正常血压、无蛋白尿的I型糖尿病患者对不同来源蛋白质的肾脏、代谢及激素反应

Renal, metabolic, and hormonal responses to proteins of different origin in normotensive, nonproteinuric type I diabetic patients.

作者信息

Kontessis P A, Bossinakou I, Sarika L, Iliopoulou E, Papantoniou A, Trevisan R, Roussi D, Stipsanelli K, Grigorakis S, Souvatzoglou A

机构信息

Renal Unit, Alexandra General Hospital, Athens, Greece.

出版信息

Diabetes Care. 1995 Sep;18(9):1233. doi: 10.2337/diacare.18.9.1233.

DOI:10.2337/diacare.18.9.1233

PMID:8612436

Abstract

OBJECTIVE

Whether the differences in renal function found in vegetarian compared with omnivorous subjects are related to quantity or quality of the protein is unknown. We have studied the renal function of nine normotensive, nonproteinuric type I diabetic patients who were fed in random order for 4 weeks either an animal protein diet (APD) (protein intake 1.1 g . kg-1 . day-1) or a vegetable protein diet VPD (protein intake 0.95 g . kg-1 . day-1). The two diets were isocaloric.

RESEARCH DESIGN AND METHODS

In a crossover study, we measured glomerular filtration rate (GFR) (inulin clearance), renal plasma flow (RPF) (p-aminohippurate clearance), plasma amino acids, growth hormone, glucagon, insulin-like growth factor I-(IGF-I), and microalbuminuria.

RESULTS

GFR and RPF were lower with the VPD than with the APD (89.9 +/- 4.1 vs. 105.6 +/- 5.1 ml . min-1 . 1.73 m-2, P < 0.05, and 425.7 +/- 22.2 vs. 477.8 +/- 32.2 ml . min-1 1.73m-2, P < 0.05, respectively). Renal vascular resistance (RVR) was higher with the VPD than with the APD (101 +/- 25 vs. 91 +/- 10 mmHg . min-1 . ml-1, P < 0.05). Filtration fraction (FF) remained unchanged after either diet. Fractional clearance of albumin fell with the VPD to 2.0 +/- 0.65 from 3.4 +/- 1.15 x 10-6 (P < 0.05). At the end of the APD and VPD, the plasma levels of growth hormone and glucagon did not differ significantly. Plasma levels of IGF-I were higher with the APD than with the VPD (1.1 +/- 0.6 vs. 0.9 +/- 0.13 U/ml, P < 0.05). Plasma concentrations of valine and lysine were significantly higher with the APD than with the VPD (234.6 +/- 30.3 vs. 164.5 +/- 25.4 mm1/1, P < 0.05, and 565 +/- 45.1 vs. 430 +/- 56.1 mmol/l, P < 0.05, respectively), whereas plasma valine was strongly correlated to the GFR (r = 0.832, P < 0.01). No differences were found in other amino acids.

CONCLUSIONS

A VPD has significantly different renal effects from an APD equal in protein intake in normotensive type I diabetic patients. This could be explained partly by differences in plasma concentrations of amino acids and IGF-I.

摘要

目的

素食者与杂食者相比，肾功能差异是与蛋白质的量还是质有关尚不清楚。我们研究了9例血压正常、无蛋白尿的I型糖尿病患者的肾功能，这些患者随机接受4周的动物蛋白饮食（APD）（蛋白质摄入量1.1 g·kg⁻¹·d⁻¹）或植物蛋白饮食（VPD）（蛋白质摄入量0.95 g·kg⁻¹·d⁻¹）。两种饮食热量相等。

研究设计与方法

在一项交叉研究中，我们测量了肾小球滤过率（GFR）（菊粉清除率）、肾血浆流量（RPF）（对氨基马尿酸清除率）、血浆氨基酸、生长激素、胰高血糖素、胰岛素样生长因子I（IGF-I）以及微量白蛋白尿。

结果

VPD组的GFR和RPF低于APD组（分别为89.9±4.1对105.6±5.1 ml·min⁻¹·1.73 m⁻²，P<0.05；425.7±22.2对477.8±32.2 ml·min⁻¹·1.73m⁻²，P<0.05）。VPD组的肾血管阻力（RVR）高于APD组（101±25对91±10 mmHg·min⁻¹·ml⁻¹，P<0.05）。两种饮食后滤过分数（FF）均保持不变。VPD组白蛋白分数清除率从3.4±1.15×10⁻⁶降至2.0±0.65（P<0.05）。在APD和VPD结束时，生长激素和胰高血糖素的血浆水平无显著差异。APD组的IGF-I血浆水平高于VPD组（1.1±0.6对0.9±0.13 U/ml，P<0.05）。APD组的缬氨酸和赖氨酸血浆浓度显著高于VPD组（分别为234.6±30.3对164.5±25.4 mmol/l，P<0.05；565±45.1对430±56.1 mmol/l，P<0.05），而血浆缬氨酸与GFR密切相关（r = 0.832，P<0.01）。其他氨基酸未发现差异。