非限制饮食的透析前慢性肾衰竭患者的蛋白质摄入量与营养状况

Protein intake and the nutritional status in patients with pre-dialysis chronic renal failure on unrestricted diet.

作者信息

Park J S, Jung H H, Yang W S, Kim H H, Kim S B, Park S K, Hong C D

机构信息

Department of Internal Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

出版信息

Korean J Intern Med. 1997 Jun;12(2):115-21. doi: 10.3904/kjim.1997.12.2.115.

DOI:10.3904/kjim.1997.12.2.115

PMID:9439145

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4531978/

Abstract

OBJECTIVES

Malnutrition is known to be highly associated with morbidity and mortality in dialysis patients. Malnutrition may begin to develop in patients with chronic renal failure(CRF) before they need dialysis. In this study, the nutritional status of patients with moderate to severe CRF on unrestricted diet was evaluated.

METHODS

We measured dietary protein intake (DPI, g/kg/day) in 64 patients with CRF and 42 normal controls(N). Nutritional indices such as serum albumin(SA, g/dl), transferrin(TF, mg/dl), prealbumin(PA, mg/dl) and insulin-like growth factor-1(IGF-1, ng/ml) were measured to evaluate the visceral proteins, and creatinine-height index(C-H, g/d/m) to evaluate the somatic proteins.

RESULTS

Mean DPI was 0.80 +/- 0.27(S.D) in CRF and 1.07 +/- 0.30 in N(p < 0.0001). DPI was lower than 0.6 in 15 CRF patients(23%). Serum albumin, transferrin and C-H were significantly lower in CRF patients than in N(p < 0.01). In patients with CRF, nutritional indices were significantly worse with lower DPI(< 0.6 g/kg/d, n = 15) than higher DPI(> 0.6 g/kg/d, n = 49)(SA 2.9 +/- 0.7 vs. 3.6 +/- 0.8, p < 0.005; TF 147 (134-179) vs. 220(182-264), p < 0.0005; PA 24 +/- 8 vs. 32 +/- 9, p < 0.001; IGF-1 123 (66-261) vs. 226(140-344), p < 0.05; C-H 0.52 +/- 0.15 vs. 0.87 +/- 0.23, p < 0.0001). CRF patients with nephrotic range proteinuria (> 3.5 g/d, n = 19) had lower SA (2.8 +/- 0.6 vs. 3.8 +/- 0.8, p < 0.0001) and PA(27 +/- 9 vs. 32 +/- 9, p < 0.05). CRF patients with diabetes mellitus (n = 20) showed worse nutrition than non-diabetic patients(SA 2.8 +/- 0.6 g/dl vs. 3.8 +/- 0.8 g/dl, p < 0.0001; TF 176 mg/dl(148-214) vs. 220 mg/dl(175-266), p < 0.05; PA 24 +/- 10 mg/dl vs. 33 +/- 8 mg/dl, p < 0.0005; IGF-1 138 ng/ml(69-269) vs 231 ng/ml(140-364), p < 0.05; C-H 0.66 +/- 0.23 vs. 0.85 +/- 0.5, p < 0.005).

CONCLUSION

A significant protein malnutrition prevails in patients with pre-dialysis CRF on unrestricted diet, especially with low protein intake. The effort to detect and correct malnutrition should be made in patients with CRF even before initiation of maintenance dialysis.

摘要

目的

已知营养不良与透析患者的发病率和死亡率高度相关。慢性肾衰竭（CRF）患者在需要透析之前可能就已开始出现营养不良。本研究评估了饮食不受限制的中重度CRF患者的营养状况。

方法

我们测量了64例CRF患者和42例正常对照（N）的膳食蛋白质摄入量（DPI，克/千克/天）。测量了血清白蛋白（SA，克/分升）、转铁蛋白（TF，毫克/分升）、前白蛋白（PA，毫克/分升）和胰岛素样生长因子-1（IGF-1，纳克/毫升）等营养指标以评估内脏蛋白，并测量了肌酐身高指数（C-H，克/日/米）以评估体蛋白。

结果

CRF患者的平均DPI为0.80±0.27（标准差），正常对照为1.07±0.30（p<0.0001）。15例CRF患者（23%）的DPI低于0.6。CRF患者的血清白蛋白、转铁蛋白和C-H显著低于正常对照（p<0.01）。在CRF患者中，DPI较低（<0.6克/千克/天，n=15）的患者营养指标显著差于DPI较高（>0.6克/千克/天，n=49）的患者（SA 2.9±0.7对3.6±0.8，p<0.005；TF 147（134-179）对220（182-264），p<0.0005；PA 24±8对32±9，p<0.001；IGF-1 123（66-261）对226（140-344），p<0.05；C-H 0.52±0.15对0.87±0.23，p<0.0001）。肾病范围蛋白尿（>3.5克/天，n=19）的CRF患者的SA（2.8±0.6对3.8±0.8，p<0.0001）和PA（27±9对32±9，p<0.05）较低。患有糖尿病的CRF患者（n=20）的营养状况比非糖尿病患者差（SA 2.8±0.6克/分升对3.8±0.8克/分升，p<0.0001；TF 176毫克/分升（148-214）对220毫克/分升（175-266），p<0.05；PA 24±10毫克/分升对33±8毫克/分升，p<0.0005；IGF-1 138纳克/毫升（69-269）对231纳克/毫升（140-364），p<0.05；C-H 0.66±0.23对0.85±0.5，p<0.005）。