Impact of Fibroblast Growth Factor 23 on Lipids and Atherosclerosis in Hemodialysis Patients
Impact of Fibroblast Growth Factor 23 on Lipids and Atherosclerosis in Hemodialysis Patients
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DOI：
10.1111/j.1744-9987.2009.00796.x
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发表时间：
2010-06-01
影响因子：
1.9
通讯作者：
Akizawa, Tadao
中科院分区：
文献类型：
--
作者：
Ashikaga, Eijin;Honda, Hirokazu;Akizawa, Tadao
终末期肾病(ESRD)患者维持性血液透析(MHD)患者血清成纤维细胞生长因子(FGF23)水平经常升高。然而，由于肾成纤维细胞生长因子受体功能可能受损，FGF23的作用尚不清楚。这项横断面研究调查了196名MHD患者(n=196)，他们没有接受包括西维拉姆在内的降脂药物治疗。于前一次血液透析(HD)前3天抽血测定血清白蛋白、钙(Ca)、磷(P)、碱性磷酸酶(ALP)、全段甲状旁腺激素(PTH)、总胆固醇(C)、高密度脂蛋白(HDL)-C、低密度脂蛋白(LDL)-C、氧化型低密度脂蛋白(LDL-C)、高敏C反应蛋白(HsCRP)、白介素6(IL-6)和纤维细胞生长因子23(FGF23)水平。使用老年营养风险指数(GNRI)评估营养状况。用B超检测颈动脉内膜中层厚度(CIMT)。FGF23与P、Ca(Alb)XP产物、完整甲状旁腺素呈正相关，与C、非高密度脂蛋白胆固醇呈负相关。与FGF23三分位数较低者相比，FGF23三分位数较高者非高密度脂蛋白胆固醇和C水平均显著降低，CIMT升高较少。多因素分析显示，高FGF23三分位数与C(调整后R2=0.14)和非高密度脂蛋白-C(调整后R2=0.20)水平降低以及CIMT增加(调整后R2=0.14)独立相关。高FGF23似乎是C和非高密度脂蛋白胆固醇降低的独立生物标志物，后者与MHD患者的动脉粥样硬化负相关。
Levels of fibroblast growth factor (FGF) 23, a phosphatonin, are frequently elevated in patients with end-stage renal disease (ESRD) who are on maintenance hemodialysis (MHD). However, the role of FGF23 remains unclear because renal FGF receptor function might be impaired. The present cross-sectional study examines a cohort of patients (n = 196) on MHD who were not undergoing therapy with lipid-lowering drugs including sevelamer. Non-fasting venous blood samples were withdrawn before the hemodialysis (HD) session on the third day after the previous HD session to measure serum levels of albumin, calcium (Ca), phosphate (P), alkaline phosphatase, intact parathyroid hormone (PTH), total cholesterol (C), high-density lipoprotein (HDL)-C, low-density lipoprotein(LDL)-C, oxidative LDL-C, high-sensitivity C-reactive protein (HsCRP), interleukin-6 (IL-6), and FGF23. Nutritional status was assessed using the geriatric nutritional risk index (GNRI). Carotid intima-medial thickness (CIMT) was assessed using a B-mode ultrasound scanner. FGF23 was positively correlated with P, Ca(alb)xP product, and intact PTH, and inversely correlated with C and non-HDL-C. In the higher FGF23 tertile, levels of both non-HDL-C and C were significantly decreased and CIMT was less elevated compared to the lower FGF23 tertile. Multivariate analysis showed that the higher FGF23 tertile was independently associated with decreases in C (adjusted r2 = 0.14) and non-HDL-C (adjusted r2 = 0.20) levels and with a less-pronounced increase in CIMT (adjusted r2 = 0.14). High FGF23 appears to be an independent biomarker of a decrease in C and non-HDL-C that is negatively associated with atherosclerosis in patients on MHD.