| Research Background:Fibroblast growth factor23(FGF23) is a new cytokine diseovered reeently which involved in phosphate metabolism, and it is a secreted protein produeed primarily in osteoblast and osteoeyte regulating the renal reabsorption of phosphate to maintain serum phosphate homeostasis. FGF23can act on specific receptors in renal tubular epithelial cell membrane to affect the activation of vitamin D3.It has been confirmed that FGF23regulate phosphate homeostasis, secondary hyperparathyroidism(SHPT),left ventricular hypertrophy (LVH) and the development of chronic kidney disease(CKD).FGF-23levels indrease early in CKD before the development of hyperphosphatemia and calcitriol deficiency.lccreaseed FGF-23may contribute to maintaining normal serum phosphate levels in the face of advancing CKD but may worsen calcitriol deficiency and thus may be a central factor in the early pathogenesis of SHPT,FGF-23has been reported to be a major independent risk factor for refractory hyperparathyroidism in dialysis patients, crcularing FGF23levels are influenced by phosphate and1,25(OH)2D3, but date about whether FGF23signaling stimulates or inhibits PTH secretion are conflicting.Given the fact that cardiocascular disease is the most important cause of death in end stage renal test disease(ESRD).Therefor,it’s very important that discussing the level of FGF-23change and dealing with the mineral metabolic disorders and cardiac tructure change in CKD patients.Objective:The aim of this study was to test plasma FGF-23levels with ELISA might be associated with the mineral metabolic disorder and cardiac structure change in CKD patients,and to provide a way of diagnosis and treatment for the late complication of CKD patients. Methods:Select88patients with chronic kidney disease in Nephrilogy in the Second Affiliated Hospital of Kunming Medical University from July2011to December2012.6patients with chronic kidney disease1(CKD1);10patients with chronic kidney disease2(CKD2);13patients with chronic kidney disease3(CKD3);15patients with chronic kidney disease4(CKD4);44patients with chronic kidney disease5(CKD5),(including29patients with peritoneal dialysis,PD and15patients with non-dialysis); and normal control group was20cases..Exelusion criteria:obvious infeetion, liver damage, fractures, caneer, vitaminD-related preparations.Refer to the K/DOQI (the CKD3of iPTH>70pg/ml, the CKD4of iPTH>110pg/ml, the CKD5of iPTH>300pg/ml)the patients of chronic kidney patients3-5(CKD3-5) divide into31patient with secondary hyperparathyroidism (SHPT) group and41patients with non-SHPT group. Refer to the international recommendation standards(Man of LVMI>135g/m2,Woman of LVMI>110g/m2) the patients of CKD3-5divide into27cases with left ventricular hypertrophy (LVH) group and45cases with non-LVH.The ages and gender among the six groups were mathed.Plasma FGF-23and1,25(OH)2D3levels were tested by enzyme-linked immunnosorbent assay (ELI SA),and biochemical parameters were collected, including phosphorus,calcium,parathyroid hormone(PTH),calcium phosphate product and glomerular filtration rate (eGRF).In CKD3-5group test left ventricular mass index(LVMI) by echocardiography.All statistical analysis was performed with SPSS17.0, p<0.05was comsidered statistically significant.Results:1.Compared with the healthy control group,the level of plasm FGF-23in CKD1-2group were significantly increased(p<0.05);but there was no significant difference between CKD1group and CKD2group (p>0.05).Compared with CKD2group,the FGF-23in CKD3-5group were significantly increased (p<0.05).In CKD4group, PD group and non-dialysis group had higher iPTH levels than the other three group (CKD1-3group)(p<0.05). The CKD1-5group with kendall analysis showed that positive correlation existed between FGF-23,serum P (p<0.01), calcium-phosphorus product (p<0.01) and iPTH (p<0.01). Howerve, FGF-23was negatively correlated with1,25(OH)2D3(p<0.01) and eGRF (p<0.01).2.Compared with the PD group,the level of iPTH was significantly increased(p<0.05) in non-dialysis group,but the level of serum P,FGF-23and1.23(OH)2D3were no significant difference(p>0.05).The level of FGF-23in PD group with Spearman analysis showed that FGF-23was positively correlated with serum iPTH(p<0.01) and LVMI(p<0.05),were negatived correlated with eGRF (p<0.05),while was not correlated with serum P (p>0.05) and serum Ca(p>0.05).3. In72patients with CKD3-5groups, the SHPT group’s level of FGF-23was significant increased than the non-STPH (p<0.01), while the level of1,25(OH)2D3was no significant difference (p>0.05). The Spearman correlated analysis showed that the level of FGF-23in SHPT was positiveiy correlated with serum P (p<0.01),serum PTH(p<0.05), and Ca×P (p<0.01),was negatively correlated with eGRF (P<0.01), while wasn’t correlated with1,25(OH)2D3(p>0.05). But the level of FGF-23in non-STPH was not correlated with any index.4.72patients of CKD3-5groups were examined by echocardiography,the level of FGF-23of LVH group was significant increased than the non-LVH group (p<0.01).Correlation analysis showed that positive correlation existed between FGF-23,serum P(p<0.05) and LVMI (p<0.05),while negative correlation existed between FGF-23and eGRF(p<0.01).Conclusions:1. The level of FGF-23of CKD2-5groups are significant higher than the normal control group and CKD1group,which shows that the renal is the main organ of metabolizing the FGF-23,as the decline in renal function,cleaning to FGF-23also fell.2. FGF-23plays some effect on the mineral metabolism of renal.There are positive correlations between FGF-23,serum P and serum iPTH.These can help have a stable environment of serum phospaate level and a normal metabolism process.3. The patients in CKD5,the level of iPTH and eGRF of PD patients lower than the patients of non-dialysis,while the FGF-23was not significantly difference,which shows PD can hardly remove plasma FGF-23.4. The plasma FGF-23in the patients of CKD with SPTH increased in parallel with the serum iPTH,which shows the FGF-23plays some effect on the development of SPTH.5. Compared with non-LVH group,the. level of FGF-23increased in LVH group,the FGF-23are positively correlated LVMI and serum P in CKD3-5groups,it shows that FGF-23may have the efection the CKD patients’cardiac structure. |
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