低磷全乳清蛋白粉对维持性血透患者营养治疗的临床意义

Lowphosphoproteinpowder Louis X diet improved nutrition status in maintenance hemodialysis patients

目的 观察证实低磷全乳清蛋白粉口服对维持性血透患者营养治疗的临床意义。方法 60例维持性血透治疗的慢性肾功能衰竭患者，平均年龄（56.8±15.4）岁；随机分为试验组、阴性对照组和治疗组，每组20人。三组均采用不同方式给予营养，乳清蛋白试验组（n=20），每天给予口服低磷全乳清蛋白粉剂1．2g／（kg·d），占总蛋白摄入量的60％，并分次服用；同时膳食中提供高生物价蛋白，摄入量为0.4克／（kg·d），占总蛋白摄入量的40％；热氮比值为836KJ：1．2g，共计时间18天；阴性对照组为普通优质蛋白质饮食组（n=20）作为阴性对照组，给予高生物价蛋白摄入量为1．2g／（kg·d），热氮比值为836KJ：1，2g；a-酮酸治疗组（n=20）给予a-酮酸制剂0．2克／（kg·d），同时给予高生物价蛋白0．4／（kg·d），热氮比值为836KJ：0．6g。在试验前、后三组患者分别检测血红蛋白、血清白蛋白、前白蛋白、血尿素氮、血肌酐、血清磷等项指标。结果 试验开始前三组患者都存在着不同程度的营养不良，两周后试验组与阴性对照组和治疗组相比，试验组患者机体蛋白质营养状态较两周前有明显改善，ALB（血清白蛋白）、PA（前白蛋白）均升高，与阴性对照组和治疗组相比均有显著差异分别为P〈0．05和P〈0．01。血红蛋白有所升高，但无统计学意义（P〉0．05）。试验后乳清蛋白组血清磷与阴性对照组和治疗组比较有显著差异（P〈0．05），血清尿素氮、肌酐等指数均降低显著（P〈0．01）。体重等其它营养相关指标无显著性差异（P〉0．05）。结论 低磷全乳清蛋白不同于酪蛋白，它在体内吸收完全，几乎无需经肾脏排泄，对肾功能代偿无明显副作用。

Objective To observe the effect of Low phosphoproteinpowder Louis X diet on nutrition status of maintenance hemodialysis （MHD） patients. Methods 60 cases of MHD patients were enrolled in this study and divided into 3 groups ： Low phosphoproteinpowder Louis X group, control group and Ketosteril group. In Low phosphoproteinpowder Louis X group（20 cases ）, 1.2g/Kg ·d Low phosphoproteinpowder Louis X was prescribed to each patient, which occupied 75% of total daily protein intake and the other 25% was high quality protein. In control group （ 20 cases ）, 1.2g/Kg·d high quality protein was prescribed to each patient. In Ketosteril group（20 cases ）, 0.2g/Kg· d Ketosteril and 0.4g/Kg ·d high quality protein were prescribed to each patient. The energy nitrogen ratio （E/N） was 836KJ/0.6g in each group. Hemoglobin, serum albumin and pre- albumin, blood urea nitrogen（BUN）, creatinine, and phosphorus were examined before and 20 days after the start of this study. Results Protein malnutrition to different extent was found in each group before the study. Significant elevation of serum albumin and pre - albumin were observed in LOw phosphoproteinpowder Louis X group patients compared to the other 2 groups （ P 〈 0.05 = , serum BUN, creatinine and phosphorus were significantly declined in Low phosphoproteinpowder Louis X group patients compared to the other 2 groups （P 〈 0.05, P 〈0.01 ）. No difference was found in hemoglobin and bodyweight among the 3 groups （P 〉 0.05 ）. Conclusion low phosphoproteinpowder Louis X diet could significantly improved nutrition status in maintenance hemodialysis patients.