低蛋白饮食联合α-酮酸对慢性肾脏病早期蛋白尿的影响研究

Low Protein Diet and Ketoacids Supplementation in Chronic Kidney Disease with Dominant Proteinuria

目的探讨早期应用低蛋白饮食联合α-酮酸能否减少蛋白尿、延缓肾脏病进展。方法将应用激素联合免疫抑制剂治疗12周后尿蛋白定量仍大于2g/d的慢性肾脏病患者分为两组:低蛋白饮食组(LPD组,蛋白0.6～0.8g.kg-1.d-1并给α-酮酸0.09g.kg-1.d-1)和正常蛋白饮食组(NPD组,蛋白1.0～1.2g.kg-1.d-1)。每月监测血压、肾功能、血清白蛋白、尿蛋白定量等指标。结果同NPD组比较,LPD组肾小球滤过率明显升高,尿蛋白定量明显下降,血清白蛋白明显升高。结论低蛋白饮食联合α-酮酸能显著减少慢性肾脏病(1～2期)蛋白尿水平,更好维持肾脏功能和营养状态。

Objective To explore whether the low protein diet supplemented with ketoacids can decrease the proteinuria and delay the progression of chronic kidney disease in early stage of CKD. Methods 24 patients suffered from chronic kidney disease with more than 2g/d urinary protein excretion were assigned to LPD group or NPD group. Blood pressure, serum creatinine, serum albumin, uxinary protein excretion were tested every month. Results A significant increase in eGFR was observed between groups. LPD group reduced urinary protein excretion more than NPD. A further remarkable finding in LPD was the increase of serum albumin, while it remained unchanged in NPD. Conclusion Patients in stage 1 - 2 of CKD receiving LPD plus Ketoacids have lower proteinuria, better renal function and nutritional status. Further research with more enroUment sample, longer follow - up should be performed to ensure a convincing conclusion.