糖尿病肾病患者血浆锶浓度与钙磷代谢的相关性研究
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摘要
目的探讨糖尿病肾病患者血浆锶(Sr~(2+))浓度与钙磷代谢相关指标的关系。方法选择2014年5月至2018年2月收治于解放军第163医院的糖尿病肾病患者500例。收集患者的临床资料以及血清生化指标,根据估算肾小球滤过率(eGFR)对患者进行慢性肾脏病(CKD)分期,并将不同分期的患者分为3组:CKD 1～2期、CKD 3期、CKD 4～5期。采用多元线性回归分析探讨血浆Sr~(2+)浓度与钙磷代谢指标之间的关系。结果总体研究人群血浆Sr~(2+)浓度的中位数为269 nmol/L,处于正常范围内。CKD 1～2期患者的血浆Sr~(2+)浓度为246 nmol/L;CKD 3期患者的血浆Sr~(2+)浓度为347 nmol/L;CKD 4～5期的患者血浆Sr~(2+)浓度为419 nmol/L。经多元线性回归分析发现,血浆Sr~(2+)浓度与eGFR(β=-0.411,P<0.01)和血浆成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)浓度(β=0.088,P<0.01)之间存在独立相关。结论糖尿病肾病患者血浆Sr~(2+)浓度与eGFR水平呈负相关,并且与钙磷代谢指标血浆FGF23浓度独立相关。
Objective To explore the relationship between concentration of plasma strontium(Sr~(2+)) and parameters of calcium and phosphorus metabolism in patients with diabetic nephropathy. Methods A total of 500 patients with diabetic nephropathy treated in the 163 th Hospital of the People's Liberation Army from May 2014 to February 2018 were selected. The clinical data and serum biochemical indicators of the patients were collected, and the patients were classified into different stages of chronic kidney disease(CKD)stages based on estimated glomerular filtration rate(eGFR): CKD stages 1～2, stage 3 and stages 4～5. Multiple linear regression analysis was used to investigate the relationship between plasma Sr~(2+)concentration and calcium-phosphorus metabolism. Results The median concentration of plasma Sr~(2+ )was 269 nmol/L, which was within the normal range. The plasma Sr~(2+) concentration in the patients with CKD stages 1～2 was 246 nmol/L; the plasma Sr~(2+)concentration in patients with CKD stage 3 was 347 nmol/L; the plasma Sr~(2+) concentration in the patients with CKD stages 4～5 was 419 nmol/L. With the multivariate analysis, plasma Sr~(2+)concentrations were found to be independently associated with eGFR(β=-0.411, P<0.01)and plasma fibroblast growth factor 23(FGF23) concentrations(β=0.088, P<0.01). Conclusions In patients with diabetic nephropathy, plasma Sr~(2+) concentration has negative correlation with eGFR, and is independently associated with plasma FGF23 concentration.
Objective To explore the relationship between concentration of plasma strontium(Sr~(2+)) and parameters of calcium and phosphorus metabolism in patients with diabetic nephropathy. Methods A total of 500 patients with diabetic nephropathy treated in the 163 th Hospital of the People's Liberation Army from May 2014 to February 2018 were selected. The clinical data and serum biochemical indicators of the patients were collected, and the patients were classified into different stages of chronic kidney disease(CKD)stages based on estimated glomerular filtration rate(eGFR): CKD stages 1～2, stage 3 and stages 4～5. Multiple linear regression analysis was used to investigate the relationship between plasma Sr~(2+)concentration and calcium-phosphorus metabolism. Results The median concentration of plasma Sr~(2+ )was 269 nmol/L, which was within the normal range. The plasma Sr~(2+) concentration in the patients with CKD stages 1～2 was 246 nmol/L; the plasma Sr~(2+)concentration in patients with CKD stage 3 was 347 nmol/L; the plasma Sr~(2+) concentration in the patients with CKD stages 4～5 was 419 nmol/L. With the multivariate analysis, plasma Sr~(2+)concentrations were found to be independently associated with eGFR(β=-0.411, P<0.01)and plasma fibroblast growth factor 23(FGF23) concentrations(β=0.088, P<0.01). Conclusions In patients with diabetic nephropathy, plasma Sr~(2+) concentration has negative correlation with eGFR, and is independently associated with plasma FGF23 concentration.
引文
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[2] Chandran S,Babu SS,Vs HK,et al.Osteogenic efficacy of strontium hydroxyapatite micro-granules in osteoporotic rat model[J].J Biomater Appl,2016,31(4):499-509.
[3] Sriranganathan D,Kanwal N,Hing KA,et al.Strontium substituted bioactive glasses for tissue engineered scaffolds:the importance of octacalcium phosphate[J].J Mater Sci Mater Med,2016,27(2):39.
[4] Taha A,Akram M,Jawad Z,et al.Strontium doped injectable bone cement for potential drug delivery applications[J].Mater Sci Eng C Mater Biol Appl,2017,80:93-101.
