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目的:探讨持续非卧床腹膜透析(CAPD)患者腹主动脉钙化与血清成纤维细胞生长因子23(FGF-23)和可溶性Klotho(s KL)水平之间的关系。方法:收集147例CAPD患者临床资料,采用ELASA法检测血清FGF-23和s KL浓度。采用腰椎侧位片评估患者腹主动脉钙化情况,比较腹主动脉非钙化组和腹主动脉钙化组的各项临床指标;用Logistic回归分析法分析患者发生腹主动脉钙化的危险因素;受试者工作特征曲线(ROC)评估FGF-23和s KL预测腹主动脉钙化的敏感度及特异度。结果:147例CAPD患者腹主动脉钙化的发生率为37.41%,腹主动脉钙化与FGF-23水平、s KL水平、年龄、透析龄、碱性磷酸酶(ALP)、血磷水平、三酰甘油(TG)、超敏C反应蛋白(hs CRP)相关。将单因素分析有统计学意义的变量纳入多因素Logistics回归,FGF-23中位水平以上者(>2 770.36 pg/ml),其发生腹主动脉钙化的危险度是中位水平及以下者的6.50倍(OR 6.50,95%CI 1.41~29.88);年龄每增加1岁,危险度增加7%(OR 1.07,95%CI 1.03~1.11);血磷>1.75 mmol/L者,其发生腹主动脉钙化的危险度是血磷≤1.75 mmol/L者的3.49倍(OR 3.49,95%CI 1.09~11.14)。s KL>296.53 pg/ml者,其腹主动脉钙化的危险度是s KL≤296.53 pg/ml者的0.25倍(OR 0.25,95%CI 0.13~0.52)。FGF-23预测腹主动脉钙化的ROC曲线下面积(AUC)为0.96(截点为2 045.14 pg/ml,其敏感度91.0%,特异度96.6%);s KL预测腹主动脉钙化的AUC为0.95(截点为434.78 pg/ml,其敏感度93.3%,特异度94.8%)。结论:CAPD患者腹主动脉钙化与FGF-23水平、s KL水平、年龄、透析龄、ALP、血磷水平、TG、hs CRP相关。血清FGF-23与s KL水平均有助于预测腹主动脉钙化,高FGF-23及低s KL的CAPD患者发生腹主动脉钙化的危险度高。
Objective: To investigate the relationship between calcification of abdominal aorta and serum levels of fibroblast growth factor 23 (FGF-23) and soluble Klotho (s KL) in patients with continuous ambulatory peritoneal dialysis (CAPD). Methods: The clinical data of 147 patients with CAPD were collected. The serum concentrations of FGF-23 and s KL were measured by ELASA. The lumbar lateral radiographs were used to evaluate the calcification of the abdominal aorta. The clinical parameters of abdominal aorta non-calcification group and abdominal aorta calcification group were compared. Logistic regression analysis was used to analyze the risk factors of abdominal aortic calcification. The working characteristic curve (ROC) was used to assess the sensitivity and specificity of FGF-23 and s KL for prediction of abdominal aortic calcification. Results: The incidence of calcification of abdominal aorta in 147 patients with CAPD was 37.41%. The aortic calcification and FGF-23 levels, s KL level, age, dialysis age, alkaline phosphatase (ALP), serum phosphate level, Glycerol (TG), high-sensitivity C-reactive protein (hs CRP). Univariate analysis of the statistically significant variables into the multi-factor Logistics regression, FGF-23 median level (> 2 770.36 pg / ml), the occurrence of abdominal aortic calcification risk is the median level of the following 6.50-fold (OR 6.50, 95% CI 1.41- 29.88). The risk increased by 7% for every 1-year increase in age (OR 1.07, 95% CI 1.03-1.11) The risk of arterial calcification was 3.49-fold (OR 3.49, 95% CI, 1.09 to 11.14) for those with serum phosphorus ≤ 1.75 mmol / L. s KL> 296.53 pg / ml, the risk of abdominal aorta calcification was 0.25-fold (OR 0.25, 95% CI 0.13 to 0.52) for those with s KL ≦ 296.53 pg / ml. The area under the ROC curve (AUC) of FGF-23 in prediction of abdominal aortic calcification was 0.96 (with a cutoff of 2045.14 pg / ml, with a sensitivity of 91.0% and a specificity of 96.6%). The AUC of s KL for predicting abdominal aortic calcification 0.95 (cut-off point of 434.78 pg / ml, the sensitivity of 93.3%, specificity of 94.8%). CONCLUSIONS: Calcification of abdominal aorta in patients with CAPD is associated with FGF-23 level, s KL level, age, dialysis age, ALP, serum phosphorus level, TG and hs CRP. Serum FGF-23 and s KL levels are helpful in predicting abdominal aortic calcification, and high risk of abdominal calcification of the aorta in CAPD patients with high FGF-23 and low s KL.