[1]侯维纳,吕爱婷,冯迎军.血清成纤维细胞生长因子23和Klotho水平与川崎病患儿冠状动脉损伤的关系[J].新乡医学院学报,2019,36(10):932-936.[doi:10.7683/xxyxyxb.2019.10.007]
　HOU Wei-na,LYU Ai-ting,FENG Ying-jun.Relationship between the serum levels of fibroblast growth factor 23 and Klotho and coronary artery injury in children with Kawasaki disease[J].Journal of Xinxiang Medical University,2019,36(10):932-936.[doi:10.7683/xxyxyxb.2019.10.007]
点击复制

血清成纤维细胞生长因子23和Klotho水平与川崎病患儿冠状动脉损伤的关系
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
36
期数:
2019年10
页码:
932-936
栏目:
临床研究
出版日期:
2019-10-05

文章信息/Info

Title:
Relationship between the serum levels of fibroblast growth factor 23 and Klotho and coronary artery injury in children with Kawasaki disease
作者:
侯维纳; 吕爱婷; 冯迎军
（郑州儿童医院心血管内科，河南　郑州　450000）
Author(s):
HOU Wei-na; LYU Ai-ting; FENG Ying-jun
(Department of Internal Medicine-Cardiovascular,Zhengzhou Children’s Hospital,Zhengzhou 450000,Henan Province,China)
关键词:
川崎病; 冠状动脉钙化; 冠状动脉损伤; 成纤维细胞生长因子23; Klotho蛋白
Keywords:
Kawasaki disease; coronary artery calcification; coronary artery injury; fibroblast growth factor 23; Klotho protein
分类号:
R725.4
DOI:
10.7683/xxyxyxb.2019.10.007
文献标志码:
A
摘要:
目的　探讨川崎病患儿血清成纤维细胞生长因子23（FGF23）、Klotho水平与冠状动脉损伤的关系。方法　选择2018年4月至2019年6月郑州儿童医院收治的315例川崎病患儿为观察对象，根据超声心动图检查结果将患儿分为合并冠状动脉损伤组（损伤组）63例与未合并冠状动脉损伤组（未损伤组）252例；另选择同期体检健康儿童261例为对照组。检测所有受试者的血清FGF23、Klotho、碱性磷酸酶（ALP）、钙（Ca）、磷（P）水平，采用Pearson法分析血清FGF23、Klotho水平与患儿ALP、Ca、P水平的关系，采用logistic多元回归分析影响川崎病患儿冠状动脉损伤的危险因素；绘制受试者工作特征曲线（ROC）评估血清FGF23、Klotho水平对川崎病患儿冠状动脉损伤的诊断价值。结果　3组受试者血清FGF23、Klotho、ALP、Ca、P水平比较差异均有统计学意义（F=244.281、11.322、148.839、24.411、68.693，P<0.001）。未损伤组患儿血清FGF23、Klotho、ALP、Ca、P水平与对照组比较差异无统计学意义（P>0.05）。与对照组和未损伤组比较，损伤组患儿血清FGF23、ALP、Ca水平显著增高（P<0.005），Klotho、P水平显著降低（P<0.05）。Pearson相关分析显示，川崎病患儿血清FGF23水平与ALP、Ca水平呈正相关（r=0.714、0.812，P<0.05），与P水平呈负相关（r=-0.596，P<0.05）；血清Klotho水平与ALP、Ca水平呈负相关（r=-0.702、-0.761，P<0.05），与P水平呈正相关（r=0.629，P<0.05）。Logistic回归分析显示，血清FGF23高表达、Klotho低表达是川崎病患儿冠状动脉损伤的危险因素（P<0.05）。血清FGF23水平诊断川崎病患儿冠状动脉损伤的曲线下面积为0.860，截断值为48.82 ng·L-1，敏感度为76.2%，特异度为90.3%；血清Klotho水平诊断川崎病患儿冠状动脉损伤的曲线下面积为0.807，截断值为36.04 ng·L-1，敏感度为67.9%，特异度为85.7%；二者联合检测诊断川崎病患儿冠状动脉损伤的曲线下面积为0.924，敏感度为90.5%，特异度为86.9%；血清FGF23、Klotho水平联合检测诊断川崎病患儿冠状动脉损伤的敏感度显著高于二者单独检测（P<0.05）。 结论　血清FGF23水平升高、Klotho水平降低是川崎病患儿发生冠状动脉损伤的危险因素，其可能通过影响Ca、P代谢而导致冠状动脉钙化损伤。
Abstract:
Objective　To investigate the relationship between the serum levels of fibroblast growth factor 23 (FGF23),Klotho and coronary artery injury in children with Kawasaki disease.Methods　Three hundred and fifteen children with Kawasaki disease admitted to Zhengzhou Children′s Hospital from April 2018 to June 2019 were selected as subjects.The children were divided into coronary artery injury group (n=63)and non-coronary artery injury group (n=252)according to the results of echocardiography.Another 261 healthy children in the same period were selected as the control