【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。更多还原

【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 was85. 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.更多还原