Intravenous calcitriol therapy increases serum concentrations of fibroblast growth factor-23 in dialysis patients with secondary hyperparathyroidism
Intravenous calcitriol therapy increases serum concentrations of fibroblast growth factor-23 in dialysis patients with secondary hyperparathyroidism
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DOI：
10.1159/000086347
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发表时间：
2005-01-01
影响因子：
--
通讯作者：
Fukagawa, M
中科院分区：
文献类型：
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作者：
Nishi, H;Nii-Kono, T;Fukagawa, M
背景/目的：成纤维细胞生长因子-23 （FGF-23）是最近发现的一种磷酸化因子。尽管有报道称透析患者血清FGF-23水平升高，但FGF-23高水平的作用尚不清楚。由于FGF-23也与维生素D代谢有关，我们检测了静脉注射骨化三醇治疗的慢性透析患者血清FGF-23水平的变化。方法：对30例重度继发性甲状旁腺功能亢进患者静脉注射骨化三醇（0.5 ~ 1.0 μ g），每周2 ~ 3次，疗程6个月。评估血清钙、磷酸盐、完整甲状旁腺激素和FGF-23水平的变化。结果：基线血清FGF-23水平明显升高。通过静脉注射骨化三醇治疗，完整甲状旁腺激素水平在第一个月有效下降（p < 0.001）。相反，FGF-23水平在研究期间逐渐升高（p = 0.027）。难治性继发性甲状旁腺功能亢进患者6个月内静脉注射骨化三醇总剂量与血清FGF-23水平显著相关（R-2 = 0.147; p = 0.036）。结论：静脉注射骨化三醇可显著降低血清完整甲状旁腺激素水平，提高血清FGF-23水平。这些患者血清中FGF-23水平极高，可能至少部分归因于维生素d的累积剂量。
Background/Aims: Fibroblast growth factor-23 (FGF-23) is a recently discovered phosphaturic factor. Although increased levels of serum FGF-23 have been reported in dialysis patients, the role of high FGF-23 levels remains unclear. Since FGF-23 is associated also with vitamin D metabolism, we examined the changes of serum FGF-23 levels in chronic dialysis patients treated with intravenous calcitriol therapy. Methods: Thirty patients with severe secondary hyperparathyroidism were treated with intravenous calcitriol (0.5-1.0 mu g) two or three times per week for 6 months. The changes of serum levels of calcium, phosphate, intact PTH, and FGF-23 were evaluated. Results: Baseline serum FGF-23 levels were markedly high. By intravenous calcitriol therapy, intact PTH levels decreased effectively in the first month (p < 0.001). In contrast, FGF-23 levels increased gradually during the study period (p = 0.027). The Delta serum FGF-23 level was significantly correlated with the total doses of calcitriol injected intravenously in 6 months in patients with refractory secondary hyperparathyroidism (R-2 = 0.147; p = 0.036). Conclusions: Intravenous calcitriol decreased serum intact PTH level and increased serum FGF-23 levels significantly. Extremely high levels of serum FGF-23 in these patients may be attributed, at least in part, to the cumulative dose of vitamin D. Copyright (C) 2005 S. Karger AG, Basel.