Elevated FGF 23 and phosphorus are associated with coronary calcification in hemodialysis patients
Elevated FGF 23 and phosphorus are associated with coronary calcification in hemodialysis patients
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DOI：
10.1007/s00467-011-1822-0
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发表时间：
2011-06-01
影响因子：
3
通讯作者：
Brewer, Eileen D.
中科院分区：
文献类型：
--
作者：
Srivaths, Poyyapakkam R.;Goldstein, Stuart L.;Brewer, Eileen D.
成人慢性血液透析（HD）患者的死亡率增加与冠状动脉钙化（CC）、血清磷（P）升高、使用含钙（Ca）的P结合剂和维生素D缺乏有关。接受透析的成人血清成纤维细胞生长因子23（FGF 23）浓度显著升高，并与死亡率增加独立相关。尽管在儿童和成人HD患者中已经描述了冠状动脉钙化，但没有报道血清FGF 23和CC之间存在显著相关性。在我们的研究中，5/16例患者患有CC。CC患者年龄较大，有较长的透析年份和较高的血清P。血清钙，总甲状旁腺激素，元素钙的摄入量，骨化三醇的剂量没有不同的CC患者。所有患者血清FGF 23水平均显著升高（平均4，024，范围874- 8，253），但CC患者显著更高（4，247 +/-10，35 vs 2，427 +/-11，92，p = 0.01），与Agatston钙化评分呈正相关（r = 0.69，p = 0.003）和血清P（r = 0.49，p = 0.05）。多因素分析显示，血清FGF 23和血清P仍是影响Agatston评分的最重要因素。这项研究证实了儿童HD患者中CC的发生，并且首次显示了儿童中CC与血清FGF 23升高之间的显著相关性。
Increased mortality of adult chronic hemodialysis (HD) patients is associated with coronary calcifications (CC), increased serum phosphorus (P), use of calcium (Ca)-containing P-binders, and vitamin D deficiency. Serum concentration of fibroblast growth factor 23 (FGF 23) is markedly elevated in adults receiving dialysis and is independently associated with increased mortality. Although coronary calcifications have been described in pediatric and adult HD patients, no significant association between serum FGF 23 and CC has been reported. In our study, 5/16 patients had CC. Patients with CC were older, had longer dialysis vintage and higher serum P. Serum Ca, total PTH, elemental Ca intake, and calcitriol doses were not different for CC patients. Serum FGF 23 levels were markedly elevated in all patients (mean 4,024, range 874-8,253), but significantly higher in patients with CC (4,247 +/- 10,35 vs 2,427 +/- 11,92, p = 0.01) and positively correlated with Agatston calcification score (r = 0.69, p = 0.003) and serum P (r = 0.49, p = 0.05). Using multivariate analysis, serum FGF 23 and serum P remained the most significant factors associated with Agatston score. This study confirms the occurrence of CC in pediatric HD patients and is the first to show a significant association between CC and elevated serum FGF 23 in children.