慢性腎臟病早期維生素D-FGF23-Klotho與蛋白尿關(guān)系
發(fā)布時(shí)間：2018-10-19 13:11
【摘要】：目的：鈣磷代謝紊亂和維生素D缺乏在慢性腎臟病(chronic kidney disease，CKD)晚期患者中普遍存在，成纖維細(xì)胞生長(zhǎng)因子23(fibroblast growth factor23,FGF-23)在Klotho蛋白的輔助下參與對(duì)CKD患者血磷、1,25二羥維生素D3[1,25-(OH)2D3]水平的調(diào)節(jié)，CKD早期患者較健康正常人已有1,25-(OH)2D3水平降低和FGF23升高，本研究CKD早期患者血清1,25-(OH)2D3、FGF23、Klotho蛋白水平與蛋白尿的發(fā)生和發(fā)展之間的關(guān)系，探討1,25-(OH)2D3-FGF23-Klotho蛋白系統(tǒng)失衡在CKD早期原發(fā)性腎小球腎炎的發(fā)病及進(jìn)展中的意義。 方法：選取2013年01月至2014年01月在大連醫(yī)科大學(xué)附屬第一醫(yī)院腎內(nèi)科住院的CKD1-2期患者共76例，其中女性40例，男性36例，年齡16-76歲之間，所有患者均為初次發(fā)病，明確有持續(xù)性蛋白尿且診斷為原發(fā)性腎小球腎炎，除外繼發(fā)性和遺傳性腎小球腎炎，無(wú)應(yīng)用糖皮質(zhì)激素、免疫抑制劑、鈣劑和維生素D等藥物史。根據(jù)患者的24h尿蛋白量分為三組：A組指24h尿蛋白定量＜1.0g，共28例；B組指1.0g≤24h尿蛋白定量＜3.5g，共24例；C組指24h尿蛋白定量≥3.5g，共24例。分別用ELISA法測(cè)定血清1,25-(OH)2D3、FGF23、Klotho蛋白濃度，磺基水楊酸比濁法檢測(cè)24h尿蛋白定量(24hUpro)，全自動(dòng)生化分析儀比色法測(cè)定血清白蛋白(Alb)、肌酐(Cr)、尿素氮(BUN)、鈣(Ca)、磷(P)水平，放射免疫發(fā)光法測(cè)定血清PTH濃度。用SPSS19.0軟件進(jìn)行數(shù)據(jù)統(tǒng)計(jì)，計(jì)量資料以x±s表示，多組均數(shù)的比較采用單因素方差分析，如均數(shù)不全相同，則采用LSD檢驗(yàn)行組間比較，相關(guān)性用Pearson相關(guān)分析，均為雙側(cè)檢驗(yàn)，，結(jié)果以P值＜0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果： 1.血鈣濃度總體隨著尿蛋白量增多呈遞減趨勢(shì)，三組均值不全相等（P＜0.01），其中C組（大量蛋白尿組）血鈣濃度明顯減低，與前兩組組間比較具有顯著性差異（P＜0.01），但A、B兩組組間比較差異無(wú)顯著性（P＞0.05）；血清磷、血清PTH在A、B、C組的均值均無(wú)明顯差異（P＞0.05）。 2.A、B、C組血清FGF23的均值有明顯的差異（P＜0.05），總體表現(xiàn)為A組＜B組＜C組，其中組間比較C組血清FGF23水平升高程度較前兩組尤為明顯，分別與A、B組組間比較差異有統(tǒng)計(jì)學(xué)意義（P＜0.05），而A、B兩組之間血清FGF23水平組間比較無(wú)統(tǒng)計(jì)學(xué)差異（P＞0.05）。 3.血清1,25(OH)2D3水平表現(xiàn)為與血清FGF23相反的變化趨勢(shì)，隨著尿蛋白量增多降低，三組的均值不全相等（P＜0.05），C組血清1,25(OH)2D3下降程度更高，分別與A、B組組間比較具有顯著性差異（P＜0.05），而A、B兩組之間血清1,25(OH)2D3水平變化不明顯，組間比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P＞0.05）。 4.血清Klotho蛋白與血清1,25(OH)2D3變化趨勢(shì)相同，隨蛋白尿增多減少，三組均值不全相等（P＜0.05），C組血清Klotho蛋白減少最明顯，分別與A、B組組間比較差異均具有顯著性（P＜0.05），但A、B兩組組間比較差異無(wú)顯著性（P＞0.05）。 5.相關(guān)分析示血鈣與24h尿蛋白定量呈顯著負(fù)相關(guān)（P＜0.01），血清1,25(OH)2D3、血清Klotho蛋白與24h尿蛋白定量呈負(fù)相關(guān)（P＜0.05），血清FGF23水平與24h尿蛋白量呈顯著正相關(guān)（P＜0.01）。 結(jié)論：慢性腎臟病早期隨著蛋白尿增多，血清1,25(OH)2D3、Klotho蛋白水平逐漸減低，血清FGF23濃度隨蛋白尿增加呈升高趨勢(shì)，1,25(OH)2D3-FGF23-Klotho蛋白系統(tǒng)的異常參與了蛋白尿的發(fā)生和發(fā)展。CKD早期已有鈣磷代謝異常。
[Abstract]:AIM: Calcium and phosphorus metabolism disorder and vitamin D deficiency are common in patients with advanced chronic kidney disease (CKD), and fibroblast growth factor 23 (FGF-23) is involved in the regulation of serum phosphorus, 1,25 dihydroxyvitamin D3[1,25-(OH) 2D3] in CKD patients with the aid of Klotho protein. The relationship between the level of serum 1,25-(OH) 2D3, FGF23, Klotho protein and the occurrence and development of proteinuria in early stage CKD patients was studied. The significance of the imbalance of 1,25-(OH) 2D3-FGF23-Klotho protein system in the pathogenesis and progression of primary glomerulonephritis in CKD was studied. Methods: 76 patients with CKD1-2 were selected from January 2013 to January 2014 in the nephrology department of the First Affiliated Hospital of Dalian Medical University. Among them, 40 were women, 36 males and 16-76 years old. All patients were primary Incidence, definite proteinuria and diagnosis of primary glomerulonephritis, with the exception of secondary and hereditary glomerulonephritis, no use of corticosteroids, immunosuppressive agents, calcium and vitamin D drugs The urinary protein was divided into three groups according to 24h urinary protein content of the patients: group A refers to 24h urinary protein dose <1. 0g, total 28 cases; group B refers to 1. 0g, 24h urinary protein quantification <3. 