Gürcan Kısakol, Birol Ocak, Barış Eser, Hüseyin Kayadibi, Sultan Özkurt, İbrahim Doğan

Erken Evre Otozomal Dominant Polikistik Bo brek Hastalıg ında FGF23, I nflamasyon ve Demir Metabolizması

Bu çalışmanın amacı erken evre Otozomal Dominant Polikistik Böbrek Hastalığı’nda (ODPBH) serum Fibroblast Growth Faktör-23 (sFGF-23) düzeyleri ile demir metabolizması, inflamasyon ve karotis intima-media kalınlığı (KİMK) arasındaki ilişkiyi araştırmaktır. Çalışma Bursa Yüksek İhtisas Eğitim ve Araştırma Hastanesinde gerçekleştirildi. Çalışmaya 40 ODPBH hastası (24 kadın) ile 40 kişilik sağlıklı kontrol (21 kadın) grubu alındı. Serum FGF-23 düzeyleri ELİSA yöntemi ile çalışıldı. Tüm çalışma popülasyonundan KİMK ölçümü yapıldı. Serum FGF-23 düzeyleri ile KİMK, hs-CRP, nötrofil/lenfosit oranı (NLO) ve demir parametreleri arasındaki ilişki korelasyon analizi ile değerlendirildi. Hasta grubunun sFGF-23 düzeyi istatistiksel olarak anlamlı düzeyde daha yüksekti. Hasta grubunda 245(182-963) pg/mL, kontrol grubunda 220(34-494) pg/mL, (P< 0.001). NLO ve hs-CRP düzeyi hasta grubunda kontrol grubuna göre istatistiksel olarak daha yüksekti (sırasıyla, P< 0.001, P= 0.003). Ayrıca KİMK hasta grubunda, kontrol grubuna göre anlamlı düzeyde daha yüksek saptandı (P= 0.037). sFGF-23 düzeyleri ile kalsiyum, hemoglobin, hematokrit, serum demir, ferritin ve NLO arasında anlamlı negatif korelasyon (sırasıyla, P= 0.009, P= 0.035, P= 0.002, P= 0.033, P= 0.017, P= 0.023), sFGF-23 ile fosfor ve total demir bağlama kapasitesi arasında ise anlamlı pozitif korelasyon saptandı (P= 0.010, P= 0.049). sFGF-23 düzeyi ile PTH, hs-CRP ve KİMK arasında ise korelasyon saptanmadı. Multivariate lineer regresyon analizinde serum fosfor düzeyi sFGF-23 tahmininde bağımsız değişken olarak saptandı. Erken evre ODPBH’da sFGF-23 düzeyi demir eksikliği ile ilişkiliyken inflamasyon ve ateroskleozis arasında ilişki saptanmadı.

FGF-23, Inflammation and Iron Metabolism in the Early Stages of Autosomal Dominant Polycystic Kidney Disease

To investigate the correlation of Fibroblast Growth Faktör-23 (sFGF-23) with iron status, inflammation and carotidintima-media thickness (CIMT) in the early stages of autosomal dominant polycystic kidney disease (ADPKD). Forty ADPKDpatients (24 female) with normal creatinine levels and 40 healthy volunteers (21 female) were included in the study. Serum FGF-23levels were measured using the ELISA technique. The associations between sFGF-23 with CIMT, hs-CRP, neutrophil lymphocyteratio (NLR) and iron parameters were evaluated using correlation analysis. Patients’ sFGF-23 levels were significantly higher [245(182-963) pg/mL; vs. 219.6 (34-494) pg/mL], (P< 0.001). NLR and hs-CRP were also found to be statistically higher in patientsthan controls (P< 0.001 and P= 0.003, respectively). CIMT was significantly higher in the patient group (P= 0.037). There werestatistically significant negative correlations between sFGF-23 and calcium, hemoglobin, hematocrit, serum iron, ferritin, and NLR(P= 0.009, P= 0.035, P= 0.002, P= 0.033, P= 0.017, P= 0.023, respectively), and positive correlations with phosporus, total ironbinding capacity and sFGF-23 (P= 0.010, P= 0.049, respectively). There was no statistically significant correlation between sFGF23 and PTH, hs-CRP and CIMT. In multivariate lineer regression analysis, serum phosphorus level was statistically significiantindependent risk factor for the determinantion of sFGF-23 level [B: 0.318, OR:130,662(32,715-228,610), P=0.010]. Our studyresults support an inverse relationship between sFGF-23 and iron deficiency but no relationship between sFGF-23 and inflammationand atherosclerosis in the early stages of ADPKD.

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