Rigalleau V, Combe C, Blanchetier V, Aubertin J, Aparicio M, Gin H
Clinique Médicale and Service de Néphrologie, Hôpital Pellegrin-Tripode, Bordeaux, France.
Kidney Int. 1997 Apr;51(4):1222-7. doi: 10.1038/ki.1997.167.
Low-protein diets (LPD) increase insulin-mediated glucose disposal in chronic renal failure (CRF), but the fate of the better utilized glucose and the effect on energy production rate are unknown. Using a two-step (1 and 5 mU x kg(-1) x min(-1)) euglycemic hyperinsulinemic clamp combined with indirect calorimetry, we studied the effects of a LPD (0.3 g x kg(-1) x day(-1), supplemented with essential amino acids and ketoanalogs) in six patients suffering from chronic renal failure. After three months of diet, no significant change was observed concerning glomerular filtration rate, body wt, or arterial pH. In the postabsorptive state, plasma glucose and insulin levels were significantly lower, and energy production rose from 15.72 +/- 0.48 to 17.16 +/- 0.67 Cal x kg(-1) x min(-1) (P < 0.05). Insulin-stimulated glucose oxidation (2.36 +/- 0.29 vs. 3.37 +/- 0.35 mg x kg(-1) x min(-1); P < 0.05 at first clamp step) and nonoxidative disposal (P < 0.05 at both clamp steps) increased after LPD. This confirms that LPD ameliorates insulin sensitivity in CRF, even for low plasma insulin concentrations. Since energy production rate is increased by LPD, the caloric intake should be increased when protein intake is restricted.
低蛋白饮食（LPD）可增加慢性肾衰竭（CRF）患者胰岛素介导的葡萄糖处置，但更好利用的葡萄糖的去向以及对能量产生率的影响尚不清楚。我们采用两步法（1和5 mU·kg⁻¹·min⁻¹）正常血糖高胰岛素钳夹技术结合间接测热法，研究了低蛋白饮食（0.3 g·kg⁻¹·d⁻¹，补充必需氨基酸和酮类似物）对6例慢性肾衰竭患者的影响。饮食三个月后，肾小球滤过率、体重或动脉pH值均未观察到显著变化。在空腹状态下，血浆葡萄糖和胰岛素水平显著降低，能量产生从15.72±0.48 Cal·kg⁻¹·min⁻¹升至17.16±0.67 Cal·kg⁻¹·min⁻¹（P<0.05）。低蛋白饮食后，胰岛素刺激的葡萄糖氧化（2.36±0.29对3.37±0.35 mg·kg⁻¹·min⁻¹；在第一个钳夹步骤时P<0.05）和非氧化处置（在两个钳夹步骤时P<0.05）均增加。这证实低蛋白饮食可改善慢性肾衰竭患者的胰岛素敏感性，即使血浆胰岛素浓度较低时也是如此。由于低蛋白饮食可提高能量产生率，因此在限制蛋白质摄入时应增加热量摄入。
