血液透析患者体内的成纤维细胞生长因子23（FGF23）与左心室肥厚及射血分数降低有关。

FGF23 in hemodialysis patients is associated with left ventricular hypertrophy and reduced ejection fraction.

作者信息

Nielsen Ture Lange, Plesner Louis Lind, Warming Peder Emil, Mortensen Ole Hartvig, Iversen Kasper Karmark, Heaf James Goya

机构信息

Department of Medicine, Zealand University Hospital, Roskilde, Denmark; Department of Cardiology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark.

Department of Cardiology, Copenhagen University Hospital, Herlev, Copenhagen, Denmark.

出版信息

Nefrologia (Engl Ed). 2019 May-Jun;39(3):258-268. doi: 10.1016/j.nefro.2018.10.007. Epub 2019 Feb 2.

DOI:10.1016/j.nefro.2018.10.007

PMID:30723045

Abstract

BACKGROUND

Fibroblast growth factor 23 (FGF23) is known to cause left ventricular hypertrophy (LVH), but controversy exists concerning its effect in dialysis. This study evaluated associations between FGF23 levels, echocardiography and prognosis in patients on hemodialysis (HD).

METHODS

Patients >18 years on chronic HD were included in this cross-sectional study. Plasma C-terminal FGF23 concentration was measured with ELISA and transthoracic echocardiography was performed, both before and after HD treatment.

RESULTS

239 haemodialysis (HD) patients were included in the study. The FGF23 was median 3560RU/ml (IQR 1447-9952). The mean left ventricular mass index (LVMI) was 110.2±26.7g/m and the left ventricular ejection fraction (LVEF) was 52.7±9.9%. Defined by LVMI, LVH was found in 110 patients (46%), of which 92 (84%) had hypertension (p<0.01). Patients with LVH had FGF23 levels of 5319 RU/ml (IQR 1858-12,859) and those without 2496 RU/ml (IQR 1141-7028) (p<0.01). FGF23 was significant positive correlated with LVMI (p<0.01), and negatively to LVEF (p<0.01). In a multivariate analysis, FGF23 was correlated with LVEF (p<0.01), but only marginally to LVMI (p<0.01). Cardiovascular events in the follow up period was not correlated with FGF23. Furthermore, FGF23 was independently correlated with overall mortality (p<0.001).

CONCLUSION

FGF23 was positively correlated with LVH and negatively to LVEF. FGF23 was an independent predictor for overall mortality.

摘要

背景

已知成纤维细胞生长因子23（FGF23）可导致左心室肥厚（LVH），但其在透析中的作用仍存在争议。本研究评估了血液透析（HD）患者中FGF23水平、超声心动图与预后之间的关联。

方法

本横断面研究纳入了年龄大于18岁的慢性HD患者。在HD治疗前后均采用酶联免疫吸附测定法（ELISA）测量血浆C末端FGF23浓度，并进行经胸超声心动图检查。

结果

239例血液透析（HD）患者纳入本研究。FGF23的中位数为3560RU/ml（四分位间距1447 - 9952）。平均左心室质量指数（LVMI）为110.2±26.7g/m，左心室射血分数（LVEF）为52.7±9.9%。根据LVMI定义，110例患者（46%）存在LVH，其中92例（84%）患有高血压（p<0.01）。LVH患者的FGF23水平为5319 RU/ml（四分位间距1858 - 12859），无LVH患者的FGF23水平为2496 RU/ml（四分位间距1141 - 7028）（p<0.01）。FGF23与LVMI呈显著正相关（p<0.01），与LVEF呈负相关（p<0.01）。在多变量分析中，FGF23与LVEF相关（p<0.01），但与LVMI仅呈微弱相关（p<0.01）。随访期间的心血管事件与FGF23无关。此外，FGF23与总死亡率独立相关（p<0.001）。