Department of Internal Medicine, Division of Nephrology University Medical Center Groningen, University of Groningen Groningen The Netherlands.
Department of Internal Medicine, Division of Endocrinology University Medical Center Groningen, University of Groningen Groningen The Netherlands.
J Am Heart Assoc. 2023 Dec 5;12(23):e031873. doi: 10.1161/JAHA.123.031873. Epub 2023 Nov 28.
FGF23 (fibroblast growth factor 23) is associated with a higher mortality risk in type 2 diabetes, but the mechanism is unclear. We aimed to study whether NT-proBNP (N-terminal pro-brain natriuretic peptide) mediates the association between FGF23 and mortality.
We analyzed C-terminal FGF23 and NT-proBNP levels in 399 patients with type 2 diabetes. Cox regression analyses were performed, followed by mediation analyses using Structural Equation Modeling. During follow-up of 9.2 [7.6-11.3] years, 117 individuals died. FGF23 was associated with all-cause mortality, independent of potential confounders (fully adjusted hazard ratio [HR], 2.32 [95% CI, 1.21-4.43], =0.01). The association was lost upon further adjustment for NT-proBNP (HR, 1.84; 95% CI, 0.91-3.73). NT-proBNP accounted for 26% of the mediation effect between FGF23 and all-cause mortality.
These findings suggest that a higher FGF23 level is associated with increased mortality in individuals with type 2 diabetes through an effect on volume homeostasis.
成纤维细胞生长因子 23（fibroblast growth factor 23，FGF23）与 2 型糖尿病患者的死亡率升高相关，但具体机制尚不清楚。我们旨在研究 N 端脑钠肽前体（N-terminal pro-brain natriuretic peptide，NT-proBNP）是否介导 FGF23 与死亡率之间的关联。
我们分析了 399 例 2 型糖尿病患者的 C 端 FGF23 和 NT-proBNP 水平。进行了 Cox 回归分析，随后使用结构方程模型进行中介分析。在 9.2[7.6-11.3]年的随访期间，有 117 人死亡。FGF23 与全因死亡率相关，独立于潜在混杂因素（完全调整后的危险比 [HR]，2.32[95%CI，1.21-4.43]，=0.01）。进一步调整 NT-proBNP 后，该关联消失（HR，1.84；95%CI，0.91-3.73）。NT-proBNP 解释了 FGF23 与全因死亡率之间 26%的中介效应。
这些发现表明，较高的 FGF23 水平与 2 型糖尿病患者的死亡率升高相关，这是通过对容量平衡的影响实现的。
