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  本文關(guān)鍵詞： 血液透析 成纖維細胞生長因子23 甲狀旁腺激素　出處：《山西醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：觀察慢性腎衰竭維持性血液透析（maintenance hemodialysis,MHD）患者血清成纖維細胞生長因子23（fibroblast growth factor23,FGF-23）及全段甲狀旁腺激素(intact parathyroid hormone,iPTH)的水平，分析FGF23水平與iPTH等影響因素的相關(guān)性，探討FGF-23對慢性腎衰竭SHPT患者的臨床意義，為MHD患者甲狀旁腺功能異常的早期防治探索一種更有效、更安全的方法。 方法：選取2012年6月至2013年6月在中日友好醫(yī)院規(guī)律血液透析（每周透析3次，每次4小時）≥3個月，年齡在18歲-70歲的血液透析患者41名，另選擇健康志愿者12名為對照組，記錄一般情況及生化指標(biāo)，采集血清檢測FGF-23及iPTH并行相關(guān)分析。 結(jié)果：（1）慢性腎衰竭MHD各組與對照組在年齡及性別均無顯著差異，但MHD患者FGF-23顯著高于對照組（1077.4±967.46pg/ml比73.99±19.58pg/ml，P0.001）；（2）依據(jù)iPTH不同將MHD分為A組(低iPTH組)、B組(iPTH達標(biāo)組)、C組(高iPTH組)，F(xiàn)GF-23在三組間有顯著性差異（分別為477.44±2293.53pg/ml、176.57±402.39pg/ml、1433.1±1984.76pg/ml，P=0.016）；（3）高iPTH組按是否有面部骨骼畸形分為兩個亞組即C1組（單純高iPTH組）及C2組（高iPTH伴骨骼畸形組），兩組間FGF23無顯著性差異（P0.05）；（4）MHD患者根據(jù)血磷水平不同再次進行分組，高血磷組與非高血磷組相比，iPTH水平顯著升高1319.66±1015.96pg/ml比583.36±980.81pg/m（lP=0.012）、相同地FGF-23也明顯升高1506.83±957.97pg/ml比452.31±696.12pg/m（lP0.001）；(5)行相關(guān)性分析顯示：FGF-23與iPTH在B組、C組呈正相關(guān)（r=0.736，P=0.005），而在A組無相關(guān)性；FGF-23與血鈣（r=0.381，P=0.005）、磷（r=0.749，P0.001）、鈣磷乘積（r=0.656，P0.001）及堿性磷酸酶（Alkaline phosphatase，ALP）（r=0.276，P=0.045）均呈正相關(guān)。 結(jié)論：MHD患者血FGF-23較健康志愿者明顯增高，與SHPT患者的iPTH相關(guān)，，并與血鈣、血磷、鈣磷乘積、ALP相關(guān)，其中與血磷的關(guān)系最為密切。FGF-23可能在SHPT的發(fā)生、發(fā)展中起著重要作用，并有可能成為慢性腎衰竭SHPT新的診斷及治療靶點。
[Abstract]:Objective: to observe the levels of serum fibroblast growth factor 23 (FGF-23) and total parathyroid hormone (PTH) in maintenance hemodialysis patients with chronic renal failure (CRF), and to analyze the correlation between FGF23 level and iPTH. To explore the clinical significance of FGF-23 in SHPT patients with chronic renal failure and to explore a more effective and safe method for the early prevention and treatment of parathyroid dysfunction in MHD patients. Methods: from June 2012 to June 2013, 41 hemodialysis patients aged from 18 to 70 years were selected for hemodialysis (3 times a week, 4 hours per week) in China-Japan Friendship Hospital. In addition, 12 healthy volunteers were selected as the control group. The general situation and biochemical indexes were recorded, and the serum samples were collected to detect FGF-23 and iPTH. Results (1) there was no significant difference in age and sex between MHD group and control group. But the FGF-23 of MHD patients was significantly higher than that of control group (1077.4 鹵967.46 PG / ml vs 73.99 鹵19.58 PG / ml P 0.001g / ml). According to iPTH, the patients with MHD were divided into A group (low iPTH group and B group). (high iPTH group FGF-23 had significant difference between the three groups (477.44 鹵2293.53 PG / ml 176.57 鹵402.39pgml1433.1 鹵1984.76pg / ml P 0.016).). The patients were divided into two subgroups: C1 group (simple high iPTH group) and C2 group (high iPTH with bone deformity group). There was no significant difference in FGF23 between the two groups. The level of FGF-23 in hyperphosphorous group was significantly higher than that in non-hyperphosphorous group (1319.66 鹵1015.96 PG / ml vs 583.36 鹵980.81 PG / ml vs 583.36 鹵980.81pg / ml 0.012g / ml), and the FGF-23 was also significantly increased by 1506.83 鹵957.97pggml / ml / 452.31 鹵696.12pgmlP0.001g / ml (452.31 鹵696.12pgP0.001g / ml). The correlation analysis showed that there was a positive correlation between FGF-23 and iPTH in group B (0.736P0.005), but there was no correlation between FGF-23 and serum calcium (0.381g / g / ml). There was a positive correlation between Ca ~ (2 +) ~ (P ~ (2 +)) and Alkaline phosphatase (ALP ~ (0.276) P ~ (0.045)). Conclusion the blood FGF-23 of the patients with SHPT is significantly higher than that of the healthy volunteers, and is related to the iPTH of the patients with SHPT, and to the serum calcium, phosphorus, calcium and phosphorus products. FGF-23 may play an important role in the occurrence and development of SHPT. And may become a new diagnosis and treatment target of chronic renal failure (SHPT).
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.5

【參考文獻】

相關(guān)期刊論文 前1條

1 馬丹丹;董靜;張凌;徐寶華;;Sagliker綜合征顱頜面畸形初步研究[J];中國血液凈化;2012年07期

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