Résumé
Objective To elucidate the association of fibroblast growth factor 23 (FGF23)with coronary artery calcification in patients with moderate and advanced stage chronic kidney diseases (CKD). Methods Serum intact FGF23 levels in 150 patients with CKD stage 3 to 5 and 25 age- and sex-matched healthy controls were measured by ELISA.The association between FGF23 and coronary artery calcification was studied. Results Serum FGF23 levels in CKD patients were significantly higher than those in healthy controls [196.46 (83.09,355.02) ng/L vs 27.17 (21.63,51.20) ng/L,P＜0.01].The levels of FGF23 were significantly higher in dialyzed patients than those in non-dialyzed patients (P＜0.01),and hemodialysis patients had higher levels as compared to peritoneal dialysis ones [6048.29 (1129.08,34807.45) ng/L vs 1625.80 (602.83,7521.78) ng/L,P＜0.01].The incidence of coronary artery calcification was relatively high in patients with moderate and advanced stage CKD (74/130,56.9％ ).Serum FGF23 level was positively correlated with coronary artery calcification score (CaS) (r=0.177,P＜0.05).Logistic regression analysis showed that age (β=0.091,OR=1.095,P＜0.01),duration of dialysis (β=2.013,OR=7.483,P＜0.05) and FGF23 level (β=0.838,OR=2.311,P＜0.05) were independent risk factors for coronary artery calcification in patients with moderate and advanced stage CKD.ROC curve of coronary artery calcification revealed that area under curve (AUC) of FGF23 was 0.705 (P＜0.01).With the cut-off value of FGF23 as 786.73 ng/L,the diagnostic sensitivity and specificity in coronary artery calcification were 62.5％ and 75.9％.ROC curve of coronary artery calcification showed that AUC of alkaline phosphatase (AKP) was 0.626 (P=0.017).With the cutoff value of AKP as 79.75 U/L,the diagnostic sensitivity and specificity in coronary artery calcification were 84.5％ and 41.5％.There was no diagnostic value of serum phosphorus in coronary artery calcification. Conclusions Serum FGF23 level is correlated with coronary artery.calcification in patients with moderate and advanced stage CKD.The sensitivity of FGF23 is lower and the specificity is higher than those of AKP for the diagnosis of coronary artery calcification.