Fořtová Magdaléna, Hanousková Lenka, Valkus Martin, Čepová Jana, Průša Richard, Kotaška Karel
Department of Medical Chemistry and Clinical Biochemistry, Charles University, Second Faculty of Medicine and University Hospital Motol, Prague, Czech Republic.
Endocr Connect. 2022 Jan 31;11(1):e210430. doi: 10.1530/EC-21-0430.
Fibroblast growth factor 23 (FGF23) is a key regulator of urine phosphate excretion. The aim of the study was to investigate the perioperative (intraoperative and postoperative) changes of plasma intact and C-terminal FGF23 (iFGF23, cFGF23) concentrations in patients with primary hyperparathyroidism (pHPT) submitted to surgery.
The study involved 38 adult patients with pHPT caused by adenoma. Parathyroid hormone (PTH) levels were investigated intraoperatively (just before the incision and 10 min after adenoma excision). cFGF23, iFGF23, phosphate, estimated glomerular filtration rate (eGFR), and procollagen type 1 N-terminal propetide (P1NP) were measured intraoperatively and postoperatively (next day after the surgery).
PTH levels decreased intraoperatively (13.10 pmol/L vs 4.17 pmol/L, P< 0.0001). FGF23 levels measured intraoperatively were at the upper level of reference interval. cFGF23 decreased postoperatively compared with the values measured just before the incision (cFGF23: 89.17 RU/mL vs 22.23 RU/mL, P< 0.0001). iFGF23 decreased as well, but the postoperative values were low. Postoperative inorganic phosphate values increased (1.03 mmol/L vs 0.8 mmol/L, P= 0.0025). We proved significant negative correlation of perioperative FGF23 with inorganic phosphate (cFGF23: Spearman's r = -0.253, P= 0.0065; iFGF23: Spearman's r = -0.245, P= 0.0085). We also found that FGF23 values just before incision correlated with eGFR (cystatin C) (cFGF23: Spearman's r = -0.499, P= 0.0014; iFGF23: Spearman's r = -0.413, P= 0.01).
Intraoperative iFGF23 and cFGF23 did not change despite PTH decreased significantly. cFGF23 and iFGF23 significantly decreased 1 day after parathyroidectomy and are associated with increase of inorganic phosphate in pHPT patients. cFGF23 and iFGF23 just before incision correlated with eGFR (cystatin C). Similar results found in both iFGF23 and cFGF23 suggest that each could substitute the other.
成纤维细胞生长因子23（FGF23）是尿磷排泄的关键调节因子。本研究旨在调查接受手术的原发性甲状旁腺功能亢进症（pHPT）患者围手术期（术中及术后）血浆完整FGF23和C端FGF23（iFGF23、cFGF23）浓度的变化。
本研究纳入38例由腺瘤引起的成人pHPT患者。术中（切口前及腺瘤切除后10分钟）检测甲状旁腺激素（PTH）水平。术中及术后（术后次日）检测cFGF23、iFGF23、磷酸盐、估算肾小球滤过率（eGFR）和I型前胶原N端前肽（P1NP）。
术中PTH水平下降（13.10 pmol/L对4.17 pmol/L，P<0.0001）。术中检测的FGF23水平处于参考区间上限。与切口前测得的值相比，术后cFGF23下降（cFGF23：89.17 RU/mL对22.23 RU/mL，P<0.0001）。iFGF23也下降，但术后值较低。术后无机磷值升高（1.03 mmol/L对0.8 mmol/L，P=0.0025）。我们证明围手术期FGF23与无机磷呈显著负相关（cFGF23：Spearman相关系数r=-0.253，P=0.0065；iFGF23：Spearman相关系数r=-0.245，P=0.0085）。我们还发现切口前的FGF23值与eGFR（胱抑素C）相关（cFGF23：Spearman相关系数r=-0.499，P=0.0014；iFGF23：Spearman相关系数r=-0.413，P=0.01）。
尽管PTH显著下降，但术中iFGF23和cFGF23并未改变。甲状旁腺切除术后1天，cFGF23和iFGF23显著下降，且与pHPT患者无机磷增加有关。切口前的cFGF23和iFGF23与eGFR（胱抑素C）相关。iFGF23和cFGF23的类似结果表明二者可相互替代。
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