α-酮酸联合低蛋白饮食对慢性乙型肝炎合并肾小球肾炎脂肪因子代谢影响研究

Effect of low-protein diet supplemented with α-keto acids on lipid metabolism in chronic hepatitis B patients complicated with chronic glomerulonephritis

目的探讨α-酮酸联合低蛋白饮食对慢性乙型肝炎合并肾小球肾炎患者脂肪因子的影响。方法将2009—2010年17例慢性乙型肝炎合并肾小球肾炎的患者随机分为两组,对照组:蛋白质0.6～0.8 g/(kg.d);治疗组:α-酮酸0.1 g/(kg.d)+蛋白质0.6～0.8/(kg.d),随访12个月,观察脂肪因子瘦素、内脂素和脂联素的变化。结果从随访的第6个月起,治疗组的瘦素、内脂素持续性下降并与对照组相比差异有统计学意义(P<0.05)。治疗组的脂联素浓度显著上升,与对照组相比,差异有统计学意义(P<0.05)。结论α-酮酸联合低蛋白饮食能够降低慢性乙型肝炎合并肾小球肾炎患者脂肪因子瘦素和内脂素水平,升高脂联素浓度。

Objective To evaluate the effects of short-term restriction of dietary protein intake （DPI） supplemented with α- keto acids on lipid factors in chronic hepatitis B patients with chronic glomerulonephritis. Methods A total of 17 chronic hepatitis B patients with chronic glomerulonephritis were randomized to either low DPI with α-keto acid supplemented （sLP） group （protein 0. 6 -0. 8 g/kg per day plus keto acid 0. 1 g/kg per day）or low DPI （LP） group （protein 0. 6 - 0. 8 g,/kg per clay） for 12 mouths. Nutritional indexes were recorded, and other clinical indexes were measured to evaluate the effect and safety respectively. Results The urine protein excretion level and microalbuminuria were significantly decreased after 6 months in the sLP group （P 〈 0. 05 ）. At month 12, serum albumin and pre-albumin levels increased significantly as compared with the baseline in the sLP group （ P 〈 0. 05 ）. We also found that serum concentrations of high-density lipoprotein （HDL） and leptin were correlated with adiponeetin （ r = 0. 508 and r = - 0. 381 , respectively, P 〈 0. 01 for both）. Conclusion Short-term low DPI （0. 6 -0. 8 g/kg per clay） combined with α-keto acids may decrease the concentrations of visfatin and leptin while increase the serum level of adiponectin in chronic hepatitis B patients with chronic glomerulonephritis.