饮食磷摄入量与慢性肾脏病患者营养状况和钙磷代谢的相关性

Relationship between dietary phosphorus intake and nutritional status and calcium and phosphorus metabolism in patients with chronic kidney disease

目的 评估3~5期慢性肾脏病(CKD)非透析患者饮食磷摄入情况,探讨饮食磷摄入量与营养状况、钙磷代谢的相关性.方法 本研究为横断面研究,选取复旦大学附属华山医院慢性肾脏病门诊3~5期CKD非透析患者为研究对象,采集患者3 d饮食日记、人体测量学指标、全面主观评定(SGA)量表评分、血生化指标和24 h尿液生化指标.按照饮食磷摄入量中位数(873 mg/d)将患者分为高磷摄入组(≥873 mg/d)和低磷摄入组(<873 mg/d).比较两组患者一般资料、人体测量学指标、SGA量表评分和血尿生化指标的差异.多因素线性回归法分析患者饮食磷摄入量与不同种类食物摄入量的相关性.结果 共纳入118例患者为研究对象,每日能量摄入为(25.48±4.45)kcal/kg,蛋白质摄入量为(0.88±0.22)g/kg,饮食磷摄入量为(862.85±233.02)mg/d.高磷摄入组与低磷摄入组患者在体重指数和SGA评分项目上的差异无统计学意义.男性高磷摄入组患者的腰围、臀围、腰臀比和小腿围明显高于低磷摄入组(均P<0.05);女性患者两组在人体测量学指标上的差异均无统计学意义.高磷摄入组的血全段甲状旁腺素(iPTH)、血钠、血三酰甘油、血RBC计数、血丙氨酸转氨酶、24 h尿尿素氮、24 h尿肌酐、24 h尿磷水平均高于低磷摄入组(均P<0.05).多因素线性回归分析结果显示,禽畜类对饮食磷摄入量的贡献最大,其次为水产类和奶类.结论 3~5期CKD非透析患者每日磷摄入量稍高于推荐摄入量,饮食磷摄入量的增多可能会导致血iPTH和血钠水平的增高,适量控制饮食磷摄入量并不会损害CKD患者的营养状况.

Objective To evaluate the dietary phosphorus intake of non-dialysis patients with chronic kidney disease(CKD)3-5 stage,and to explore the relationship between dietary phosphorus intake,nutritional status,and calcium and phosphorus metabolism.Methods A cross-sectional study was conducted.Non-dialysis patients of CKD 3-5 stage in Huashan Hospital outpatient clinic were selected.Three-day dietary diaries,anthropometric indicators,subjective global assessment(SGA)scores,blood and 24-hour urine biochemical indicators were collected.According to the median dietary phosphorus intake(873 mg/d),the patients were divided into high phosphorus intake group(≥873 mg/d)and low phosphorus intake group(<873 mg/d).The differences of characteristics,anthropometricindicators,SGA scores,blood and urine biochemical indicators between the two groups were compared.Multivariate linear regression analysis was used to analyze the correlation between dietary phosphorus intake and different kinds of food intake.Results A total of 118 patients were enrolled.The daily energy intake was(25.48±4.45)kcal/kg,protein intake was(0.88±0.22)g/kg and phosphorus intake was(862.85±233.02)mg/d.There were no significant differences in body mass index and SGA scores between high phosphorus intake group and low phosphorus intake group.The waist circumference,hip circumference,waist-hip ratio and leg circumference of male patients in high phosphorus intake group were higher than those in low phosphorus intake group(all P<0.05).There were no significant differences in anthropometric indicators between the two groups of female patients.The serum levels of intact parathyroid hormone(iPTH),sodium,triglyceride,blood RBC count,alanine aminotransferase,24-hour urine urea nitrogen,24-hour urine creatinine and 24-hour urine phosphate in the high phosphorus intake group were higher than those in the low phosphorus intake group(all P<0.05).Multivariate regression analysis showed that pork and chicken contributed the most to dietary phosphorus intake,followed by fish and dairy.Conclusions The daily dietary phosphorus intake of non-dialysis of CKD 3-5 stage patients is slightly higher than the recommended intake.The increase of dietary phosphorus intake may lead to the increase of serum iPTH and sodium levels.Proper control of dietary phosphorus intake will not impair the nutritional status of CKD patients.