必需氨基酸和酮酸在极低蛋白饮食治疗慢性肾功能不全中的作用

Role of essential amino acid ketoacid in very low protein intake treating chronic renal insufficiency

目的 了解必需氨基酸和酮酸是否有助于改善极低蛋白饮食（ Ｖ Ｌ Ｐ Ｄ） 治疗慢性肾功能不全时可能造成的营养不良和顺应性差等问题。方法 比较１６ 例慢性肾功能不全患者应用 Ｖ Ｌ Ｐ Ｄ和 Ｖ Ｌ Ｐ Ｄ 加必需氨基酸和酮酸前、后营养参数、肾功能指标、估算蛋白质摄入（ Ｅ Ｐ Ｉ） 变化的情况。结果 Ｖ Ｌ Ｐ Ｄ 治疗后，患者的体重、上臂中部周径、血清前白蛋白及 Ｉ Ｇ Ｆ１ 均显著下降；血 Ｂ Ｕ Ｎ 降低（ Ｐ＜ ０ ．０１） ， Ｃｃｒ 无明显改变； Ｅ Ｐ Ｉ高于 Ｖ Ｌ Ｐ Ｄ 的要求。加用必需氨基酸和酮酸后，血清前白蛋白升高（ Ｐ＜ ０ ．０５） ；体重、上臂中部周径及血 Ｉ Ｇ Ｆ１ 均有所上升，但差异无显著性；血 Ｂ Ｕ Ｎ 进一步下降， Ｃｃｒ略有上升，但无统计学意义； Ｅ Ｐ Ｉ无改变。结论 必需氨基酸和酮酸在 Ｖ Ｌ Ｐ Ｄ 治疗慢性肾功能不全中有改善并维持病人营养状况的趋势；但未发现能改善对 Ｖ Ｌ Ｐ Ｄ 的顺应性；能减少氮质产物积聚，有助于减轻尿毒症症状及并发症。

Objective It is reported that very low protein diet, VLPD can delay the progression of chronic renal insufficiency, but it may lead to malnutrition and poor compliance. This study is designed to find out whether essential amino acids and ketoacids can be supplemented to settle these problems. Methods VLPD was given during the first four weeks, then essential amino acids and ketoacids were added during the following four weeks. Nutrition parameters, renal function and EPI(estimated protein intake) were measured before and after VLPD and VLPD supplemented with essential amino acids and ketoacids.Results After four weeks of VLPD, body weight, mid arm circumference and the levels of seum IGF 1 and BUN were significantly decreased ( P <0.01); EPI was higher than 0.3g·kg -1 ·d -1 . After essential amino acids and ketoacids had been added for four weeks, the level of serum pre albumin was significantly increased ( P <0.05); body weight, mid arm circumference and the level of serum IGF 1 were slightly increased but of no statistical significance; EPI had no change.Conclusion Essential amino acids and ketoacids may help to maintain the nutritional status of the patients with chronic renal insufficiency who received VLPD but can not improve the compliance; VLPD supplemented with essential amino acids and ketoacids can reduce the accumulation of nitrogen products, relieve the uremic symptoms as well as the complications.(Shanghai Med J, 1999,22∶532 535)