高C末端成纤维细胞生长因子-23、完整甲状旁腺激素和白细胞介素-6作为维持性血液透析患者瓣膜钙化的决定因素
High C-Terminal Fibroblast Growth Factor-23, Intact Parathyroid Hormone, and Interleukin-6 as Determinants of Valvular Calcification in Regular Hemodialysis Patients.
作者信息
Kandarini Yenny, Mahadita Gede Wira, Herawati Sianny, Wibhuti Ida Bagus Rangga, Widiana I Gde Raka, Ayu Nyoman Paramita
机构信息
Department of Internal Medicine, Division of Nephrology and Hypertension, Udayana University Sanglah Hospital, Denpasar, Bali, Indonesia.
Department of Clinical Pathology and Laboratory Medicine, Udayana University Sanglah Hospital, Denpasar, Bali, Indonesia.
出版信息
Int J Gen Med. 2022 Apr 20;15:4227-4236. doi: 10.2147/IJGM.S359168. eCollection 2022.
PURPOSE
Biggest cause of death in chronic kidney disease-hemodialysis (CKD-HD) patients is cardiovascular disease (CVD). Cardiovascular disease is often associated with mineral bone disorders (MBD), especially vascular and valvular calcification. Biomarkers such as C-terminal-fibroblast growth factor-23 (FGF-23), intact parathyroid hormone (iPTH), and interleukin-6 (IL-6) were investigated. Only few studies have focused on valvular calcification in CKD-HD patients, with controversial results. The present study aimed to investigate whether high C-terminal-FGF-23, iPTH, and IL-6 can be used as determinants of valvular calcification in CKD-MBD patients undergoing regular HD.
PATIENTS AND METHODS
This was an analytical cross-sectional study which involved CKD-HD patients aged 18-60 years with no history of CVD, malignancy, and diabetes mellitus. C-terminal FGF-23 was measured using enzyme-linked immunosorbent assay (ELISA) kit, iPTH using chemiluminescent immunometric method, and IL-6 using sandwich enzyme immunoassay technique. Valvular calcification on aortic and mitral valves was examined with echocardiography. Data analysis was done using Chi-squared test or Fisher's exact test as appropriate and multivariate logistic regression analysis.
RESULTS
Bivariate analysis with Fisher's exact test showed significant association of prevalence ratio (PR) of C-terminal FGF-23 (PR = 1.33; p = 0.003; CI (1.017-1.748)), iPTH (PR = 1.361; p = 0.002; CI (1.02-1.816)), and IL-6 (PR = 1.2; p = 0.019; CI (1.000-1.446)) with valvular calcification. Multivariate analysis with logistic regression showed high C-terminal FGF-23 (exp (B) value of 16.44; p = 0.045; CI (1.07-252.75)), iPTH (exp (B) value of 33.312; p = 0.016; CI (1.94-571.71)), and IL-6 (exp (B) value of 21.58; p = 0.0381; CI (1.18-394.87)) were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.
CONCLUSION
This study demonstrated that high C-terminal FGF-23, iPTH, and IL-6 were determinants of valvular calcification in CKD-MBD patients undergoing regular HD.
目的
慢性肾脏病 - 血液透析（CKD - HD）患者的主要死因是心血管疾病（CVD）。心血管疾病常与矿物质骨 disorder（MBD）相关，尤其是血管和瓣膜钙化。对诸如 C 末端成纤维细胞生长因子 - 23（FGF - 23）、完整甲状旁腺激素（iPTH）和白细胞介素 - 6（IL - 6）等生物标志物进行了研究。仅有少数研究关注 CKD - HD 患者的瓣膜钙化，结果存在争议。本研究旨在调查高 C 末端 FGF - 23、iPTH 和 IL - 6 是否可作为接受定期血液透析的 CKD - MBD 患者瓣膜钙化的决定因素。
患者与方法
这是一项分析性横断面研究，纳入年龄在 18 - 60 岁、无 CVD、恶性肿瘤和糖尿病病史的 CKD - HD 患者。使用酶联免疫吸附测定（ELISA）试剂盒测量 C 末端 FGF - 23，采用化学发光免疫分析法测量 iPTH，使用夹心酶免疫测定技术测量 IL - 6。通过超声心动图检查主动脉和二尖瓣的瓣膜钙化情况。根据情况使用卡方检验或 Fisher 精确检验以及多因素逻辑回归分析进行数据分析。
结果
Fisher 精确检验的双变量分析显示，C 末端 FGF - 23 的患病率比（PR）（PR = 1.33；p = 0.003；CI（1.017 - 1.748））、iPTH（PR = 1.361；p = 0.002；CI（1.02 - 1.816））和 IL - 6（PR = 1.2；p = 0.019；CI（1.000 - 1.446））与瓣膜钙化存在显著关联。逻辑回归的多因素分析显示，高 C 末端 FGF - 23（exp（B）值为 16.44；p = 0.045；CI（1.07 - 25⒎75））、iPTH（exp（B）值为 33.312；p = 0.016；CI（1.94 - 571.71））和 IL - 6（exp（B）值为 21.58；p = 0.0381；CI（1.18 - 394.87））是接受定期血液透析的 CKD - MBD 患者瓣膜钙化的决定因素。
结论
本研究表明，高 C 末端 FGF - 23、iPTH 和 IL - 6 是接受定期血液透析的 CKD - MBD 患者瓣膜钙化的决定因素。
Zotero 插件