α酮酸联合限蛋白饮食对2型糖尿病肾病的影响

Effect of low-protein-diet associate with α-ketose on diabetic nephropathy in type 2 diabetes mellitus

目的评估限蛋白质摄入联合α酮酸治疗对Ⅲ、Ⅳ期2型糖尿病肾病在营养状况和胰岛素抵抗方面的影响。方法选择住院治疗的Ⅲ、Ⅳ期2型糖尿病肾病患者66例,分为三组,分别予以普通饮食、单独低蛋白低磷饮食(A组)和低蛋白低磷饮食联合α酮酸-必需氨基酸制剂(B组)治疗12个月,定期测定患者的糖化血红蛋白、血脂、肾功能、血红蛋白、白蛋白、24 h尿白蛋白、肌酐清除率、空腹胰岛素及血糖,测量血压、体重指数、体脂百分比,三头肌皮褶厚度、上臂肌围等。结果三组病人体重指数(BM I)、三头肌皮褶厚度(TSF)、上臂肌围(MAMC)、糖化血红蛋白、血清白蛋白、肾功能、血红蛋白、血脂治疗前后差异无统计学意义(P>0.05)。而24 h尿白蛋白A、B组治疗后均低于治疗前(P<0.05),而且B组的24 h尿白蛋白的降低优于A组(P<0.05)。肌酐清除率(CCr)A、B组治疗后均高于治疗前(P<0.05)。治疗后B组的胰岛素抵抗指数、空腹胰岛素低于A组和对照组(P<0.05)。结论低蛋白饮食联合α酮酸治疗可以显著减少Ⅲ、Ⅳ期2型糖尿病肾病病人24 h尿白蛋白排出量,增加肌酐清除率及其胰岛素敏感性,从而减缓肾病的进程,减少慢性肾功能衰竭的发生,而且可以防止糖尿病其他并发症的发展,对血糖、血脂等的控制均是有利的。

Objective To evaluate the effect of low - protein - diet associate with keto/amino acid on the resist of insulin and nutritional status in Ⅲ and Ⅳ period diabetic nephropathy of type 2 diabetes mellitus. Methods Sixty - six patients with Ⅲ and Ⅳ period diabetic nephropathy were divided into three groups ： group A was given low protein and low phosphorus diet（LPD） for 12 months; B group was given LPD supplemented with α- keto acids for 12 months; control group was given routine diet for 12 months. Body mass index （BMI） ,glycosglated hemoglobin, lipids, renal function, hemoglobin, serum albumin, 24 h urine albumin excretion, creatinine clearance ratio （CCr） and fasting plasm a glucose（FPG） , fasting serum insulin（FINS） ,triceps skin - flod thickness（TSF） , aim muscle cricumference（MAMC） were determined every 3 months. Results Body mass index （BMI） , glycosglated hemoglobin, lipids, renal function, hemoglobin,serum albumin had no significant differece existed in 3 groups neither before nor after treatment（ P 〉 0.05）. There were significant different in 24 h urine albumin excretion and CCr after treated than before at groups A and B （ P 〈 0.05）. The level of group B insulin resistance index and FINS were lower than that in group A （ P 〈 0.05 ）. Conclusion LPD supplemented with α - keto acids could lessen 24 h urine albumin excretion and increase CCr and insulin sensitivity. There were benefit to patients with Ⅲ, Ⅳ period diabetic nephropathy of type 2 diabetes mellitus.