α-酮酸配伍低蛋白饮食对腹膜透析患者残余肾功能的保护作用

Effects of α -ketoacid- supplemented low-protein diet therapy on residual renal function in CAPD patients

目的前瞻性观察α-酮酸配伍低蛋白饮食对长期持续性不卧床腹膜透析(CAPD)患者残余肾功能(RRF)的影响。方法随访第二军医大学长海医院肾内科CAPD患者89例(完成随访且资料完整共78例)1年,随机分为α-酮酸配伍低蛋白饮食组(酮酸组,31例)、低蛋白组(26例)、常规蛋白组(21例)。检测治疗前、后胆固醇(TC)、甘油三酯(TG)、血磷(P3+)、全段甲状旁腺激素(iPTH)和体重指数(BMI)等指标,动态观察饮食治疗前、后6个月、12个月的RRF变化;并监测患者平均动脉压、腹膜透析超滤量、残余尿量、水钠潴留情况。结果3组治疗前、后平均动脉压、腹膜透析超滤量及腹膜透析蛋白丢失量差异均无显著性(P>0.05),但酮酸组、低蛋白组腹膜透析蛋白丢失量治疗后有下降趋势;同样,常规蛋白组尿蛋白定量治疗后较酮酸组、低蛋白组升高(均P<0.05),酮酸组治疗后尿蛋白量降低幅度最大(t=9.971,P<0.01);3组治疗12个月后残余尿量均明显减少,常规蛋白组较酮酸组降低更显著(t=8.445,P<0.05);但酮酸组血HCO3-值较常规蛋白组升高(t=6.460,P<0.05)。随观察时间延长,3组RRF均呈下降趋势,12个月时常规蛋白组RRF降低幅度最大,酮酸组最小,2组相比有统计学意义(P<0.05);酮酸组、常规蛋白组PA、RBP、TRF、Scr升高明显(P<0.01),但2组之间差异无显著性(P>0.05);而酮酸组、低蛋白组血P3+、iPTH水平与常规蛋白组相比呈下降趋势,但各组间无显著性意义(P>0.05)。结论α-酮酸配伍低蛋白饮食在保持良好营养状况的基础上,可有效保护CAPD患者的RRF,延缓肾脏病的进展。

Objective To investigate the effect of α -ketoacid supplemented low protein diet therapy on protecting residual renal function（RRF） of patients with continuous ambulatory peritoneal dialysis（CAPD） prospectively. Methods Seventy eight CAPD patients who were randomly assigned to a low-protein diet supplemented with α-ketoacid group（ketoacid group, 31 patients）, low-protein diet group（LPD groupe, 26 patients） and routine protein diet group （RPD group, 21 patients） were investigated and followed-up for one year. The serum levels of albumin（Alb）, prealbumin（PA）, transferrin （TF）, retinal-binding-protein,（RBP）,total cholesterol （TC）, triglyceride （TG）,phosphorus （P＋＋＋）,intaet parathyroid hormone （iPTH） were measured. Examinations of RRF, mean arterial pressure（MAP）, peritoneal ultrafiltration（UF）,residual urine volume（RUV） and the status of water-sodium retention were performed at baseline, median and at the end of the follow-up. Results There were no significiant differences in MAP, UF and peritoneal dialysate albumin loss between these groups. However, the trend of peritoneal dialysate albumin loss in ketoacid group and LPD group was descendent. Proteinuria decreased most significantly in ketoacid group（P〈0. 01）.Compared to low-protein diet group, serum levels of PA, RBP, TRF had a significant increment both in ketoacid group and routine protein diet group（P〈0. 01）, but there was no significance between these two groups（P〉0. 05）. There was an incremental tendency in Alb, TC, TG, but no significance（P 〉0.05）. Compared to RPD group, levels of RRF, RUV were significantly higher both in ketoacid group and LPD group（P〈 0. 01） There was an decrease tendency in P and iPTH, but no significance among three groups（P 〉0.05）. Conclusion α -ketoacid supplemented low protein diet therapy have a tendency of protecting RRF in CAPD patients while maintaining patients in good nutritional state.