Pretreatment serum FGF-23 levels predict the efficacy of calcitriol therapy in dialysis patients
Pretreatment serum FGF-23 levels predict the efficacy of calcitriol therapy in dialysis patients
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DOI：
10.1111/j.1523-1755.2005.00178.x
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发表时间：
2005-03-01
影响因子：
19.6
通讯作者：
Fukagawa, M
中科院分区：
文献类型：
--
作者：
Kazama, JJ;Sato, F;Fukagawa, M
背景资料。预测骨化三醇治疗效果的指标可用于继发性甲状旁腺功能亢进症的临床实践。成纤维细胞生长因子-23(成纤维细胞生长因子-23)是新近发现的一种循环磷酸因子。尿毒症患者血液循环水平升高。研究对象为血浆完整甲状旁腺激素(IPTH)水平大于300pg/ml的透析患者。骨化三醇每周静脉注射三次。血浆iPTH水平在24周内降至300pg/mL以下者为治疗成功者。建立了检测人成纤维细胞生长因子-23的双抗体夹心酶联免疫吸附试验系统。对62例患者进行了分析。治疗前血清成纤维细胞生长因子-23水平与iPTH水平、钙磷产物水平和维生素D活性治疗史有关。成功接受骨化三醇治疗的患者治疗前血清成纤维细胞生长因子-23、iPTH和钙水平较低。Logistic回归分析显示，治疗前iPTH和FGF23水平对治疗效果有显著影响。使用接受者操作曲线的分析表明，对于确定未来对骨化三醇治疗无效的患者，成纤维细胞生长因子-23是最好的筛查试验。FGF23<9860 ng/L、iPTH<591pg/mL者治疗成功率为88.2%，而FGF23<9860 ng/L、iPTH<591pg/ml者仅为4.2%。治疗前血清成纤维细胞生长因子-23水平是预测骨化三醇疗效的良好指标。血清成纤维细胞生长因子-23水平的测定，特别是与iPTH水平的联合检测，对于继发性甲状旁腺功能亢进症的临床实践是一项有希望的实验室检查。
Background. The predictor for the result of calcitriol therapy would be useful in the clinical practice of secondary hyperparathyroidism. Fibroblast growth factor-23 (FGF-23) is a newly found circulating phosphaturic factor. Its circulating level is elevated in uremia.Methods. Dialysis patients with plasma intact parathyroid hormone (iPTH) levels greater than 300 pg/mL were included in the study. Calcitriol was intravenously injected three times a week. The patients whose plasma iPTH levels dropped below 300 pg/mL within 24 weeks were defined as those who had been successfully treated. A sandwich enzyme-linked immunosorbent assay (ELISA) system that detects human FGF-23 was applied.Results. Sixty-two patients were analyzed. The pretreatment FGF-23 levels were related to the iPTH levels, calcium x phosphate product levels, and history of active vitamin D therapy. The pretreatment FGF-23, iPTH, and calcium levels were lower in the patients who would be successfully treated with calcitriol. A logistic regression study revealed that the pretreatment iPTH and FGF-23 levels significantly affected the therapy results. Analyses using a receiver-operated curve revealed that FGF-23 was the best screening test for identifying patients with future refractory response to calcitriol therapy. The treatment would be successful in 88.2% of those with FGF-23 less than or equal to9860 ng/L and iPTH less than or equal to591 pg/mL, while it would be successful in only 4.2% of those with FGF-23 >9860 ng/L and iPTH >591 pg/mL.Conclusion. Pretreatment serum FGF-23 levels were a good indicator in predicting the response to calcitriol therapy. The measurement of serum FGF-23 levels, especially in combination with iPTH levels, is a promising laboratory examination for the clinical practice of secondary hyperparathyroidism.