維持性血液透析患者血清FGF-23水平和血管鈣化關(guān)系的研究
發(fā)布時間：2018-07-23 20:46
【摘要】：背景目前全球慢性腎臟病(CKD)發(fā)病率及發(fā)病數(shù)量呈明顯增多趨勢,據(jù)統(tǒng)計全球每年約有10%-13%的人群發(fā)病,其中約1%的患者發(fā)展至CKD5期。我國每年約有1萬人進入透析階段。鈣磷代謝紊亂和心血管疾病并發(fā)癥足維持性血液透析患者的嚴重的并發(fā)癥,也是影響患者生活質(zhì)量和生存率的主要因素。許多證據(jù)表明,尿毒癥患者長期鈣磷代謝紊亂可引起繼發(fā)性甲狀旁腺功能亢進、礦物質(zhì)和骨代謝異常、轉(zhuǎn)移性鈣化,包括心肌、肺、心臟瓣膜及血管等。以上因素均與慢性腎功能衰竭的死亡率增加相關(guān)聯(lián),其中心血管并發(fā)癥是導致血液透析患者死亡的首要原因。研究發(fā)現(xiàn),血管鈣化是發(fā)生心血管事件的主要原因。而血液透析患者發(fā)生血管鈣化的機制比較復雜,有多種危險因素參與,除了傳統(tǒng)的心血管危險因素如高齡、男性、吸煙史、高血壓、糖尿病、高脂血癥等外,近年的大量研究發(fā)現(xiàn)血管鈣化的中心環(huán)節(jié)是慢性炎癥和動脈粥樣硬化。而動脈粥樣硬化與鈣磷代謝紊亂、營養(yǎng)不良、慢性炎癥等因素有關(guān)。 成纖維細胞生長因子(Fibroblast growth factor-23, FGF-23),是一種新型的鈣磷和維生素D調(diào)節(jié)因子,在維持性血液透析患者的外周血中顯著增高,是血液透析患者血管鈣化的獨立危險因素。維持性血液透析患者普遍存在鈣磷代謝紊亂和低1,25(OH)2D3,而口服維生素D受體激活劑(骨化三醇)的治療可能引起FGF-23水平升高,那么是否會加重血管鈣化的研究較少。2009年,KDIGO指南中建議采用腹部側(cè)位片聯(lián)合超聲心動圖檢查來評估血管鈣化情況。 目的觀察我血液透析中心維持性血液透析患者腹主動脈及心臟瓣膜鈣化、頸動脈內(nèi)膜中層厚度(IMT)增厚的情況,分析引起血管鈣化的危險因素,探討FGF-23水平與血管鈣化各危險因素之間的關(guān)系及長期口服小劑量維生素D治療對血管鈣化危險因素的作用。 方法選擇我中心2013.3—2014.2維持性血液透析的患者63例,健康對照組20例,兩組均用雙抗夾心酶聯(lián)ELISA法檢測血清成纖維細胞生長因子-23(FGF-23)水平。記錄所有血液透析患者一般資料及臨床資料,完善相關(guān)實驗室檢查,用全自動生化分析儀檢測鈣(Ca)、磷(Pi)、堿性磷酸酶(ALP)、白蛋白(ALB)、膽固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、血糖(Glu)、肌酐(Scr)、血紅蛋白(Hb)等,用免疫化學發(fā)光法測甲狀旁腺素(iPTH),用免疫透射比濁法測鐵蛋白(FER)、維生素B12(V-B12)和超敏C-反應蛋白(hsCRP),采用彩色多普勒超聲儀檢測有無心肌及瓣膜鈣化、頸動脈內(nèi)膜中層厚度(IMT)及有無動脈斑塊形成,腰椎側(cè)位X片查腹主動脈鈣化情況。統(tǒng)計學處理采用SPSS17.0統(tǒng)計軟件包,以P0.05為差異有統(tǒng)計學意義。 結(jié)果1、維持性血液透析患者的臨床資料：63例患者平均年齡52.5±23.33歲。原發(fā)�。郝阅I小球腎炎23例(36.5%),糖尿病腎病25例(39.6%),多囊腎1例(1.6%),高血壓腎病11例(17.5%),原因不明3例(4.8%)。其中已口服小劑量骨化三醇治療3個月以上的患者有33例(占52.38%)。 2、鈣化發(fā)生情況：63例維持性血液透析患者中無血管鈣化的患者33例(無鈣化組),有血管鈣化的31例(鈣化組),其中有11例發(fā)生腹主動脈血管鈣化,發(fā)生率為17.5%；有心臟瓣膜鈣化5例(主動脈瓣或和二尖瓣鈣化、心肌鈣化),發(fā)生率為7.9%；頸動脈內(nèi)膜中層厚度(IMT)大于0.9mm或斑塊形成的患者有8例(12.7%)；多處鈣化同時存在的患者7例(11.1%)。 鈣化組與非鈣化組比較,年齡、透析齡、Pi、鈣磷乘積、ALB、hsCRP、FGF-23有顯著差別,差異有統(tǒng)計學意義,P0.05。骨化三醇治療組血管鈣化率(36.36%)較非骨化三醇治療組血管鈣化率(63.33%)明顯降低,差異有統(tǒng)計學意義,P0.05。 3、多因素logistic回歸分析血管鈣化的危險因素,結(jié)果顯示：年齡、hsCRP、Pi、FGF-23及未服用骨化三醇可能是發(fā)生血管鈣化的主要危險因素,高水平的ALB為保護性因素。 4、FGF-23水平與血磷及鈣磷乘積成正相關(guān),與ALB、ALP、Ca、hsCRP、年齡、透析齡、iPTH、口服骨化三醇均無明顯相關(guān)性。 5、骨化三醇治療組血Ca(2.16±0.20mmol/L)較非骨化三醇治療組Ca(1.9910.27mmol/L)明顯升高,差異有統(tǒng)計學意義,P0.05。骨化三醇治療組iPTH (33.98±22.39pmol/L)、 ALP (90.29±43.22U/L)、hsCRP (5.40±3.92mg/L)、CaxPi (56.76±13.97mg2/ml2)水平較非骨化三醇治療組iPTH (52.9±36.49pmol/L)、ALP (128.20±82.14U/L)、hsCRP(9.05±8.34)、 Ca×Pi (49.66±14.62mg2/ml2)明顯降低,差異有統(tǒng)計學意義,P0.05。對FGF-23無顯著影響。 結(jié)論1、血液透析患者血管鈣化的危險因素有：年齡、血FGF-23、Pi、hsCRP及未服用骨化三醇,高ALB為保護性因素。 2、小劑量骨化三醇治療可能導致血鈣升高,使iPTH、hsCRP、ALP、Ca×Pi下降,有可能導致血管鈣化發(fā)生率減低。對FGF-23無顯著影響。
