高通量血液透析对终末期肾衰患者FGF23、动脉硬化及心功能的影响-东南大学学报医学版

高通量血液透析对终末期肾衰患者FGF23、动脉硬化及心功能的影响

单位：南京医科大学附属无锡市人民医院肾内科, 江苏无锡 214023

分类号：R459.5

出版年·卷·期（页码）：2017·36·第一期（53-57）

摘要：

目的：观察高通量血液透析（HFHD）对终末期肾衰（ESRD）患者成纤维细胞生长因子23（FGF23）水平及钙磷代谢紊乱、动脉硬化和心脏功能的影响，进一步明确HFHD在减少ESRD并发症上的优势。方法：回顾性分析在我院透析治疗的ESRD患者的临床资料，根据透析方式分为高通量组（20例）和低通量组（20例），记录两组患者透析前及规律透析2、4、6个月后FGF23水平、血清学指标的变化和透析前、规律透析6个月后颈动脉内膜中层厚度（cIMT）、左心室射血分数（LVEF），分析影响ESRD患者FGF23水平的相关因素及不同透析方式对ESRD患者血清学指标、动脉硬化、心脏功能等的影响。结果：透析前两组性别、年龄、基础疾病、营养状况和药物使用以及治疗前血红蛋白（Hb）、白蛋白（ALB）、估算肾小球滤过率（eGFR）、血清Ca²⁺、P^3-、甲状旁腺激素（PTH）、FGF-23水平比较，差异均无统计学意义（P>0.05）。高通量组血清P^3-在治疗2、4、6个月时显著低于低通量组，LDLC在治疗4、6个月时与低通量组相比显著下降，Hb、HDLC在治疗6个月时较低通量组显著升高，而TG、PTH、FGF23在治疗6个月时较低通量组显著降低。两组透析6个月后的LVEF较透析前均有上升，但差异无统计学意义，两组间比较差异也无统计学意义。高通量组透析6个月后的cIMT较低通量组显著下降，差异有统计学意义（P<0.05）。治疗6个月后，FGF23与透析时间、Hb、血Ca²⁺呈负相关，与TG、血磷、PTH、cIMT呈正相关，与是否为HFHD呈负相关，与白蛋白、HDLC、LDLC、LVEF、KT/V、URR无显著相关。结论：对ESRD患者，HFHD可以更好地清除FGF23、纠正贫血和钙磷代谢紊乱、改善心脏功能。

Objective:To observe the effects of high-flux hemodialysis (HFHD) on the level of fibroblast growth factor 23 (FGF23),calcium and phosphorus metabolism,arteriosclerosis and cardiac function in patients with end-stage renal diseases(ESRD) in order to further define the strengths of HFHD in reducing ESRD patients' complications.Methods:Forty cases taken hemodialysis at Wuxi People's Hospital were retrospectively analyzed by reviewing their clinical data.Twenty subjects underwent HFHD,while 20 underwent low-flux hemodialysis (LFHD).The levels of FGF23 and serological indexes were recorded before hemodialysis and after regular hemodialysis respectively for 2,4 and 6 months;Carotid intima-media thickness (cIMT) and left ventricular ejection fraction (LVEF) were observed before and after 6-month hemodialysis.Factors affecting FGF23 levels of ESRD patients' were analyed.The influences of different ways of hemodialysis upon serological indexes,arteriosclerosis and cardiac functioning in ESRD patients were also researched.Results:Before hemodialysis,no statistical differences were found between the two groups in sex,age,basic disease,nutriture,drug use and levels of Hb,ALB,estimated glomerular filtration rate (eGFR),serum Ca²⁺,serum P^3-,parathyroid homone(PTH) and FGF23 before medical treatment(P>0.05).The levels of P^3- in HFHD group after 2-month-hemodialysis,4-month-hemodialysis and 6-month-hemodialysis were significantly lower than those in LFHD group.LDLC in HFHD group after 4-month-hemodialysis and 6-month-hemodialysis were significantly lower than those in LFHD group.After 6-month hemodialysis,TG、PTH and FGF23 in the HFHD group were significantly lower than those in the LFHD group,whereas levels of Hb and HDLC in the HFHD group were significantly elevated compared to those in the LFHD group.Besides,no significant difference was found between the two groups in level of LVEF.Compared to the LFHD group,the HFHD group demonstrated significantly lower level of cIMT after 6-month-hemodialysis(P<0.05).There was a negative correlation between FGF23 and dialysis time,Hb,Ca²⁺;a positive correlation between FGF23 and TG,P^3-,PTH,cTMT;a negative correlation between FGF 23 and HFHD group,and no significant correlation between FGF23 and Alb,HDLC,LDLC,LVEF,KT/V,URR.Conclusion:HFHD can better cleared FGF23 level,redress anemia,calcium and phosphorous metabolic disorder,and improve cardiac functioning.

参考文献：

[1] COVIC A,KOTHAWALA P,BERNAL M,et al.Systematic review of the evidence underlying the association between mineral metabolism disturbances and risk of all-cause mortality,cardiovascular mortality and cardiovascular events in chronic kidney disease[J].Nephrol Dial Transplant,2009,24(5):1506-1523.
[2] REBECA RG,ANTONIA GM,BEATRIZ GF,et al.FGF23 in type 2 diabetic patients:relationship with bone metabolism and vascular disease[J].Diabetes Care,2014,37(5):89-90.
[3] GUTIERREZ OM,MANNSTADT M,ISAKOVA T,et al.Fibroblast growth factor 23 and mortality among patients undergoing hemodialysis[J].N Engl J Med,2008,359(6):584-592.
[4] 黄文瑾,刘必成.维持性血液透析患者脂质代谢紊乱与心脑血管事件关系的临床研究[J].东南大学学报:医学版,2012,31(6):720-724.
[5] XIAO F,QIN QC,JIAN PN,et al.High-flux hemodialysis benefits hemodialysis patients by reducing serum FGF-23 levels and reducing vascular calcification[J].Med Sci Monit,2015,11(21):3467-3473.
[6] MARTIN A,DDAVI V,QUARLES LD.Regulation and function of the FGF23/Klotho endocrine pathways[J].Physiol Rev,2012,92(1):131-155.
[7] 张志坚,陈涵枝,孙铸兴,等.高通量透析对终末期肾衰患者FGF-23及微炎症状态的影响[J].中华医学杂志,2015,95(26):2074-2078.
[8] HOOGEVEEN RC,GAUBATZ JW,SUN WS,et al.small dense low-density lipoprotein-cholesterol concentrations predict risk for coronary heart disease[J].Arterioscler Thromb Vasc Biol,2014,34(5):1069-1077.
[9] LULLO LD,GORINI A,RUSSO D,et al.Left ventricular hypertrophy in chronic kidney disease patients:from pathophysiology to treatment[J].Cardiorenal Med,2015,5(4):254-266.
[10] WALD R,GOLDSTEIN MB,PERL J,et al.Association between conversion to in-centre nocturnal hemodialysis and left ventricular mass regression in patients with end-stage renal disease[J].Can J Cardiol,2016,32(3):369-377.
[11] TURAN MN,KIRCELLI F,YAPRAK M,et al.FGF-23 levels are associated with vascular calcification,but not with atherosclerosis,in hemodialysis patients[J].Int Urol Nephrol,2016,48(4):609-617.

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