饮食限盐对非透析慢性肾脏病患者血压影响的研究

Effect of dietary salt restriction on blood pressure of hypertensive patients with chronic kidney disease

目的观察饮食限盐对合并高血压的非透析慢性肾脏病（chronic kidney disease，CKD）患者血压的影响。方法收集2006年6～12月于北京大学第一医院肾内科就诊的26例24h尿钠排泄量（24hUNa）大于100mmol／d的CKD合并高血压患者，给予饮食指导，观察8周后血压、血及尿电解质、肾功能及尿蛋白的变化。观察期间患者降压药维持不变．观察结束时24hUNa较限钠前下降≤10％认为限钠失败。结果18例患者限钠成功，24hUNa由（243．8±71．2）mmol／d下降至（135．0±49．1）mmol／d（P〈0．01）。与治疗前相比，其收缩压平均下降11．4mnlHg（P〈0．01）（1mmHg=0．133kPa）；舒张压平均下降6．8mmHg（P=0．008）；平均动脉压下降8．4mnlHg（P=0．001）；尿蛋白中位数由1．17g／d降至0．94g／d。在8例限钠失败患者中，观察期开始及结束时的24hUNa分别为（166．4±41．4）mmol／d和（203．3±67．3）mmol／d（P=0．069），其收缩压、舒张压、平均动脉血压和尿蛋白均无明显变化（P〉0．05）.结论饮食限盐可有益于CKD合并高血压患者的降压治疗，并可能有助于减少尿蛋白.

Objective To study the effects of salt restriction on blood pressure in hypertensive patients with chronic kidney disease （CKD）. Methods From July to December,2006,26 hypertensive CKD patients with 24 h urinary sodium excretion （UNa） over 100 mmol/d were enrolled and received dietary education and sodium spoon. Their BP level,blood/ urine electrolytes,serum creatinine and amount of urinary protein were measured before- and after- 8 weeks. Anti-hypertension therapy kept unchanged during the observation period and those with UNa decreased less than 10% at the end of observation were considered as salt restriction failure. Results Eighteen patients succeeded with a reduction of UNa from （ 243.8 ± 71.2 ） mmol/d to （ 135.0 ± 49. 1 ） mmol/d （ P 〈 0.01 ）. Their average BP level reduced 11.4 mm Hg systolicly （ P 〈0.01 ） and 6.8 mm Hg diastolicly （ P =0. 008） ,respectively. The mean blood pressure （MBP） reduced averagedly 8.4 mm Hg （ P = 0. 001 ） , accompanied with some decrease of urinary protein amount. Eight patients failed to restrict their salt intake with 24 h UNa （ 166.4 ± 41.4 ） mmol/d vs （ 203.3 ± 67.3 ） mmol/d （ P = 0. 069 ）. No significant changes could be observed in their systolic BP,diastolic BP,MBP and amount of urinary protein. Conclusion Restriction of dietary salt intake itself call bring beneficial effect to BP control and urinary protein control in hypertensive CKD patients.