[Abstract]:Background the incidence and number of CKD in global chronic kidney disease (CKD) are increasing obviously. According to the statistics, about 1% of the patients have developed to the CKD5 stage. About 10 thousand people enter the dialysis stage each year in China. The disorder of calcium and phosphorus metabolism and the complications of cardiovascular disease are serious in the maintenance hemodialysis patients. The complications are also the main factors affecting the quality of life and survival of patients. Many evidence suggests that chronic metabolic disorders of calcium and phosphorus in uremia patients can cause secondary hyperparathyroidism, abnormal mineral and bone metabolism, metastatic calcification, including myocardium, lung, heart valve and blood vessels. All of these factors are associated with chronic renal failure. Cardiovascular complications are the leading causes of death in hemodialysis patients. Studies have found that vascular calcification is the main cause of cardiovascular events. The mechanism of vascular calcification in hemodialysis patients is complex, with a variety of risk factors involved, with the exception of the traditional cardiovascular risk factors such as high. Age, male, smoking history, hypertension, diabetes, hyperlipidemia and so on. A large number of recent studies have found that the central link of vascular calcification is chronic inflammation and atherosclerosis, and atherosclerosis is associated with disorders of calcium and phosphorus metabolism, malnutrition, chronic inflammation and so on.
Fibroblast growth factor-23 (FGF-23), a new type of calcium phosphorus and vitamin D regulator, is significantly increased in the peripheral blood of maintenance hemodialysis patients. It is an independent risk factor for vascular calcification in hemodialysis patients. There is a widespread disorder of calcium and phosphorus metabolism and low 1,25 (OH) in maintenance hemodialysis patients. 2D3, while the treatment of oral vitamin D receptor activator (ossified three alcohol) may cause a higher level of FGF-23, then the study of whether or not it will aggravate vascular calcification is less.2009 years. The KDIGO guide recommends the use of abdominal side slice combined echocardiography to assess vascular calcification.
