成纤维细胞生长因子23 与肾脏疾病.pdfVIP

肾脏病与透析肾移植杂志 第22 卷 第4 期 20 13 年8 月 ·357 · ·医学继续教育 · 成纤维细胞生长因子23 与肾脏疾病 卢剑萍 综述 程 震 审校 摘 要 成纤维细胞生长因子23 (FGF23 )是钙磷代谢平衡研究的热点之一。FGF23 主要通过 FGF 受体 (FGFR)及其共受体蛋白klotho 作用于肾脏、甲状腺等靶器官，与甲状旁腺激素、1，25 (OH)D 、klotho 蛋白之间关 2 3 系密切，共同调节机体钙磷平衡。在慢性肾脏病(CKD)患者中，FGF23 水平明显升高，并与进展为终末期肾病、心 血管事件、死亡相关，部分归咎于FGF23 通过klotho 非依赖途径导致的心脏直接脱靶毒效应。临床上提出了一系 列可能降低FGF23 水平的措施，这些措施可能改善CKD 患者预后。 关键词 成纤维细胞生长因子23 慢性肾脏病 钙磷代谢平衡 预后 Update on fibroblast growth factor 23 in kidney disease L U Jianp ing ，CHENG Zhen Research Institute of Nep hrop athy ，Jingling Hosp ital ，Nanj ing University School of Medicine ，Nanj ing 210016 ，China ABSTRACT FGF23 (fibroblast growth factor 23 )is a hot topic in regulation of the calcium and phosphate metabolism． The classical effects of FGF23 in the kidney and parathyroid glands are mediated by its binding to FGF receptors (FGFRs)complexed to the co-receptor klotho ，maintaining the calcium and phosphate homeostasis with the help of other regulators :PTH ，1，25 (OH)D ，and klotho． CKD is a clinical condition in which FGF23 levels are most markedly 2 3 elevated． Elevated FGF23 level may have an ‘off-target ’direct toxicity indepondent of klotho in the heart ，which may in part explained observations that CKD patients with elevated FGF23 level shown independently association with progression of CKD and development of cardiovascular events and mortality． Therapeutic strategies targeting FGF23 reduction may be helpful in improving outcomes for patients with CKD． Key words fibroblast growth factor 23 chron