成纤维细胞生长因子 23：肾功能下降的生物标志物。
Fibroblast Growth Factor 23: A Biomarker of Kidney Function Decline.
机构信息
Tufts Medical Center, Boston, Massachusetts, USA.
University of Washington, Seattle, Washington, USA.
出版信息
Am J Nephrol. 2018;47(4):242-250. doi: 10.1159/000488361. Epub 2018 Apr 5.
BACKGROUND
Fibroblast growth factor 23 (FGF-23) is a hormone that regulates phosphorus levels and vitamin D metabolism. Previous studies have shown FGF-23 to be a risk factor for incident end-stage renal disease; however, there are less data on the association of FGF-23 with earlier kidney-related outcomes.
METHODS
Serum FGF-23 was assayed using an intact ELISA assay in 2,496 participants of the Healthy Aging and Body Composition Study, a cohort of well-functioning older adults. Kidney function was estimated by assaying cystatin C at baseline and years 3 and 10. The associations between FGF-23 and decline in kidney function (defined by estimated glomerular filtration rate (eGFR) decline ≥30% or ≥3 mL/min/year) and incident chronic kidney disease (CKD; incident eGFR <60 mL/min/1.73 m2 and ≥1 mL/min/year decline) were evaluated. Models were adjusted for demographics, baseline eGFR, urine albumin/creatinine ratio, comorbidity, and serum calcium, phosphorus, 25(OH) vitamin D and parathyroid hormone.
RESULTS
The mean (SD) age was 75 (3) years, with 52% female and 38% black. There were 405 persons with 30% decline, 702 with >3 mL/min/year decline, and 536 with incident CKD. In fully adjusted continuous models, doubling of FGF-23 concentrations was not associated with kidney function decline (OR [95% CI] = 0.98 [0.82-1.19] for ≥30% decline and OR 1.17 [95% CI 1.00-1.37] for ≥3 mL/min/year decline), or incident CKD (incident rate ratio [IRR] 1.05 [95% CI 0.91-1.22]). In adjusted quartile analysis, the highest quartile of FGF-23 was significantly associated with incident CKD (IRR 1.27 [95% CI 1.02-1.58] for highest vs. lowest quartile).
CONCLUSION
Higher FGF-23 concentrations were not consistently associated with decline in kidney function or incident CKD in community-dwelling older adults.
背景
成纤维细胞生长因子 23（FGF-23）是一种调节磷水平和维生素 D 代谢的激素。先前的研究表明，FGF-23 是终末期肾病发病的一个危险因素；然而，关于 FGF-23 与早期肾脏相关结果的关联的数据较少。
方法
在健康老龄化和身体成分研究（一项功能良好的老年人队列研究）的 2496 名参与者中，使用完整的 ELISA 测定法测定血清 FGF-23。在基线和第 3 年和第 10 年测定胱抑素 C 来估计肾功能。评估 FGF-23 与肾功能下降（定义为估计肾小球滤过率（eGFR）下降≥30%或≥3 mL/min/年）和新发慢性肾脏病（CKD；新发 eGFR <60 mL/min/1.73 m2 和≥1 mL/min/年下降）之间的关系。模型调整了人口统计学因素、基线 eGFR、尿白蛋白/肌酐比值、合并症以及血清钙、磷、25（OH）维生素 D 和甲状旁腺激素。
结果
平均（SD）年龄为 75（3）岁，女性占 52%，黑人占 38%。有 405 人 eGFR 下降≥30%，702 人 eGFR 下降>3 mL/min/年，536 人患有新发 CKD。在完全调整的连续模型中，FGF-23 浓度加倍与肾功能下降无关（≥30%下降的 OR [95%CI] = 0.98 [0.82-1.19]，≥3 mL/min/年下降的 OR 1.17 [95%CI 1.00-1.37]）或新发 CKD（发病率比 [IRR] 1.05 [95%CI 0.91-1.22]）。在调整后的四分位分析中，FGF-23 的最高四分位数与新发 CKD 显著相关（最高四分位 vs. 最低四分位的 IRR 1.27 [95%CI 1.02-1.58]）。
结论
在社区居住的老年人中，较高的 FGF-23 浓度与肾功能下降或新发 CKD 不一致相关。
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