Objective To observe the calcification of abdominal aorta and heart valve and the thickness of carotid intima media thickness (IMT) in the maintenance hemodialysis patients at hemodialysis center, to analyze the risk factors of vascular calcification and to explore the relationship between the risk factors of FGF-23 and the risk factors of vascular calcification and the long-term oral dose of vitamin D in the treatment of vascular calcium. The role of the risk factors.
Methods 63 patients with 2013.3 to 2014.2 maintenance hemodialysis and 20 healthy controls were selected. The level of serum fibroblast growth factor -23 (FGF-23) was detected by double anti sandwich ELISA method in the two groups. The general data and clinical data of all hemodialysis patients were recorded, the related laboratory examination was perfected, and the automatic biochemical analysis was used. The apparatus detected calcium (Ca), phosphorus (Pi), alkaline phosphatase (ALP), albumin (ALB), cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), blood glucose (Glu), creatinine (Scr), hemoglobin (Hb), and so on. Immunochemiluminescence was used to measure the parathyroid hormone (iPTH) and immunoturbidimetry. The hypersensitive C- reactive protein (hsCRP) was used to detect the calcification of the myocardium and valve, the thickness of the carotid artery intima media (IMT) and the atherosclerotic plaque in the carotid artery, and the calcification of the abdominal aorta at the lumbar side of the lumbar vertebra by the color Doppler ultrasound. The statistical treatment was statistically significant with the difference of the SPSS17.0 statistical package. The difference was statistically significant with the difference of P0.05.
Results 1, the clinical data of maintenance hemodialysis patients: the average age of 63 patients was 52.5 + 23.33 years old. The primary disease: 23 cases of chronic glomerulonephritis (36.5%), 25 cases of diabetic nephropathy (39.6%), 1 cases of polycystic kidney (1.6%), 11 cases of hypertensive nephropathy (17.5%), unexplained 3 cases (4.8%). There were 33 cases (52.38%).
2, calcification occurred in 63 cases of maintenance hemodialysis patients without vascular calcification in 33 cases (no calcification group) and 31 cases of vascular calcification (calcification group), of which 11 cases had abdominal aorta calcification, the incidence was 17.5%, 5 cases with cardiac valve calcification (aortic valve or mitral calcification, cardiac calcification), the incidence of 7.9%; neck 7.9%. Eight patients (12.7%) had intima-media thickness (IMT) greater than 0.9 mm or plaque formation, and seven patients (11.1%) had multiple calcifications.
Compared with the non calcification group, age, age, Pi, calcium and phosphorus product, ALB, hsCRP, FGF-23 had significant differences, and the difference was statistically significant. The vascular calcification rate (36.36%) in P0.05. three alcohol treatment group was significantly lower than that of non ossified three alcohol treatment group (63.33%), and the difference was statistically significant, P0.05.
3, the risk factors of vascular calcification were analyzed by multiple factor Logistic regression. The results showed that age, hsCRP, Pi, FGF-23 and not taking ossification three alcohol may be the main risk factors for vascular calcification, and high level ALB is a protective factor.
4. FGF-23 levels were positively correlated with serum phosphorus and calcium-phosphorus product, but not with ALB, ALP, Ca, hsCRP, age, dialysis age, iPTH and oral calcitriol.
5, the blood Ca (2.16 + 0.20mmol/L) in the three group of the ossification group was significantly higher than that in the non ossified three alcohol treatment group. The difference was statistically significant. The P0.05. ossification three alcohol treatment group was iPTH (33.98 + 22.39pmol/L), ALP (90.29 + 43.22U/L), hsCRP (5.40 + 3.92mg/L), and CaxPi (56.76 +) was more than the non ossified three alcohol treatment group (52.9). + 36.49pmol/L), ALP (128.20 + 82.14U/L), hsCRP (9.05 + 8.34), Ca * Pi (49.66 + 14.62mg2/ml2) obviously decreased, the difference was statistically significant, P0.05. had no significant effect on FGF-23.
Conclusion 1. The risk factors of vascular calcification in hemodialysis patients are age, serum FGF-23, Pi, hsCRP and no calcitriol. High ALB is the protective factor.
