Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, Centro Médico Nacional de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México; División de Medicina Molecular, Centro de Investigación Biomédica de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.
Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, Centro Médico Nacional de Occidente, Delegación Jalisco, Instituto Mexicano del Seguro Social, Guadalajara, México.
Arch Med Res. 2018 Oct;49(7):451-455. doi: 10.1016/j.arcmed.2019.01.008. Epub 2019 Feb 1.
Diabetic nephropathy is a leading cause of chronic kidney disease (CKD). In diabetes, changes in serum levels of both soluble alpha Klotho (sKL) and fibroblast growth factor 23 (FGF-23) have been associated with CKD progression.
To evaluate the associations of circulating levels of sKL and FGF-23 with the presence of early nephropathy (EN) in diabetic patients.
A cross-sectional study in 136 Mexicans with type 2 diabetes mellitus (T2DM). Early nephropathy was defined as an estimated glomerular filtration rate (≥60 ml/min) and urinary albumin excretion (≥30 mg/g). Serum concentrations of sKL and FGF-23 were measured using ELISA. Associations were evaluated with multiple logistic regression.
Fifty-two subjects had EN. Median values of sKL and FGF-23 for all individuals were 244 pg/mL (interquartile range [IQR]: 201-402) and 92 pg/mL (IQR: 39-507), respectively. A positive correlation was found between levels of sKL and FGF-23 (r = 0.38; p <0.001). FGF-23 levels correlated negatively with angiotensin-II receptor blocker therapy (ARB, r = 0.24; p <0.01). Subjects without EN were younger (59 vs. 63 years old, p = 0.02). Elevated concentrations of FGF-23 were negatively associated with EN (Odds Ratio [OR] = 0.29, 95% Confidence Interval [95% CI] = 0.13, 0.65).
In Mexican diabetic patients, serum levels of FGF-23 were positively correlated with sKL but negatively correlated with ARB therapy. In addition, a higher concentration of FGF-23 reduced the odds of early nephropathy in patients with T2DM.
糖尿病肾病是慢性肾脏病（CKD）的主要原因。在糖尿病中，可溶性 klotho（sKL）和成纤维细胞生长因子 23（FGF-23）的血清水平变化与 CKD 进展有关。
评估循环 sKL 和 FGF-23 水平与糖尿病患者早期肾病（EN）的关系。
对 136 名墨西哥 2 型糖尿病（T2DM）患者进行横断面研究。早期肾病定义为估算肾小球滤过率（≥60ml/min）和尿白蛋白排泄率（≥30mg/g）。采用 ELISA 法测定血清 sKL 和 FGF-23 浓度。采用多元逻辑回归评估相关性。
52 例患者存在 EN。所有患者 sKL 和 FGF-23 的中位数分别为 244pg/ml（四分位距[IQR]：201-402）和 92pg/ml（IQR：39-507）。sKL 和 FGF-23 水平之间存在正相关（r=0.38；p<0.001）。FGF-23 水平与血管紧张素 II 受体阻滞剂（ARB）治疗呈负相关（r=0.24；p<0.01）。无 EN 患者年龄较小（59 岁比 63 岁，p=0.02）。较高的 FGF-23 浓度与 EN 呈负相关（比值比[OR]0.29，95%置信区间[95%CI]0.13-0.65）。
在墨西哥糖尿病患者中，血清 FGF-23 水平与 sKL 呈正相关，但与 ARB 治疗呈负相关。此外，较高浓度的 FGF-23 降低了 T2DM 患者早期肾病的发病风险。
