The Influence of Glomerular Filtration Rate and Age on Fibroblast Growth Factor 23 Serum Levels in Pediatric Chronic Kidney Disease
The Influence of Glomerular Filtration Rate and Age on Fibroblast Growth Factor 23 Serum Levels in Pediatric Chronic Kidney Disease
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DOI：
10.1210/jc.2009-1576
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发表时间：
2010-04-01
影响因子：
5.8
通讯作者：
Cochat, Pierre
中科院分区：
文献类型：
--
作者：
Bacchetta, Justine;Dubourg, Laurence;Cochat, Pierre
背景：成纤维细胞生长因子23（FGF 23）是一种磷酸尿因子，是肾脏1 α-羟化酶活性的抑制因子。虽然FGF 23在慢性肾脏病（CKD）中的重要性已在成人中得到证实，但在儿童患者中的信息却很少。目的：本研究的目的是：1）根据肾小球滤过率（GFR）确定血清FGF 23水平的参考值。（通过参考标准、菊粉清除率测量）、性别和年龄;以及2）在227名CKD儿童的前瞻性单中心队列中评估不同病因和治疗对FGF 23血清水平的影响结果：年龄、体重、身高、GFR（平均值+/- SD）值分别为：11.3 +/- 4.1岁、37 +/- 16 kg、140 +/- 20 cm和98 +/- 34 ml/min/1.73 m2。钙、磷酸盐、PTH、25羟维生素D、1，25二羟维生素D、C-末端FGF 23和完整FGF 23（平均值+/- SD）水平为：2.43 +/- 0.11 mmol/l、1.41 +/- 0.22 mmol/l、41 +/- 23 pg/ml、24 +/- 10 ng/ml、152 +/- 72 pmol/l、76 +/- 134相对单位/ml，和44 ± 37 pg/ml。FGF 23血清水平范围很广，但当GFR降低时，FGF 23水平升高。FGF 23血清水平不受性别的影响，但随着年龄的增长而增加。在单变量分析中，皮质类固醇治疗似乎与FGF 23血清水平升高相关。多元线性回归分析发现，GFR，体重指数，和实体器官移植对FGF 23血清levels.Conclusion的显着影响：年龄，GFR，体重指数，和实体器官移植似乎影响FGF 23血清水平在儿科人群。糖皮质激素对FGF 23代谢的影响应进一步研究;进一步的纵向研究也将有助于更好地确定儿童CKD中FGF 23血清水平在疾病进展、心血管发病率和骨残疾方面的预后影响。（临床内分泌代谢杂志95：1741-1748，2010）
Background: Fibroblast growth factor 23 (FGF23) is a phosphaturic factor and a suppressor of 1 alpha-hydroxylase activity in the kidney. Although its importance in chronic kidney disease (CKD) has been demonstrated in adults, there is little information in pediatric patients.Objectives: The aims of this study were: 1) to determine reference values for FGF23 serum levels according to glomerular filtration rate (GFR) (measured by the reference standard, inulin clearance), gender, and age; and 2) to evaluate the effects of different etiologies and treatments on FGF23 serum levels in a prospective single-center cohort of 227 CKD children (119 boys).Results: Age, body weight, height, and GFR (mean +/- SD) values were: 11.3 +/- 4.1 yr, 37 +/- 16 kg, 140 +/- 20 cm, and 98 +/- 34 ml/min per 1.73 m(2), respectively. Calcium, phosphate, PTH, 25 hydroxyvitamin D, 1,25 dihydroxyvitamin D, C-terminal FGF23, and intact FGF23 (mean +/- SD) levels were: 2.43 +/- 0.11 mmol/liter, 1.41 +/- 0.22 mmol/liter, 41 +/- 23 pg/ml, 24 +/- 10 ng/ml, 152 +/- 72 pmol/liter, 76 +/- 134 relative units/ml, and 44 +/- 37 pg/ml, respectively. There was a wide range of FGF23 serum levels, but FGF23 levels increased when GFR decreased. FGF23 serum levels were not modified by gender, but they increased with age. In univariate analysis, corticosteroid therapy seemed to be associated with increased FGF23 serum levels. A multivariate linear regression analysis found a significant impact of GFR, body mass index, and solid organ transplantation on FGF23 serum levels.Conclusion: Age, GFR, body mass index, and solid organ transplantation seem to influence FGF23 serum levels in a pediatric population. The impact of corticosteroids on FGF23 metabolism should be further investigated; further longitudinal studies will also help to better define the prognostic impact of FGF23 serum levels in pediatric CKD in terms of disease progression, cardiovascular morbidities, and bone disabilities. (J Clin Endocrinol Metab 95: 1741-1748, 2010)