2, small dose of ossification of three alcohol may lead to a increase in blood calcium and decrease iPTH, hsCRP, ALP, Ca x Pi, which may lead to a decrease in the incidence of vascular calcification. There is no significant effect on FGF-23.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5
本文編號：2140592
[Abstract]:Background the incidence and number of CKD in global chronic kidney disease (CKD) are increasing obviously. According to the statistics, about 1% of the patients have developed to the CKD5 stage. About 10 thousand people enter the dialysis stage each year in China. The disorder of calcium and phosphorus metabolism and the complications of cardiovascular disease are serious in the maintenance hemodialysis patients. The complications are also the main factors affecting the quality of life and survival of patients. Many evidence suggests that chronic metabolic disorders of calcium and phosphorus in uremia patients can cause secondary hyperparathyroidism, abnormal mineral and bone metabolism, metastatic calcification, including myocardium, lung, heart valve and blood vessels. All of these factors are associated with chronic renal failure. Cardiovascular complications are the leading causes of death in hemodialysis patients. Studies have found that vascular calcification is the main cause of cardiovascular events. The mechanism of vascular calcification in hemodialysis patients is complex, with a variety of risk factors involved, with the exception of the traditional cardiovascular risk factors such as high. Age, male, smoking history, hypertension, diabetes, hyperlipidemia and so on. A large number of recent studies have found that the central link of vascular calcification is chronic inflammation and atherosclerosis, and atherosclerosis is associated with disorders of calcium and phosphorus metabolism, malnutrition, chronic inflammation and so on.
Fibroblast growth factor-23 (FGF-23), a new type of calcium phosphorus and vitamin D regulator, is significantly increased in the peripheral blood of maintenance hemodialysis patients. It is an independent risk factor for vascular calcification in hemodialysis patients. There is a widespread disorder of calcium and phosphorus metabolism and low 1,25 (OH) in maintenance hemodialysis patients. 2D3, while the treatment of oral vitamin D receptor activator (ossified three alcohol) may cause a higher level of FGF-23, then the study of whether or not it will aggravate vascular calcification is less.2009 years. The KDIGO guide recommends the use of abdominal side slice combined echocardiography to assess vascular calcification.
Objective To observe the calcification of abdominal aorta and heart valve and the thickness of carotid intima media thickness (IMT) in the maintenance hemodialysis patients at hemodialysis center, to analyze the risk factors of vascular calcification and to explore the relationship between the risk factors of FGF-23 and the risk factors of vascular calcification and the long-term oral dose of vitamin D in the treatment of vascular calcium. The role of the risk factors.
Methods 63 patients with 2013.3 to 2014.2 maintenance hemodialysis and 20 healthy controls were selected. The level of serum fibroblast growth factor -23 (FGF-23) was detected by double anti sandwich ELISA method in the two groups. The general data and clinical data of all hemodialysis patients were recorded, the related laboratory examination was perfected, and the automatic biochemical analysis was used. The apparatus detected calcium (Ca), phosphorus (Pi), alkaline phosphatase (ALP), albumin (ALB), cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL), blood glucose (Glu), creatinine (Scr), hemoglobin (Hb), and so on. Immunochemiluminescence was used to measure the parathyroid hormone (iPTH) and immunoturbidimetry. The hypersensitive C- reactive protein (hsCRP) was used to detect the calcification of the myocardium and valve, the thickness of the carotid artery intima media (IMT) and the atherosclerotic plaque in the carotid artery, and the calcification of the abdominal aorta at the lumbar side of the lumbar vertebra by the color Doppler ultrasound. The statistical treatment was statistically significant with the difference of the SPSS17.0 statistical package. The difference was statistically significant with the difference of P0.05.
Results 1, the clinical data of maintenance hemodialysis patients: the average age of 63 patients was 52.5 + 23.33 years old. The primary disease: 23 cases of chronic glomerulonephritis (36.5%), 25 cases of diabetic nephropathy (39.6%), 1 cases of polycystic kidney (1.6%), 11 cases of hypertensive nephropathy (17.5%), unexplained 3 cases (4.8%). There were 33 cases (52.38%).
2, calcification occurred in 63 cases of maintenance hemodialysis patients without vascular calcification in 33 cases (no calcification group) and 31 cases of vascular calcification (calcification group), of which 11 cases had abdominal aorta calcification, the incidence was 17.5%, 5 cases with cardiac valve calcification (aortic valve or mitral calcification, cardiac calcification), the incidence of 7.9%; neck 7.9%. Eight patients (12.7%) had intima-media thickness (IMT) greater than 0.9 mm or plaque formation, and seven patients (11.1%) had multiple calcifications.
