Zhang Mi-mi, Zhao Yan, Zhu Ying-li
1. Department of Nutrition and Food Hygiene,Public Health College of Harbin Medical University,Harbin 150081,China2 Department of Clinical Nutrition,Hegang People's Hospital,Hegang,Heilongjiang 154101,China;
Department of Nutrition and Food Hygiene,Public Health College of Harbin Medical University,Harbin 150081,China2 Department of Clinical Nutrition,Hegang People's Hospital,Hegang,Heilongjiang 154101,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2015 Aug;37(4):384-91. doi: 10.3881/j.issn.1000-503X.2015.04.003.
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.
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.
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 ± 8.48)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).
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.
探讨慢性肾脏病(CKD)患者个体化低蛋白饮食干预是否能改善一般状况、延缓肾功能恶化及推迟进入透析时间。
2011年7月至2012年7月收治的40例CKD住院患者,签署知情同意书后,根据随机数字表法随机分为正常蛋白饮食组和个体化低蛋白饮食组,每组各20例,干预6个月。分别于干预前及干预6个月结束时检测尿蛋白水平及肾功能生化指标。
两组患者干预前尿蛋白水平、肾功能及生化指标比较,差异无统计学意义。干预6个月后,两组患者舒张压、蛋白质摄入量、血尿素氮、尿酸、钾、磷、C反应蛋白、24小时尿素氮及尿蛋白均较干预前显著降低,即(101.70±15.78)mmHg比(91.75±15.52)mmHg,(63.87±24.70)g/d比(50.02±14.07)g/d,(20.01±7.69)mmol/L比(15.11±4.90)mmol/L,(362.75±84.56)μmol/L比(302.20±8.48)μmol/L,(5.22±0.75)mmol/L比(4.79±0.36)mmol/L,(2.07±0.68)mmol/L比(1.57±0.41)mmol/L,1.19[0.65,4.17]mg/L比0.74[0.38,1.33]mg/L,70.6[8.70,101.18]mmol/L比16.93[3.23,72.27]mmol/L,1.00[0.30,1.00]g/d比0.15[0,0.83]g/d(均P<0.05),其中个体化低蛋白饮食组白蛋白及血红蛋白水平较正常蛋白饮食组显著升高,分别为(0.34±0.07)g/L比(0.37±0.05)g/L,(99.38±21.89)g/L比(126.35±14.11)g/L,差异有统计学意义(P<0.0�)。与尿蛋白产生最相关的是前白蛋白(r=0.924,P<0.05)。个体化低蛋白饮食组干预6个月后血尿素氮、钾、钠、钙、磷、24小时尿素氮、尿比重、尿蛋白及血红蛋白改善情况均显著优于正常蛋白饮食组(P<0.05)。
个体化低蛋白饮食干预对CKD患者有确切疗效,能明显改善患者状况,延缓肾功能恶化,提高血清前白蛋白水平,减少尿蛋白产生,值得临床推广应用。