Bianchi G P, Marchesini G, Fabbri A, Rondelli A, Bugianesi E, Zoli M, Pisi E
Institute of General Clinical Medicine, University of Bologna, Italy.
J Intern Med. 1993 May;233(5):385-92. doi: 10.1111/j.1365-2796.1993.tb00689.x.
In a randomized cross-over comparison, the effects of a mainly vegetable protein diet were compared with an animal protein diet in eight patients with cirrhosis and chronic permanent encephalopathy, under optimum lactulose therapy. After a run-in period, patients were fed two equi-caloric, equi-nitrogenous diets for 7 days (71 g total proteins), containing either 50 g protein of animal origin or 50 g vegetable proteins. In the last 3 days of each period, nitrogen balance was significantly better during the vegetable protein diet (+0.2 (SD 1.4) g vs. -1.7 (2.4); P < 0.01), the difference being entirely due to a reduced urinary nitrogen excretion. Average daytime integrated blood glucose was slightly higher during vegetable proteins, whereas insulin, plasma amino acids and ammonia were lower. The clinical grading of encephalopathy improved slightly on vegetable proteins, and psychometric tests improved significantly, but remained grossly abnormal. Compliance to dietary manipulation was good. The data prove that a mainly vegetable protein diet is worthwhile in cirrhotic patients with chronic encephalopathy under optimum lactulose therapy. Improved nitrogen balance may be related to more effective nitrogen use for protein synthesis, probably due to blunted hormonal response, and largely outweighs the effects on encephalopathy.
在一项随机交叉对照研究中，对8例肝硬化合并慢性永久性脑病患者在最佳乳果糖治疗下，比较了主要含植物蛋白饮食与动物蛋白饮食的效果。经过导入期后，患者接受两种等热量、等氮量的饮食，为期7天（总蛋白71克），一种饮食含50克动物源性蛋白，另一种含50克植物蛋白。在每个阶段的最后3天，植物蛋白饮食期间的氮平衡明显更好（+0.2（标准差1.4）克对-1.7（2.4）克；P<0.01），差异完全归因于尿氮排泄减少。植物蛋白饮食期间白天平均综合血糖略高，而胰岛素、血浆氨基酸和氨水平较低。植物蛋白饮食时脑病的临床分级略有改善，心理测试显著改善，但仍严重异常。患者对饮食调整的依从性良好。数据证明，在最佳乳果糖治疗下，主要含植物蛋白的饮食对肝硬化合并慢性脑病患者是值得的。氮平衡改善可能与蛋白质合成中氮的更有效利用有关，可能是由于激素反应减弱，且在很大程度上超过了对脑病的影响。
