血清趋化素、脂联素、胱抑素C及FGF23预测慢性肾脏病4-5期患者血液透析后钙磷代谢紊乱的价值

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摘要目的探讨血清趋化素(Chemerin)、脂联素(ADPN)、胱抑素C(CysC)及成纤维细胞生长因子23(FGF23)预测慢性肾脏病(chronic kidney disease,CKD)4-5期患者维持性血液透析(maintenance hemodialysis,MHD)后钙磷代谢紊乱的价值。方法选取解放军总医院第三医学中心2018-01至2020-01确诊并接受MHD治疗的112例CKD 4-5期患者。使用美国R&D公司提供的试剂盒检测血清Chemerin、ADPN、CysC及FGF23水平,检测方法为酶联免疫吸附试验,分析血清Chemerin、ADPN、CysC及FGF23水平与血液透析患者钙磷代谢紊乱的关系。结果 112例CKD 4-5期患者中,伴钙磷代谢紊乱19例,钙磷代谢紊乱发生率为16.96%;钙磷代谢紊乱组血清Chemerin、ADPN、CysC及FGF23水平均高于钙磷代谢正常组,差异有统计学意义(P<0.05);经多元Logistic回归分析结果显示,血清Chemerin(OR=2.497,95%CI 1.150~5.422)、ADPN(OR=4.473,95%CI 1.373~14.574)、CysC(OR=28.448,95%CI 1.469~551.000)及FGF23(OR=1.140,95%CI 1.030~1.261)过表达是CKD患者发生钙磷代谢紊乱的影响因素(OR＞1,P<0.05);绘制ROC曲线发现,血清Chemerin、ADPN、CysC及FGF23水平单项及联合检测用于预测接受血液透析治疗患者钙磷代谢紊乱风险的AUC均＞0.80,均有一定预测价值。结论血清Chemerin、ADPN、CysC及FGF23水平与CKD行MHD治疗患者钙磷代谢紊乱有密切联系,可将上述指标作为CKD行MHD治疗患者钙磷代谢紊乱风险预测因子,以及时预测患者钙磷代谢紊乱发生风险。

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关键词 ：慢性肾脏病, 血液透析, 钙磷代谢, 血清趋化素, 脂联素, 胱抑素C, 成纤维细胞生长因子23

Abstract：Objective To investigate the role of serum levels of chemokine levels, adiponectin (ADPN), cystatin C (CysC) and fibroblast growth factor 23 (FGF23) in predicting calcium and phosphorus metabolism disorders in patients with 4-5 stages of chronic kidney disease (CKD) after hemodialysis.Methods One hundred and twelve patients with CKD 4-5 who had been diagnosed and treated with MHD in the Third Medical Center of PLA General Hospital between January 2018 and January 2020 were selected. An America-made kit was used to detect serum levels of chemerin, ADPN, CysC and FGF23 by means of enzyme-linked immunosorbent assay. The relationship between serum chemerin, ADPN, CysC and FGF23 levels and calcium and phosphorus metabolism disorders in hemodialysis patients was analyzed.Results Among the 112 CKD4-5 patients, 19 (16.96%) had calcium and phosphorus metabolism disorders.The serum levels of chemerin, ADPN, CysC and FGF23 in the disorder group were higher than those in the normal group, and the difference was statistically significant (P<0.05).Multiple Logistic regression analysis showed that overexpressions of serum chemerin (OR=2.497, 95%CI 1.150-5.422),ADPN (OR=4.473, 95%CI 1.373-14.574), CysC (OR=28.448, 95%CI 1.469-551.000) and FGF23 (OR=1.140, 95%CI 1.030-1.261) were influencing factors of calcium and phosphorus metabolism disorders in CKD patients (OR>1, P<0.05).The ROC curve suggested that the AUC of serum levels of chemerin, ADPN, CysC and FGF23 used alone or in combination to predict the risk of calcium and phosphorus metabolism disorders among patients under hemodialysis was above 0.80.Conclusions Serum levels of chemerin, ADPN, CysC and FGF23 are closely related to calcium and phosphorus metabolism disorders in CKD patients undergoing MHD treatment,so they can be used as predictors of the risk of such disorders.

Key words： chronic kidney disease hemodialysis calcium and phosphorus metabolism serum chemerin adiponectin cystatin C fibroblast growth factor 23

收稿日期: 2021-07-14

ZTFLH:

R692.3

通讯作者: 张艳霞,E-mail:yanxia0915@163.com

作者简介: 张静洁,硕士,医师。

引用本文:

张静洁, 石雨申, 张艳霞. 血清趋化素、脂联素、胱抑素C及FGF23预测慢性肾脏病4-5期患者血液透析后钙磷代谢紊乱的价值[J]. 武警医学, 2022, 33(2): 129-133. ZHANG Jingjie, SHI Yushen, ZHANG Yanxia. The role of serum chemerin, adiponectin, cystatin and FGF23 levels in predicting calcium and phosphorus metabolism in patients with 4-5 stages of chronic kidney disease after hemodialysis treatment. Med. J. Chin. Peop. Armed Poli. Forc., 2022, 33(2): 129-133.

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http://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 http://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2022/V33/I2/129

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