本文選題：慢性腎臟病 + 成纖維細胞生長子23　； 參考：《大連醫(yī)科大學》2017年碩士論文

【摘要】：目的:通過酶聯(lián)免疫吸附實驗(enzyme-linked immunosorbent assay,ELISA)檢測慢性腎臟病(chronic kidney diseases,CKD)未透析患者血清成纖維細胞生長子23(fibroblast growth factor-23,FGF23)、Klotho的水平,探討二者與鈣磷代謝指標之間的關(guān)系。方法:選取2016年1月1日至2016年12月31日在本院腎內(nèi)科住院的未透析的CKD患者,共90例。根據(jù)腎小球濾過率(estimated glomerular filtration rate,e GFR)將患者分為CKD1期16例、CKD2期11例、CKD3期23例、CKD4期25例、CKD5期15例。收集研究對象的一般臨床資料。應(yīng)用全自動生化分析儀檢測血鈣、血磷、血清肌酐、血清白蛋白、24h尿電解質(zhì)等;應(yīng)用免疫化學熒光法檢測全段甲狀旁腺激素(intact parathyroidhormone,i PTH);應(yīng)用ELISA法測定血清FGF23、Klotho、1,25-二羥維生素D3(1,25-(OH)2-Vit D3)的濃度;根據(jù)所得數(shù)據(jù),計算校正鈣、鈣磷乘積、尿磷排泄分數(shù)(fractional excretion of urine phosphate,Fe Pi),并根據(jù)EPI公式計算e GFR。所有數(shù)據(jù)均用Microsoft Office Excel軟件預(yù)處理后利用R Language version 3.2.2進行統(tǒng)計分析,P0.05表示差異具有統(tǒng)計學意義。結(jié)果:1.從整體上來看,CKD未透析患者FGF23的水平隨CKD的進展而升高并且方差分析的結(jié)果顯示,CKD分期對于FGF23水平的影響具有顯著的統(tǒng)計學意義(P=0.042)。與FGF23變化趨勢相反,Klotho水平隨CKD分期升高而顯著降低(P0.000)。在反應(yīng)鈣磷代謝的各項指標中,PTH、血磷、鈣磷乘積、尿磷排泄分數(shù)等指標的水平隨CKD的進展而顯著升高,而1,25-二羥維生素D3、血鈣、24h尿磷等指標的水平隨著CKD進展逐漸降低。2.相關(guān)分析結(jié)果顯示,CKD未透析患者FGF23與Klotho(r=-0.22,P0.05)、1,25-二羥維生素D3水平(r=-0.20,P0.05)之間存在負相關(guān)。而Klotho與我們關(guān)注的鈣磷代謝指標、e GFR均存在顯著的相關(guān)性,其中,Klotho與1,25-二羥維生素D3(r=0.35,P0.01)、血鈣(r=0.25,P0.05)、24h尿磷(r=0.23,P0.05),e GFR(r=0.51,P0.01)呈正相關(guān),而與PTH(r=-0.45,P0.01)、血磷(r=-0.34,P0.01)、鈣磷乘積(r=-0.32,P0.01)、尿磷排泄分數(shù)(r=-0.43,P0.01)呈負相關(guān)。對整體數(shù)據(jù)進行校正后(剔除CKD2期的數(shù)據(jù))進行二次分析,結(jié)果顯示FGF23與各項指標的相關(guān)性,都有一定程度的升高,同時除了與Klotho、1,25-二羥維生素D3的負相關(guān)外,FGF23與e GFR(r=-0.27,P0.05)之間也表現(xiàn)出顯著的負相關(guān)。根據(jù)數(shù)據(jù)可視化結(jié)果,從整體變化趨勢上來看,FGF23隨CKD進展的變化趨勢,與PTH、血磷、鈣磷乘積、尿磷排泄分數(shù)一致,與1,25-二羥維生素D3、血鈣、24h尿磷、e GFR相反。3.將FGF23和Klotho數(shù)據(jù)以中位數(shù)為標準,劃分為高、低兩個水平,比較不同水平之間腎臟鈣磷代謝指標之間的差異。結(jié)果顯示,以不同水平FGF23劃分的組別中,各項鈣磷代謝指標不存在明顯差異,而根據(jù)Klotho水平劃分的組別中,各項鈣磷代謝指標均存在顯著的差異。4.剔除CKD2期患者的數(shù)據(jù),比較CKD1期、3期、4期、5期未透析患者FGF23、Klotho在不同性別之間的差異。結(jié)果顯示,FGF23水平在CKD1期、3期、4期、5期未透析患者不同性別中均無顯著差異,Klotho水平只有在CKD5期中男性明顯高于女性,差異有顯著性差異。結(jié)論:慢性腎臟病未透析患者FGF23水平隨CKD進展逐漸升高,Klotho水平隨CKD進展逐漸降低,二者變化存在顯著負相關(guān)。但是從整體上來看,FGF23隨CKD進展的變化趨勢,與PTH、血磷、鈣磷乘積、尿磷排泄分數(shù)一致,與1,25-二羥維生素D3、血鈣、24h尿磷、e GFR相反。在CKD患者中Klotho水平,與1,25-二羥維生素D3、血鈣、24h尿磷,e GFR正相關(guān),與PTH、血磷、鈣磷乘積、尿磷排泄分數(shù)呈負相關(guān)。
[Abstract]:Objective: to detect the relationship between the serum fibroblast growth rate 23 (fibroblast growth factor-23, FGF23) in patients with chronic renal disease (chronic kidney diseases, CKD) by enzyme-linked immunosorbent assay (ELISA), and to explore the relationship between the two and the calcium and phosphorus metabolism index. Method: 1 in 2016. 90 cases of non dialysis CKD patients hospitalized in the Department of Nephrology from 1 to December 31, 2016 were divided into 16 cases of CKD1 phase according to the glomerular filtration rate (estimated glomerular filtration rate, e GFR), 11 cases in CKD2, 23 cases in CKD3, 25 in CKD4 phase, 15 in CKD5 period. The general clinical data of the study subjects were collected. The automatic biochemical score was used. Blood calcium, blood phosphorus, serum creatinine, serum albumin, 24h urine electrolyte, etc. were detected by an analyzer. The total parathyroid hormone (intact parathyroidhormone, I PTH) was detected by immunofluorescence, and the concentration of serum FGF23, Klotho, 1,25- dihydroxyvitamin D3 (1,25- (OH)) was measured by ELISA, and the correction calcium, calcium and phosphorus multiplication