功能相关的死亡率之间的关系。次要目的是检查 FGF23 与 CVD 相关死亡之间的关系。
方法
基于人群的 MrOS 瑞典队列纳入了 3014 名男性（年龄 69-81 岁）。在纳入时，检测了完整的 FGF23、完整甲状旁腺激素（PTH）、25 羟维生素 D（25D）、钙和磷。在平均 4.5 年的随访后收集死亡率数据。发生了 352 例死亡，其中 132 例为 CVD 死亡。使用 FGF23 的四分位数分析 FGF23 与死亡率之间的关系。使用 Kaplan-Meier 曲线和对数秩检验来检查事件时间。使用 Cox 比例风险回归分析 FGF23 在四分位数中的关系，以及 FGF23 作为连续变量与死亡率之间的关系。还在肾小球滤过率（eGFR）高于 60 ml/min/1.73 m2 的亚组中分析了这些关联。
结果
FGF23 与全因死亡率之间没有关联，风险比（HR）95%置信区间（CI）：1.02（0.89-1.17）。对于 CVD 死亡，在调整 eGFR 和其他混杂因素后，HR（95%CI）为 1.26（0.99-1.59）/（1-SD）log10FGF23 增加。在 eGFR >60 ml/min/1.73 m2 的亚组中，CVD 死亡的 HR（95%CI）为 55%（13-111）/（1-SD）log10FGF23 增加。
结论
在老年社区居住男性中，FGF23 与全因死亡率无关，但与 CVD 死亡有弱相关性，即使在调整 eGFR 和其他混杂因素后也是如此。与 CVD 死亡的相关性仅在肾功能正常的亚组中明显。
Zotero 插件