[5] Rohnke M,Pfitzenreuter S,Mogwitz B,et al.Strontium release from Sr2+-loaded bone cements and dispersion in healthy and osteoporotic rat bone[J].J Control Release,2017,262:159-169.
[6] Ren ZZ,Bütz DE,Wahhab AN,et al.Additive effects of fibroblast growth factor 23 neutralization and dietary phytase on chick calcium and phosphorus metabolism[J].Poult Sci,2017,96(5):1167-1173.
[7] Bradbury EJ,Wilkinson SJ,Cronin GM,et al.Nutritional geometry of calcium and phosphorus nutrition in broiler chicks.Growth performance,skeletal health and intake arrays[J].Animal,2014,8(7):1071-1079.
[8] Jafari Giv Z,Avan A,Hamidi F,et al.Nutrients intake,and serum calcium and phosphorus levels:an evidence-based study[J].J Clin Lab Anal,2018,32(2):e22235.
[9] Sun ZW,Fan QH,Wang XX,et al.High stocking density alters bone-related calcium and phosphorus metabolism by changing intestinal absorption in broiler chickens[J].Poult Sci,2018,97(1):219-226.
[10] Mohan T,Velusamy P,Chakrapani LN,et al.Impact of EGCG supplementation on the progression of diabetic nephropathy in rats:an insight into fibrosis and apoptosis[J].J Agric Food Chem,2017,65(36):8028-8036.
[11] Dhanesha N,Doddapattar P,Chorawala MR,et al.ADAMTS13 retards progression of diabetic nephropathy by inhibiting intrarenal thrombosis in mice[J].Arterioscler Thromb Vasc Biol,2017,37(7):1332-1338.
[12] Bherwani S,Ahirwar AK,Saumya AS,et al.The study of association of Vitamin B12 deficiency in type 2 diabetes mellitus with and without diabetic nephropathy in North Indian Population[J].Diabetes Metab Syndr,2017,11(Suppl 1):S365-S368.
[13] Oyabu C,Ushigome E,Matsumoto S,et al.Maximum home blood pressure is a useful indicator of diabetic nephropathy in patients with type 2 diabetes mellitus:KAMOGAWA-HBP study[J].Diab Vasc Dis Res,2017,14(6):477-484.
[14] Rodionov RN,Heinrich A,Brilloff S,et al.ADMA reduction does not protect mice with streptozotocin-induced diabetes mellitus from development of diabetic nephropathy[J].Atheroscler Suppl,2017,30:319-325.
[15] Hou B,Qiang G,Zhao Y,et al.Salvianolic acid A protects against diabetic nephropathy through ameliorating glomerular endothelial dysfunction via inhibiting AGE-RAGE signaling[J].Cell Physiol Biochem,2017,44(6):2378-2394.
[16] Mansournia N,Riyahi S,Tofangchiha S,et al.Subclinical hypothyroidism and diabetic nephropathy in Iranian patients with type 2 diabetes[J].J Endocrinol Invest,2017,40(3):289-295.
[17] Wang M,Wang S,Yao D,et al.A novel long non-coding RNA CYP4B1-PS1-001 regulates proliferation and fibrosis in diabetic nephropathy[J].Mol Cell Endocrinol,2016,426:136-145.
[18] Chou ST,Tseng ST.Oxidative stress markers in type 2 diabetes patients with diabetic nephropathy[J].Clin Exp Nephrol,2017,21(2):283-292.
[19] Senba H,Furukawa S,Sakai T,et al.Serum lipoprotein(a) levels and diabetic nephropathy among Japanese patients with type 2 diabetes mellitus[J].J Diabetes Complications,2016,30(5):923-927.
[20] Synhaeve N,Wade-Gueye NM,Musilli S,et al.Chronic exposure to low concentrations of strontium 90 affects bone physiology but not the hematopoietic system in mice[J].J Appl Toxicol,2014,34(1):76-86.
[21] Qi W,Yan YB,Wang PJ,et al.The co-effect of Cordyceps sinensis and strontium on osteoporosis in ovariectomized osteopenic rats[J].Biol Trace Elem Res,2011,141(1-3):216-223.
[22] Coyne DW,Andress DL,Amdahl MJ,et al.Effects of paricalcitol on calcium and phosphate metabolism and markers of bone health in patients with diabetic nephropathy:results of the VITAL study[J].Nephrol Dial Transplant,2013,28(9):2260-2268.
[23] Chen H,Wang DG,Yuan L,et al.Clinical characteristics of patients with diabetic nephropathy on maintenance hemodialysis:a multicenter cross-sectional survey in Anhui province,Eastern China[J].Chin Med J (Engl),2016,129(11):1291-1297.
[24] Inci A,Sari F,Olmaz R,et al.Soluble Klotho levels in diabetic nephropathy:relationship with arterial stiffness[J].Eur Rev Med Pharmacol Sci,2016,20(15):3230-3237.