5g, total 24 cases; group C refers to 24h urinary protein quantitative urinary protein 3.5g, total 2 In 4 cases, serum albumin (Alb), calcium lactate (Cr), sodium dihydrogen phosphate (Alb), calcium (Ca) and phosphorus (P) were determined by ELISA. The serum albumin (Alb), calcium lactate (Cr), calcium lactate (Ca), calcium (Ca), phosphorus (P) were determined by the method of ELISA. Determination of PTH in Serum by Radioimmunoassay Data statistics were carried out with SPSS19. 0 software. The measured data were represented by x/ s, and the comparison of multiple groups using single-factor analysis of variance, if the difference was not the same, compared with the LSD test line group, Pearson correlation analysis was used for the correlation, and both sides were double sides. The results showed that there was statistical difference between P <0.05 and P <0.05. Meaning. Results: 1. The concentration of blood calcium decreased gradually with the increase of urine protein, and the mean values of the three groups were not all equal (P <0.01). There was no significant difference between group A and group B (P> 0.05); serum phosphorus and serum PTH had no significant difference between group A, group B and group C. (P> 0.05) There was significant difference in the mean value of FGF23 in group A, B and C (P <0.05). There was no statistically significant difference in serum FGF23 level between group A and B (P <0.05). The level of serum 1,25 (OH) 2D3 was similar to that of serum FGF23, and the mean value of serum 1,25 (OH) 2D3 was not all equal in group C (P <0.05), and the decrease of serum 1,25 (OH) 2D3 in group C was higher than that of group A and group B, respectively. There was no significant difference in serum 1,25 (OH) 2D3 levels between groups A and B. There was no statistical significance (P> 0.05). 4. Serum Klotho protein was the same as that of serum 1,25 (OH) 2D3, decreased with the increase of proteinuria, and the three groups were not all equal (P <0.05). There was significant difference between group A and group B (P <0.05). There was no significant difference (P> 0.05). 5. Correlation analysis showed significant negative correlation between serum calcium and 24h urine protein (P <0.01), serum 1,25 (OH) 2D3, serum Klotho protein negatively correlated with 24h urine protein (P <0.05), serum FGF23 level and 2. Conclusion: With the increase of proteinuria, the level of serum 1,25 (OH) 2D3 and Klotho protein decreased gradually in the early stage of chronic renal disease. The concentration of FGF23 increased with proteinuria, and 1,25 (OH) 2D3-FGF23-Kl. Abnormal involvement of other protein systems
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692
本文編號(hào)：2281219
[Abstract]:AIM: Calcium and phosphorus metabolism disorder and vitamin D deficiency are common in patients with advanced chronic kidney disease (CKD), and fibroblast growth factor 23 (FGF-23) is involved in the regulation of serum phosphorus, 1,25 dihydroxyvitamin D3[1,25-(OH) 2D3] in CKD patients with the aid of Klotho protein. The relationship between the level of serum 1,25-(OH) 2D3, FGF23, Klotho protein and the occurrence and development of proteinuria in early stage CKD patients was studied. The significance of the imbalance of 1,25-(OH) 2D3-FGF23-Klotho protein system in the pathogenesis and progression of primary glomerulonephritis in CKD was studied. Methods: 76 patients with CKD1-2 were selected from January 2013 to January 2014 in the nephrology department of the First Affiliated Hospital of Dalian Medical University. Among them, 40 were women, 36 males and 16-76 years old. All patients were primary Incidence, definite proteinuria and diagnosis of primary glomerulonephritis, with the exception of secondary and hereditary glomerulonephritis, no use of corticosteroids, immunosuppressive agents, calcium and vitamin D drugs The urinary protein was divided into three groups according to 24h urinary protein content of the patients: group A refers to 24h urinary protein dose <1. 