复方α-酮酸对慢性肾脏病钙磷代谢的影响

Influence of compound α- keto acid on calcium and phosphorus metabolism in chronic kidney disease

目的通过极低蛋白饮食联合复方α-酮酸(开同)和常规低蛋白饮食在慢性肾脏病(chronic kidney disease,CKD)IV期中的作用,评估其对钙磷代谢和PTH的影响。方法采用前瞻、随机、对照临床研究,对24例CKD患者,肌酐清除率低于30ml/min,随机分为两组,极低蛋白饮食+开同组(VLPD+Ket组)和低蛋白饮食组(LPD组),每组12例患者,观察4个月。结果所有患者营养状态均得到充分维持,游离钙在VLPD+Ket组无明显变化,LPD组趋于下降;血磷在VLPD+Ket组下降[(1.48±0.16)mmol/L和(1.29±0.36)mmol/L,P<0.05],LPD组无变化。LPD组甲状旁腺激素明显升高[(241±138)pg/ml和(494±390)pg/ml,P<0.01],该参数与钙呈负相关(r=-0.75,P=0.02),而与磷呈正相关(r=0.71,P=0.03)。结论 VLPD+Ket能维持CKD IV期患者正常的营养状况,同时还具有改善钙磷代谢、降低尿素氮和稳定PTH的作用,进一步预防和降低肾性骨病的发生,有明显底预防和降低肾性骨病发生的作用。

Objective To discuss the role of a very low -protein diet combined with compound a -keto acid（ketostefil, Ket） on calcium and phosphorus metabolism in compmison with a conventional low - protein diet（LPD） in stage IV chronic kidney disease（ CKD）, so as to evaluate its influence on calcium and phosphorus metabolism and PTH. Methods Twen- ty -four patients with stage IV CKD with creatinine clearance less than 30ml/min were recruited in this prospective, ran- domized, and controlled clinical study, who were randomly assigned to VLPD ＋ Ket group （ n = 12） and conventional LPD group（ n = 12）. All the patients were followed up for 4 months. Results Nutritional status of all patients was adequately maintained, ionized calcium showed no significant change in VLPD ＋ Ket group, and tended to decline in LPD group. Se-rum phosphorus decreased from 1.48±0.16mmol/L to 1.29 ±0.36mmol/L in VLPD ＋ Ket group （ P 〈 0.05 ）. No change was found in serum calcium and phosphorus of LPD group. Serum parathormone （PTH） increased significantly from 241 ±138pg/ml to 494 ±390pg/ml in LPD group （P 〈 0.05）, which was negatively correlated with ionized calcium concentra- tion（ r = - 0.75, P = 0.02 ）, and positively with serum phosphorus concentration （ r = 0. 71, P = 0.03 ）. Conclusions VLPD plus Ket can maintain the nutritional status of the patients with stage IV CKD, as well as improve calcium and phos- phorus metabolism, reduce BUN and stabilize the level of PTH, further preventing the occurrence of renal osteodystrophy.