Gan Lu, Zhou Qiaoling
Department of Nephrology, Xiangya Hospital, Central South University, Changsha 410008, China.
Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2017 Sep 28;42(9):1058-1065. doi: 10.11817/j.issn.1672-7347.2017.09.011.
To analyze the levels of serum calcium, phosphate, fibroblast growth factor 23 (FGF23), and Klotho proteins in patients with chronic kidney disease (CKD), and to investigate the correlations of FGF23 and Klotho proteins with cardiac complicates in patients with chronic kidney disease-mineral and bone disorder (CKD-MBD). Methods: A total of 180 CKD-MBD patients were enrolled for this study. Among them, 60 patients underwent regular hemodialysis, 60 patients did not undergo renal replacement therapy and 60 patients were diagnosed as second hyperparathyroidism (SHPT). Thirty age and gender-matched health volunteers served as controls. Serum samples were collected and tested, and the demographical, clinical and biochemical data were all recorded. FGF23 and Klotho levels in serum samples were analyzed by enzyme-linked immunosorbent assay. Data of echocardiography and plain abdominal X rays were collected as well. The influential factors for cardiovascular injury, the relationship between biochemical indexes and ectopic calcification, and the correlations of FGF23 and Klotho with cardiac complicates were analyzed Results: Patients, who kept hemodialysis, especially those with SHPT, exhibited an increase in serum FGF23 level while a decrease in serum Klotho protein levels (P<0.01). Patients with higher levels of serum FGF23 were more likely to have ectopic calcification (OR=4.667), while patients with lower levels of serum Klotho had high risks to get myocardial hypertrophy (OR=3.496). Receiver operator characteristic (ROC) curve analysis showed that the area under the curve (AUC) for FGF23 was 0.778 (P<0.01) while for Klotho was 0.715 (P<0.01). Conclusion: Patients, who kept hemodialysis, especially those with SHPT, have a significant increase in serum FGF23 protein levels and a significant decrease in serum Klotho protein levels. Serum FGF23 and Klotho protein levels are closely correlated with left ventricular enlargement and hypertrophy. Serum FGF23 and Klotho protein are risk factors for heart.
分析慢性肾脏病（CKD）患者血清钙、磷、成纤维细胞生长因子23（FGF23）和Klotho蛋白水平，并探讨FGF23和Klotho蛋白与慢性肾脏病-矿物质和骨异常（CKD-MBD）患者心脏并发症的相关性。方法：本研究共纳入180例CKD-MBD患者。其中，60例患者接受规律血液透析，60例患者未接受肾脏替代治疗，60例患者被诊断为继发性甲状旁腺功能亢进（SHPT）。30名年龄和性别匹配的健康志愿者作为对照。采集血清样本进行检测，并记录人口统计学、临床和生化数据。采用酶联免疫吸附测定法分析血清样本中FGF23和Klotho水平。同时收集超声心动图和腹部平片数据。分析心血管损伤的影响因素、生化指标与异位钙化的关系以及FGF23和Klotho与心脏并发症的相关性。结果：维持血液透析的患者，尤其是SHPT患者，血清FGF23水平升高而血清Klotho蛋白水平降低（P<0.01）。血清FGF23水平较高的患者更容易发生异位钙化（OR=4.667），而血清Klotho水平较低的患者发生心肌肥厚的风险较高（OR=3.496）。受试者工作特征（ROC）曲线分析显示，FGF23的曲线下面积（AUC）为0.778（P<0.01），而Klotho的AUC为0.715（P<0.01）。结论：维持血液透析的患者，尤其是SHPT患者，血清FGF23蛋白水平显著升高，血清Klotho蛋白水平显著降低。血清FGF23和Klotho蛋白水平与左心室扩大和肥厚密切相关。血清FGF23和Klotho蛋白是心脏的危险因素。