group.The serum levels of FGF23,Klotho,alkaline phosphatase (ALP),calcium (Ca),phosphate (P) of all subjects were measured.The relationship between the serum levels of FGF23,Klotho and ALP,Ca,P was analyzed by Pearson correlation in children with Kawasaki disease.The risk factors of coronary artery injury in children with Kawasaki disease was analyzed by logistic multiple regression analysis.The diagnostic value of serum levels of FGF23 and Klotho for coronary artery injury of children with Kawasaki disease was evaluated by receiver operating characteristic curve (ROC).Results　There were significant differences in serum levels of FGF23,Klotho,ALP,Ca and P among the three groups (F=244.281,11.322,148.839,24.411,68.693;P<0.001).There was no significant difference in serum levels of FGF23,Klotho,ALP,Ca and P between the non-coronary artery injury group and the control group (P>0.05).Compared with the control group and the non-coronary artery injury group,the serum levels of FGF23,ALP and Ca in the coronary artery injury group increased significantly,while the levels of Klotho and P decreased significantly (P<0.05).Pearson correlation analysis showed that the serum level of FGF23 was positively correlated with the levels of ALP and Ca (r=0.714,0.812;P<0.05); and it was negatively correlated with the level of P (r=-0.596,P<0.05); the serum level of Klotho was negatively correlated with the levels of ALP and Ca (r=-0.702,-0.761;P<0.05),and it was positively correlated with the level of P (r=0.629,P<0.05).Logistic regression analysis showed that the high expression of FGF23 and low expression of Klotho in serum were risk factors of coronary artery injury in children with Kawasaki disease (P<0.05).The area under the curve of the serum level of FGF23 in diagnosis of coroary artery injury in children with Kawasaki disease was 0.860,truncation value was 48.82 ng·L-1,sensitivity was 76.2%,specificity was 90.3%;the area under the curve of the serum level of Klotho in diagnosis of coronary artery injury in children with Kawasaki disease was 0.807,truncation value was 36.04 ng·L-1,sensitivity was 67.9%,specificity was 85.7%;the area under the curve of the combined detection of FGF23 and Klotho in diagnosis of coronary artery injury in children with Kawasaki disease was 0.924,the sensitivity was 90.5%,and the specificity was 86.9%.The sensitivity of combined detection of serum levels of FGF23 and Klotho in diagnosis of coronary artery injury in children with Kawasaki disease was significantly higher than that of FGF23 or Klotho single detection (P<0.05).Conclusion　The increasing serum level of FGF23 and decreasing serum level of Klotho are risk factors of coronary artery injury in children with Kawasaki disease，which may lead to coronary artery calcification injury by affecting Ca and P metabolism.

