中国血液净化

›› 2006, Vol. 5 ›› Issue (10): 724-727.

• 论著 • 上一篇    下一篇

α-酮酸配伍低蛋白饮食对长期腹膜透析患者营养状况影响的临床研究

郭志勇 袁伟杰 李保春 孙莉静 郭云珊 于 蕾   

  1. 200433 上海，第二军医大学附属长海医院肾内科
  • 收稿日期:1900-01-01 修回日期:1900-01-01 出版日期:2006-10-12 发布日期:2006-10-12

  • Received:1900-01-01 Revised:1900-01-01 Online:2006-10-12 Published:2006-10-12

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摘要： 目的 前瞻性观察α-酮酸配伍低蛋白饮食对长期持续性不卧床腹膜透析(CAPD)患者营养状况的影响。方法 随访第二军医大学附属长海医院肾内科CAPD患者78例共1年，随机分为低蛋白饮食加α-酮酸组(酮酸组，31例)、低蛋白组(26例)、常规蛋白组(21例?)。检测营养指标包括：血清白蛋白(Alb)、前白蛋白(PA)、转铁蛋白(TRF)、视黄醇结合蛋白(RBP)、胆固醇(TC)、甘油三酯(TG)、血浆瘦素(Leptin)、肱三头肌处皮褶厚度(TSF)，上臂肌围(MAMC)和体重指数(BMI)等，计算残余肾功能(RRF)、Kt/V、肌酐清除率(Ccr),并监测血清氨基酸谱变化。结果 与低蛋白组相比，酮酸组、常规蛋白组的营养指标升高，尤以PA、RBP、TRF、Scr升高明显(P＜0.01)；而酮酸组与常规蛋白组相比，BMI、TSF、MAMC、Alb、TC及TG有升高趋势，但无显著性意义(P＞0.05)；酮酸组缬氨酸(Val)、亮氨酸(Leu)、异亮氨酸(Ile)水平均高于低蛋白组及常规蛋白组(P＜0.01及＜0.05)；与常规蛋白组相比，酮酸组与低蛋白组Kt/V、Ccr、尿量均升高(P＜0.05)，而酮酸组与常规蛋白组的水钠潴留发生率无显著性差异(P＞0.05)。结论 低蛋白饮食加α-酮酸有缓解尿毒症CAPD患者营养不良的作用，并能显著提高血浆支链氨基酸(BCAA)水平。

关键词: 低蛋白饮食, 营养不良, 残余肾功能, α-酮酸, 腹膜透析

Abstract:

Objective To observe the role of low-protein diet and combination withα-ketoacid therapy in improving nutritional status of patients with continuous ambulatory peritoneal dialysis(CAPD) prospectively. Methods Seventy-eight CAPD patients were investigated and followed-up for one year. They were randomly assigned to a low-protein diet supplemented with α-ketoacid group(ketoacid group), low-protein diet group and routine protein diet group. The serum levels of albumin(Alb), prealbumin(PA), transferring(TF), retinal-binding-protein(RBP)，total cholesteral(TC)， griglyceride (TG)，Leptin were measured. Triceps skinfoles (TSF),midarm riuscle circumference(MAMC), body mass index(BMI), residual renal function(RRF), Kt/V, clearance of creatinine(Ccr) and levels of serum amino acids were performed. Results Compared to low-protein diet group, serum levels of PA, RBP, TRF had a significant increment both in ketoacid group and routine protein diet group (P ＜0.01), but there was no significance between these two groups(P＞0.05). There was an incremental tendency in Alb, TC, TG, but no significance(P ＞0.05). The serum concentrations of Valine(Val), Leucine(Leu), Isoleucine(Ile) were significantly increased in ketoacid group (P ＜0.01), compared to the other groups. Levels of KT/V, Ccr, residual urine volume were significantly higher both in ketoacid group and routine protein diet group(P ＜0.01). Conclusions Low-protein diet and combination withα-ketoacid therapy have a tendency of relieving malnutritional status and improving the levels of BCAA.

Key words: Malnutrition, Residual renal function, α-ketoacid, Peritoneal dialysis

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