中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2015, Vol. 37 ›› Issue (4): 384-391.doi: 10.3881/j.issn.1000-503X.2015.04.003

• 论著 • 上一篇    下一篇

个体化低蛋白饮食干预对慢性肾脏病患者肾功能的影响

张蜜蜜1,2, 赵艳1(), 朱英莉2   

  1. 1哈尔滨医科大学 公共卫生学院营养与食品卫生学教研室,哈尔滨 150081

    2鹤岗市人民医院营养科,黑龙江鹤岗 154101
  • 收稿日期:2014-06-27 出版日期:2015-05-25 发布日期:2015-08-31
  • 作者简介:

    通信作者:赵 艳 电话:0451-87502837,电子邮件:amyzhaoyan@sina.com

Effect of Individualized Low-protein Diet Intervention on Renal Function of Patients with Chronic Kidney Disease

Mi-mi ZHANG1,2, Yan ZHAO1(), Ying-li ZHU2   

  1. 1 Department of Nutrition and Food Hygiene,Public Health College of Harbin Medical University,Harbin 150081,China

    2 Department of Clinical Nutrition,Hegang People’s Hospital,Hegang,Heilongjiang 154101,China
  • Received:2014-06-27 Online:2015-05-25 Published:2015-08-31

摘要: 目的

探讨个体化低蛋白饮食干预对慢性肾脏病患者是否能改善患者全身状态、减慢肾功能恶化速度、推迟进入透析的时间。

方法

选取2011年7月至2012年7月因慢性肾脏病住院患者40例,签署知情同意书后随机数字表法分为普通低蛋白饮食组和个体化低蛋白饮食组,入选患者分别于入组时及干预6个月后检测尿蛋白及生化、肾功能等指标。

结果

两组患者在入组时尿蛋白、肾功能及生化指标等差异无统计学意义;个体化低蛋白饮食组患者干预前与干预6个月后舒张压、摄入蛋白质、尿素氮、尿酸、钾、磷、C反应蛋白、24 h尿素氮、尿蛋白分别为(101.70±15.78)mmHg 和(91.75±15.52)mmHg(1 mmHg=0.133 kPa)、(63.87±24.70)g/d和(50.02±14.07)g/d、(20.01±7.69)mmol/L和(15.11±4.90)mmol/L、(362.75±84.56)μmol/L和(302.20±88.48)μmol/L、(5.22±0.75)mmol/L和(4.79±0.36)mmol/L、(2.07±0.68)mmol/L和(1.57±0.41)mmol/L、1.19[0.65,4.17] mg/L和0.74[0.38,1.33] mg/L、70.6 [8.70,101.18] mmol/L和16.93[3.23,72.27] mmol/L、1.00[0.30,1.00] g/d和0.15 [0,0.83] g/d,干预后各指标显著低于入组前(P均<0.05);前白蛋白、血红蛋白分别为(0.34±0.07)g/L和(0.37±0.05)g/L、(99.38±21.89)g/L和(126.35±14.11)g/L,干预后较入组前显著增加,差异具有统计学意义(P<0.05)。而与尿蛋白产生最为相关的因素为前白蛋白(r=0.924,P<0.05)。两组患者干预前后各项指标的差值在尿素氮、钾、钠、钙、磷、24 h尿素氮、尿比重、尿蛋白、血红蛋白等方面个体化低蛋白饮食组效果更好,差异具有统计学意义(P<0.05)。

结论

个体化低蛋白饮食干预对慢性肾脏病患者疗效确切,能显著改善患者病情、延缓肾功能的恶化,而增加血清前白蛋白含量可能会降低尿蛋白的生成,值得临床推广。

关键词: 个体化低蛋白饮食, 慢性肾脏病, 尿蛋白, 肾功能

Abstract: Objective

To investigate whether individualized low-protein diet intervention for patients with chronic kidney disease(CKD)could improve the general condition,slow the deterioration of renal function,and delay the time of entering dialysis.

Methods

Forty CKD inpatients between July 2011 and July 2012 were randomly given with normal or individualized low-protein diet for six months according to random number table after signing informed consent. The levels of urine protein and biochemical indexes of renal function were measured at baseline and at the end of dietary intervention for six months,respectively.

Results

The baseline urine protein level,renal function,and biochemical indexes were not significantly different between these two groups. The diastolic blood pressure,protein intake,blood urea nitrogen,uric acid,potassium,phosphorus,C-reaction protein,24-hour urea nitrogen,and urine protein after six months were significantly lower than those at baseline,that is,(101.70±15.78)mmHg vs.(91.75±15.52)mmHg,(63.87±24.70)g/d vs.(50.02±14.07)g/d,(20.01±7.69)mmol/L vs.(15.11±4.90)mmol/L,(362.75±84.56)μmol/L vs.(302.20±88.48)μmol/L,(5.22±0.75)mmol/L vs.(4.79±0.36)mmol/L,(2.07±0.68)mmol/L vs.(1.57±0.41)mmol/L,1.19 [0.65,4.17] mg/L vs. 0.74 [0.38,1.33] mg/L,70.6 [8.70,101.18] mmol/L vs. 16.93 [3.23,72.27] mmol/L,1.00 [0.30,1.00] g/d vs. 0.15 [0,0.83] g/d(all P<0.05),among which albumin and hemoglobin were significantly higher [(0.34±0.07)g/L vs.(0.37±0.05)g/L,(99.38±21.89)g/L vs.(126.35±14.11)g/L,respectively] in the individualized low-protein diet group. The difference was statistically significant(P<0.05). The most relevant for urine protein producing was prealbumin (r=0.924,P<0.05). The differences of blood urea nitrogen,potassium,sodium,calcium,phosphorus,24-hour urea nitrogen,urine specific gravity,urine protein,and hemoglobin in six months in the individualized low-protein diet group were significantly better than those in the normal low protein-diet group(P<0.05).

Conclusions

Individualized low-protein diet intervention may have definite curative effectiveness in CKD patients. It can markedly improve the patients’ condition,slow down the deterio-ration of renal function,and increase serum prealbumin levels that may reduce the generation of urine protein. It is worthy of wider clinical application.

Key words: individualized low-protein diet, chronic kidney disease, urine protein, renal function

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