参考文献/References:

［1］　钱颖,王有成,方晓丹,等.大剂量丙种球蛋白联合阿司匹林对川崎病患儿T淋巴细胞亚群、血管内皮因子、炎症因子水平的影响［J］.中华全科医学,2017,15(3):454-456.
［2］　刘慧,鲁珊,邢燕,等.2007年至2016年单中心川崎病临床特征及变化趋势分析［J］.中华实用儿科临床杂志,2018,33(21):1627-1630.
［3］　胡秀芬,温宇.丙种球蛋白无反应型川崎病的发病机制及治疗进展［J］.中华实用儿科临床杂志,2017,32(21):1612-1615.
［4］　伍文娟,崔燕海,黎思嘉,等.维持性血液透析患者的血浆可溶性尿激酶型纤溶酶原激活物受体与冠状动脉钙化及心血管事件的关系［J］.肾脏病与透析肾移植杂志,2017,26(1):26-30.
［5］　白冰,王彩丽,吕丽,等.慢性肾脏病患者血管钙化与成纤维细胞生长因子23-Klotho轴的关系［J］.国际移植与血液净化杂志,2017,15(2):17-22.
［6］　VOSSEN L M,SCHURGERS L J,VAN V B J,et al.Menaquinone-7 supplementation to reduce vascular calcification in patients with coronary artery disease: rationale and study protocol (vitak-CAC trial)［J］.Nutrients,2015,7(11):8905-8915.
［7］　RICHTER B,HALLER J,HAFFNER D,et al.Klotho modu-lates FGF23-mediated NO synthesis and oxidative stress in human coronary artery endothelial cells［J］.Pflugers Arch,2016,31(9):1621-1635.
［8］　张清友,简佩君,杜军保.风湿热、心内膜炎及川崎病委员会，美国心脏病学会及美国儿科学会川崎病的诊断、治疗及长期随访指南介绍［J］.中华实用儿科临床杂志,2012,27(13):1049-1056.
［9］　江彦秋,黄先玫.川崎病的免疫与遗传学发病机制研究进展［J］.中华实用儿科临床杂志,2017,32(9):717-720.
［10］　欧阳冰，唐林芬，戚胡敏，等．甲泼尼龙联合丙种球蛋白治疗川崎病疗效观察［J］．新乡医学院学报，2018，35(10):907-909，913．
［11］　孙秀丽．川崎病急性期患儿外周血T淋巴细胞亚群变化［J］.新乡医学院学报，2017，34(10):940-942．
［12］　张偲,罗小平.低磷抗维生素D性佝偻病诊治进展［J］.中国实用儿科杂志,2017,32(9):669-673.
［13］　CHEN C D,LI H,LIANG J,et al.The anti-aging and tumor suppressor protein Klotho enhances differentiation of a human oligodendrocytic hybrid cell line［J］.J Mol Neurosci,2015,55(1):76-90.
［14］　HASEGAWA T,YAMAMOTO T,HONGO H,et al.Vascular calcification-pathological mechanism and clinical application-vascular calcification in Klotho deficient environment［J］.Clin Calcium,2015,25(5):693-699.
［15］　MORITA H,TAKEDA Y,FUJITA S I,et al.Gender specific association between serum fibroblast growth factor 23/α-Klotho and coronary artery and aortic valve calcification［J］.J Atheroscler Thromb,2015,22(12):1338-1346.
［16］　吴艺青,高银龙,陶静,等.黄芪对慢性肾脏病大鼠钙磷代谢及FGF23-Klotho轴的影响［J］.南京中医药大学学报,2018,34(2):118-122.
［17］　李韶南,刘震,李维杰.雌激素调控Notch1信号通路对卵巢去势大鼠血管钙化的影响［J］.中华实用诊断与治疗杂志,2019,33(2):11-14.
［18］　PANH L,RUIDAVETS J B,ROUSSEAU H,et al.Association between serum alkaline phosphatase and coronary artery calcification in a sample of primary cardiovascular prevention patients［J］.Atherosclerosis,2017,260(1):81-86.
［19］　FELSENFELD A J,LEVINE B S,RODRIGUEZ M.Pathophysiology of calcium,phosphorus,and magnesium dysregulation in chronic kidney disease［J］.Semin Dial,2015,28(6):391-405.
［20］　COELHO F O,JORGE L B,DE A B V,et al.Chronic nicotine exposure reduces klotho expression and triggers different renal and hemodynamic responses in Klotho-haploinsufficient mice［J］.Am J Physiol Renal Physiol,2018,314(5):992-998.

相似文献/References:

[1]胡勇军,杨　红,王　丹,等.彩色多普勒超声心动图对川崎病冠状动脉瘤的诊断价值[J].新乡医学院学报,2003,20(04):265.
[2]胡勇军,杨 红,王 丹,等.彩色多普勒超声心动图对川崎病冠状动脉瘤的诊断价值[J].新乡医学院学报,2003,20(04):265.
[3]欧阳冰,唐林芬,戚胡敏,等.甲泼尼龙联合丙种球蛋白治疗川崎病疗效观察[J].新乡医学院学报,2018,35(10):907.[doi:10.7683/xxyxyxb.2018.10.014]
　OUYANG Bing,TANG Lin-fen,QI Hu-min,et al.Effect of methylprednisolone combined with gamma globulin in the treatment of Kawasaki disease[J].Journal of Xinxiang Medical University,2018,35(10):907.[doi:10.7683/xxyxyxb.2018.10.014]
[4]孙秀丽.川崎病急性期患儿外周血T淋巴细胞亚群变化[J].新乡医学院学报,2017,34(10):940.[doi:10.7683/xxyxyxb.2017.10.019]
　SUN Xiu-li.Changes of peripheral blood T lymphocyte subsets in the acute stage of Kawasaki disease[J].Journal of Xinxiang Medical University,2017,34(10):940.[doi:10.7683/xxyxyxb.2017.10.019]

更新日期/Last Update: 2019-10-05