were calculated according to the obtained data. Product, fractional excretion of urine phosphate, Fe Pi, and statistical analysis of E GFR. all data calculated on the basis of EPI formula for e GFR.. The level of CKD increased and the results of variance analysis showed that the effect of CKD staging on FGF23 level had significant statistical significance (P=0.042). Contrary to the FGF23 trend, Klotho level decreased significantly with the increase of CKD staging (P0.000). In the indicators of calcium and phosphorus metabolites, PTH, blood phosphorus, calcium and phosphorus products, urine phosphorus excretion. The level of scores and other indexes increased significantly with the progress of CKD, while the level of 1,25- dihydroxyvitamin D3, blood calcium, 24h urine phosphorus and so on gradually decreased with the progress of.2. correlation analysis showed that there was a negative correlation between FGF23 and Klotho (r=-0.22, P0.05) and 1,25- dihydroxyvitamin levels in CKD non dialysis patients. There is a significant correlation between E GFR and Klotho and 1,25- dihydroxyvitamin D3 (r=0.35, P0.01), blood calcium (r=0.25, P0.05), 24h urinary phosphorus (r=0.23, P0.05). 01) negative correlation. After the correction of the overall data (excluding the CKD2 period data) for two analysis, the results show that the correlation between FGF23 and various indicators has a certain degree of increase, and in addition to the negative correlation with Klotho, 1,25- dihydroxyvitamin D3, FGF23 and E GFR (R =-0.27, P0.05) also showed significant negative correlation. According to the data, Visual results, from the overall trend of change, FGF23 changes with CKD, and PTH, blood phosphorus, calcium and phosphorus product, urine phosphorus excretion score, and 1,25- dihydroxyvitamin D3, calcium, 24h urine phosphorus, e GFR in the opposite.3., the median of FGF23 and Klotho data is divided into high, low two levels, and the comparison of different levels of kidney calcium and phosphorus between the different levels The difference between metabolic indices showed that there was no significant difference in calcium and phosphorus metabolism in groups with different levels of FGF23, and there were significant differences in calcium and phosphorus metabolism indices according to the Klotho level in groups divided by.4. to eliminate CKD2 patients, compared to CKD1, 3, 4, and 5 stage non dialysis patients FGF23, Klot The difference between ho in different sexes showed that there was no significant difference in FGF23 level in CKD1, 3, 4, and 5 non dialysis patients. The level of Klotho was significantly higher than that of women in the CKD5 stage. The difference was significant. Conclusion: the level of FGF23 in the patients with chronic renal disease was gradually increased with the progression of CKD and Klotho level. As CKD progresses gradually, there is a significant negative correlation between the two changes. But on the whole, the change trend of FGF23 with CKD is the same as PTH, the product of blood phosphorus, calcium and phosphorus, and the opposite of 1,25- dihydroxyvitamin D3, blood calcium, 24h phosphorous, e GFR. R was positively correlated, negatively correlated with PTH, blood phosphorus, calcium phosphorus production and urinary phosphorus excretion fraction.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692

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