中国血液净化

中国血液净化 ›› 2014, Vol. 13 ›› Issue (12): 805-809.doi: 10.3969/j.issn.1671-4091.2014.12.001

• 临床研究 •    下一篇

α-酮酸联合低蛋白饮食对2型糖尿病肾病患者营养状态及尿蛋白量的影响

谷立杰1, 董婷1, 王嘉琳1, 吴晶1 ,黄艳茹1 ,袁伟杰1 ,陈靖2 ,倪丽2 ,严海东3,张瑞青3 ,汪年松4 ,简桂花4 ,谭亚琼4   

  1. 200080 上海，1上海交通大学附属第一人民医院肾内科
    200040 上海，2复旦大学附属华山医院肾内科
    200120 上海，3同济大学附属东方医院
    200233 上海，4上海交通大学附属第六人民医院肾内科
  • 收稿日期:2014-07-28 修回日期:2014-08-12 出版日期:2014-12-12 发布日期:2014-12-12
  • 通讯作者: 袁伟杰: ywj4169@163.com E-mail:ywj4169@163.com
  • 基金资助:

    国家卫生行业科研专项项目(201002010)；国家自然基金(81300611)

Effects of low protein diet supplemented with α-ketoacids on nutritional status and urinary protein excretion in patients with diabetic nephropathy

  • Received:2014-07-28 Revised:2014-08-12 Online:2014-12-12 Published:2014-12-12

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摘要： 目的  观察α-酮酸(KA)联合低蛋白饮食对2 型糖尿病肾病(DN)患者营养状态及尿蛋白的影响。方法上海4 家医院共68 例确诊为2 型DN 患者随机入选，最终完成疗程且资料完整的DN 患者61 例，均属慢性肾脏病3～4 期。分低蛋白饮食组(LPD，n=31)和α-酮酸联合低蛋白饮食组(LPD+KA，n=30)，共随访12 个月。依据各组患者每3 个月临床及生化等指标评价LPD+KA 对DN 患者肾功能、蛋白尿、营养状态等疗效。结果随访12 个月后，2 组通过24h 尿素氮计算得到每日蛋白摄入量差别只有0.015 g/(kg·day)，无统计学意义(P＞0.05)。随访期间，LPD 组GFR 平均下降-2.41±2.53ml/(min·1.73 m2)，LPD+KA组为-2.26±2.03ml/(min·1.73 m2)，2 组间无显著性差异(P＞0.05)；与LPD 组尿蛋白量下降0.15±0.36 g/24h 相比，LPD+KA 组下降(0.43±0.35 g/24h)更明显，差异有统计学意义(P＜0.01)。2 组患在
随访期间营养状况均良好，与单纯低蛋白饮食相比，加用α-酮酸可增加患者血清白蛋白和前白蛋白浓度(P＜0.05)。结论α-酮酸联合低蛋白饮食较单纯低蛋白饮食在维持较好的营养状态下可更好地降低DN 患者蛋白尿，但无显著改善肾功能的作用。

关键词: 糖尿病肾病, α-酮酸, 低蛋白饮食, 营养状态, 蛋白尿

Abstract: Objective To explore the effects of low-protein diet supplemented with α-ketoacids (KA) on nutritional status and urinary protein excretion in patients with diabetic nephropathy (DN). Methods A total of 61 patients with DN of type II diabetes at chronic kidney disease stages 3～4 were included in this study. They were randomly divided into two groups, low protein diet group [LPD group, 0.6 g protein/kg/day and 30 kcal/(kg·day)] and LPD+KA group [0.6 g protein/kg/day, 30 kcal/kg/day, and 100mg KA/(kg·day)]. Blood and 24h urine samples were collected at baseline and every 3 months for routine examinations to evaluate
the efficacy of LPD+KA diet. Results After 12 months of the treatment, there was no statistical difference in daily protein intake estimated by 24h urinary urea nitrogen between LPD group and LPD+KA group (P＞0.05). There was also no statistical difference in the decline of GFR [-2.41±2.53 ml/min/1.73m2 vs. -2.26±
2.03 ml/(min·1.73m2), P＞0.05] between LPD group and LPD+KA group. Proteinuria decreased more in LPD+KA group (0.43±0.35 g/24h) than in LPD group (0.15±0.36 g/24h; P＜0.01). Patients in both groups were in a good nutritional condition. However, serum albumin and prealbumin increased only in LPD+KA
group (P＜0.05). Conclusion Low protein diet supplemented with KA is associated with a greater decrease of proteinuria under a good nutrition status, as compared with low protein diet alone.

Key words: diabetic nephropathy,  α-ketoacids, low protein diet, nutritional status, proteinuria