Compared with the non calcification group, age, age, Pi, calcium and phosphorus product, ALB, hsCRP, FGF-23 had significant differences, and the difference was statistically significant. The vascular calcification rate (36.36%) in P0.05. three alcohol treatment group was significantly lower than that of non ossified three alcohol treatment group (63.33%), and the difference was statistically significant, P0.05.
3, the risk factors of vascular calcification were analyzed by multiple factor Logistic regression. The results showed that age, hsCRP, Pi, FGF-23 and not taking ossification three alcohol may be the main risk factors for vascular calcification, and high level ALB is a protective factor.
4. FGF-23 levels were positively correlated with serum phosphorus and calcium-phosphorus product, but not with ALB, ALP, Ca, hsCRP, age, dialysis age, iPTH and oral calcitriol.
5, the blood Ca (2.16 + 0.20mmol/L) in the three group of the ossification group was significantly higher than that in the non ossified three alcohol treatment group. The difference was statistically significant. The P0.05. ossification three alcohol treatment group was iPTH (33.98 + 22.39pmol/L), ALP (90.29 + 43.22U/L), hsCRP (5.40 + 3.92mg/L), and CaxPi (56.76 +) was more than the non ossified three alcohol treatment group (52.9). + 36.49pmol/L), ALP (128.20 + 82.14U/L), hsCRP (9.05 + 8.34), Ca * Pi (49.66 + 14.62mg2/ml2) obviously decreased, the difference was statistically significant, P0.05. had no significant effect on FGF-23.
Conclusion 1. The risk factors of vascular calcification in hemodialysis patients are age, serum FGF-23, Pi, hsCRP and no calcitriol. High ALB is the protective factor.
2, small dose of ossification of three alcohol may lead to a increase in blood calcium and decrease iPTH, hsCRP, ALP, Ca x Pi, which may lead to a decrease in the incidence of vascular calcification. There is no significant effect on FGF-23.
【學位授予單位】：山西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R692.5
【參考文獻】
相關(guān)期刊論文 前10條
1 何映琴;陳惠珊;菅宏蘊;;骨化三醇注射液對繼發(fā)性甲狀旁腺功能亢進的療效觀察[J];當代醫(yī)學;2012年21期
2 陳昕;彭波;陳明;;終末期腎病患者血管鈣化與鈣化抑制物[J];國際泌尿系統(tǒng)雜志;2006年01期
3 宦紅娣;張軍力;張景紅;陸蓓莉;馬麗娜;楊黃;楊峻;;慢性腎臟病患者鈣磷代謝及調(diào)節(jié)因子的變化[J];臨床內(nèi)科雜志;2008年11期
4 沈麗,殷峻,盧維晟,楊旭峰,姚俊宇,王一塵;動脈粥樣硬化與骨質(zhì)疏松的相關(guān)性研究[J];上海第二醫(yī)科大學學報;2005年10期
5 唐卓;秦愛平;;阿侖膦酸鈉和骨化三醇對絕經(jīng)后女性糖尿病伴骨質(zhì)疏松癥患者動脈硬化的影響[J];心血管康復醫(yī)學雜志;2010年06期
6 付平;唐萬欣;;慢性腎臟病患者血管鈣化的診治進展[J];中國血液凈化;2008年05期
7 李開龍;陳菁;詹俊;王燕;景宇;何婭妮;;維持性血液透析患者外周血成纖維細胞生長因子23水平與血管鈣化關(guān)系的研究[J];中國血液凈化;2011年02期
8 中華醫(yī)學會腎臟病分會透析移植登記工作組 ,錢家麒,張偉明 ,徐筱琪;1999年度全國透析移植登記報告[J];中華腎臟病雜志;2001年02期
9 王笑云,陸衛(wèi)平,趙秀芬;高磷對血管平滑肌細胞骨鈣素mRNA表達和鈣沉積的影響[J];中華腎臟病雜志;2003年02期
10 葉云潔,倪兆慧,錢家麒,何穎欣;終末期腎病微炎癥狀態(tài)和動脈粥樣硬化的關(guān)系[J];中華腎臟病雜志;2004年03期
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