Sinha Manish D, Turner Charles, Booth Caroline J, Waller Simon, Rasmussen Pernille, Goldsmith David J A, Simpson John M
Department of Paediatric Nephrology, Evelina London Children's Hospital, Guys & St Thomas' NHS Foundation Trust, Room 64, Sky Level, Westminster Bridge Road, London, SE1 7EH, UK,
Pediatr Nephrol. 2015 Oct;30(10):1843-52. doi: 10.1007/s00467-015-3125-3. Epub 2015 May 15.
The aim of this study was to evaluate the association of serum intact fibroblast growth factor 23 (FGF23) concentrations with indexed left ventricular mass in children with non-dialysis stages 3-5 of chronic kidney disease (CKD).
The study cohort comprised 83 children (51 boys; mean age 12.1 ± 3.2 years) with a mean estimated glomerular filtration rate (eGFR) of 32.3 ± 14.6 ml/min/1.73 m(2) who underwent clinic and ambulatory blood pressure measurement (ABPM), echocardiography and evaluation of biochemical markers of CKD-associated mineral bone disease.
The mean left ventricular mass index (LVMI) was 35.9 ± 8.5 g/m(2.7) (± standard deviation), with 30 (36.1 %) children showing left ventricular hypertrophy (LVH), all eccentric, as defined using age-specific criteria. For all subjects, the mean FGF23 concentration was 142.2 ± 204.4 ng/l and the normalised distribution following log transformation was 1.94 ± 0.39. There was significant univariate correlation of LVMI with GFR, body mass index (BMI) z-score and calcium intake, but not with 24-h systolic ABPM z-score, log intact parathyroid hormone or log FGF23. On multivariate analysis following adjustment for confounders, only elemental calcium content (g/kg/day) estimated from prescribed calcium-based phosphate binder dose (β = 154.9, p < 0.001) and BMI z-score (β = 2.397, p = 0.003) maintained a significant positive relationship with LVMI (model r (2) = 0.225).
We observed no significant relationship of FGF23 with LVMI. Larger studies in children are needed to clarify the roles of calcium-containing phosphate binders and FGF23 with LV mass and their roles in the evolution of the development of adverse cardiovascular outcomes.
本研究旨在评估慢性肾脏病（CKD）非透析3 - 5期儿童血清完整成纤维细胞生长因子23（FGF23）浓度与左心室质量指数之间的关联。
研究队列包括83名儿童（51名男孩；平均年龄12.1±3.2岁），平均估算肾小球滤过率（eGFR）为32.3±14.6 ml/min/1.73 m²，这些儿童接受了临床和动态血压测量（ABPM）、超声心动图检查以及CKD相关矿物质骨病生化标志物的评估。
平均左心室质量指数（LVMI）为35.9±8.5 g/m².⁷（±标准差），30名（36.1%）儿童表现为左心室肥厚（LVH），均为离心性肥厚，采用年龄特异性标准定义。所有受试者的平均FGF23浓度为142.2±204.4 ng/l，对数转换后的正态分布为1.94±0.39。LVMI与肾小球滤过率、体重指数（BMI）z评分和钙摄入量存在显著的单变量相关性，但与24小时收缩压ABPM z评分、对数化的完整甲状旁腺激素或对数化的FGF23无关。在对混杂因素进行调整后的多变量分析中，仅根据规定的含钙磷结合剂剂量估算的元素钙含量（g/kg/天）（β = 154.9，p < 0.001）和BMI z评分（β = 2.397，p = 0.003）与LVMI保持显著的正相关关系（模型r² = 0.225）。
我们观察到FGF23与LVMI之间无显著关系。需要对儿童进行更大规模的研究，以阐明含磷钙剂和FGF23在左心室质量方面的作用及其在不良心血管结局发展演变中的作用。