0g, total 28 cases; group B refers to 1. 0g, 24h urinary protein quantification <3. 5g, total 24 cases; group C refers to 24h urinary protein quantitative urinary protein 3.5g, total 2 In 4 cases, serum albumin (Alb), calcium lactate (Cr), sodium dihydrogen phosphate (Alb), calcium (Ca) and phosphorus (P) were determined by ELISA. The serum albumin (Alb), calcium lactate (Cr), calcium lactate (Ca), calcium (Ca), phosphorus (P) were determined by the method of ELISA. Determination of PTH in Serum by Radioimmunoassay Data statistics were carried out with SPSS19. 0 software. The measured data were represented by x/ s, and the comparison of multiple groups using single-factor analysis of variance, if the difference was not the same, compared with the LSD test line group, Pearson correlation analysis was used for the correlation, and both sides were double sides. The results showed that there was statistical difference between P <0.05 and P <0.05. Meaning. Results: 1. The concentration of blood calcium decreased gradually with the increase of urine protein, and the mean values of the three groups were not all equal (P <0.01). There was no significant difference between group A and group B (P> 0.05); serum phosphorus and serum PTH had no significant difference between group A, group B and group C. (P> 0.05) There was significant difference in the mean value of FGF23 in group A, B and C (P <0.05). There was no statistically significant difference in serum FGF23 level between group A and B (P <0.05). The level of serum 1,25 (OH) 2D3 was similar to that of serum FGF23, and the mean value of serum 1,25 (OH) 2D3 was not all equal in group C (P <0.05), and the decrease of serum 1,25 (OH) 2D3 in group C was higher than that of group A and group B, respectively. There was no significant difference in serum 1,25 (OH) 2D3 levels between groups A and B. There was no statistical significance (P> 0.05). 4. Serum Klotho protein was the same as that of serum 1,25 (OH) 2D3, decreased with the increase of proteinuria, and the three groups were not all equal (P <0.05). There was significant difference between group A and group B (P <0.05). There was no significant difference (P> 0.05). 5. Correlation analysis showed significant negative correlation between serum calcium and 24h urine protein (P <0.01), serum 1,25 (OH) 2D3, serum Klotho protein negatively correlated with 24h urine protein (P <0.05), serum FGF23 level and 2. Conclusion: With the increase of proteinuria, the level of serum 1,25 (OH) 2D3 and Klotho protein decreased gradually in the early stage of chronic renal disease. The concentration of FGF23 increased with proteinuria, and 1,25 (OH) 2D3-FGF23-Kl. Abnormal involvement of other protein systems
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 鮑宏達(dá);汪年松;;FGF23與CKD患者鈣磷代謝的研究進(jìn)展[J];中國(guó)中西醫(yī)結(jié)合腎病雜志;2012年04期
2 劉莎;張東亮;劉文虎;;成纖維細(xì)胞生長(zhǎng)因子23-甲狀旁腺素軸在礦物質(zhì)-骨代謝異常中的作用[J];中國(guó)血液凈化;2013年01期
本文編號(hào)：2281219
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