The Proportion Of Th17 Cells In Peripheral Blood And Expression Of IL-17,RANKL,OPG And FGF23 In Serum Of Non-dialysis Patients With CKD-MBD And Their Clinical Significance

Objectives: To compare the proportion of T helper cells 17(Th17)in peripheral blood,and the Expression level of serum interleukin17(IL-17),receptor activator of NF-κB ligand(RANKL),osteoprotegerin(OPG)and Fibroblast growth factor-23(FGF23)in patients with chronic kidney disease-mineral and bone disorder(CKD-MBD)in different stages of non-dialysis.To analyze its correlation with renal function and calcium and phosphorus metabolism indexes,and explore its clinical value in the diagnosis,prevention and treatment of CKD-MBD.Methods: A total of 75 non-dialysis patients with CKD-MBD admitted to our hospital from January 2021 to October 2022 were included as the study group.The basic data and laboratory data of the patients were collected,and another 30 healthy subjects matching the gender and age of the study group were selected as the control group.The proportion of Th17 cells in peripheral blood was determined by flow cytometry,and the levels of IL-17,RANKL,OPG and FGF23 in serum were determined by ELISA.The patients were grouped according to CKD staging criteria,and the differences in the above indexes were compared among all groups,and the correlations between Th17 cell proportion,IL-17,RANKL,OPG,FGF23 and renal function and calcium and phosphorus metabolism indexes were analyzed.The influence factors of Th17 cell ratio,IL-17,RANKL,OPG and FGF23 were further investigated by multiple stepped-linear regression analysis.Results: 1.The proportion of Th17 cells in the study group was significantly higher than that the control group(P<0.05),and the proportion of peripheral blood Th17 cells in the CKD2-3 stage group was significantly higher than that the control group,and the proportion of Th17 cells in the CKD5 stage group was significantly higher than that the control group,CKD2-3 stage group and CKD4 stage group(P<0.05).2.With the progress of renal function in patients with CKD,the levels of serum IL-17,RANKL,OPG and FGF23 increased gradually(P<0.05).3.Correlation analysis showed that the proportion of Th17 cells was positively correlated with serum IL-17(P<0.05),serum IL-17 was positively correlated with SCr,BUN,P,and negatively correlated with e GFR(P<0.05),serum RANKL,OPG,FGF23 were positively correlated with SCr,BUN,Cys C,P,PTH,negatively correlated with e GFR and Ca(P<0.05),and serum IL-17 was positively correlated with RANKL,OPG and FGF23(P<0.05).4.Multiple linear regression analysis showed that serum IL-17 was an independent factor affecting the proportion of Th17 cells;the proportion of Th17 cells,FGF23 and Ca were independent influencing factors of IL-17;Cys C was an independent influencing factor of RANKL;Cys C and IL-17 were independent influencing factors of OPG;e GFR,Ca and IL-17 were independent influencing factors of FGF23.Conclusions: 1.The elevated level of peripheral blood Th17 cells and serum IL-17 in patients with CKD-MBD may be related to the occurrence and development of CKDMBD;2.With the decrease of glomerular filtration function in CKD-MBD patients,serum levels of RANKL,OPG and FGF23 showed an increasing trend;Serum RANKL,OPG and FGF23 were positively correlated with blood PTH and P,and negatively correlated with blood Ca.Monitoring the level of these indicators has certain clinical significance for judging the occurrence and progression of CKD-MBD.