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目的比较中心夜间血液透析(INHD)和传统血液透析(CHD)患者循环成纤维细胞生长因子23(FGF23)水平差异并探讨影响患者FGF23水平的因素。方法收集第二军医大学长征医院44例INHD及64例CHD患者空腹静脉血,测定患者钙、磷、全段甲状旁腺素(iPTH)、尿素清除指数(Kt/V)、25-羟维生素D、铁蛋白、血红蛋白、血脂、FGF23等指标并比较两组各指标的差异,采用多重线性回归分析探究FGF23的影响因素,Pearson相关性分析探究FGF23与血钙、血磷、钙磷乘积、iPTH、25-羟维生素D、Kt/V的相关性。结果 INHD患者血磷较CHD患者低(P<0.05),INHD透析充分性明显高于CHD,INHD患者循环FGF23水平低于CHD患者(P<0.05)。FGF23与钙、磷、钙磷乘积相关(P<0.01),与iPTH及Kt/V不相关。结论 INHD比CHD更能有效改善慢性肾脏病-矿物质和骨异常(CKD-MBD)参数。钙磷乘积是血液透析患者FGF23水平的独立影响因素,INHD通过减少钙磷乘积降低血清FGF23水平可能是其改善患者临床预后的机制之一。
Objective To compare the differences of circulating fibroblast growth factor 23 (FGF23) levels between central night hemodialysis (INHD) and conventional hemodialysis (CHD) patients and to explore the factors influencing the level of FGF23 in patients. Methods Fasting venous blood was collected from 44 patients with INHD and 64 patients with CHD from Changzheng Hospital, Second Military Medical University. The levels of calcium, phosphorus, iPTH, Kt / V, 25-hydroxyvitamin D , Ferritin, hemoglobin, blood lipid, FGF23 and other indicators and compare the differences between the two indicators, using multiple linear regression analysis to explore the influencing factors of FGF23, Pearson correlation analysis of FGF23 and serum calcium, phosphorus, calcium and phosphorus products, iPTH, 25-hydroxy vitamin D, Kt / V correlation. Results The serum phosphorus in INHD patients was lower than that in CHD patients (P <0.05). INHD dialysis adequacy was significantly higher than that in CHD patients. The level of circulating FGF23 in INHD patients was lower than that in CHD patients (P <0.05). FGF23 was related to the product of calcium, phosphorus and calcium (P <0.01), but not to iPTH and Kt / V. Conclusion INHD is more effective than CHD in improving the parameters of chronic kidney disease - mineral and bone abnormalities (CKD-MBD). The product of calcium and phosphorus is an independent factor affecting the level of FGF23 in hemodialysis patients. INHD can reduce serum FGF23 level by decreasing the product of calcium and phosphorus, which may be one of the mechanisms of improving the clinical prognosis of patients.