中、晚期慢性肾衰竭患者的蛋白摄入及营养状况

Dietary protein intake and nutritional status in patients with moderate to severe chronic renal failure

目的 评估非限制饮食的中、晚期慢性肾衰 (CRF)患者饮食蛋白摄入 (DPI)和营养状况。方法 在 36例中、晚期透析前CRF患者和 2 0例正常对照组中 ,测定DPI和营养指标 ,包括血清白蛋白 (Alb)、转铁蛋白 (TF)、前白蛋白 (pre Alb)、胰岛素样生长因子 1(IGF 1)。结果 CRF患者DPI(0 78± 0 2 5 )g·kg-1·d-1低于正常对照组 (1 0 4± 0 31)g·kg-1·d-1,P <0 0 1;Alb、TF亦显著减低 (P均 <0 0 1)。其中 10例CRF患者DPI <0 6 g·kg-1·d-1(2 8% ) ;DPI <0 6g·kg-1·d-1的CRF患者 (n =10 )与DPI≥ 0 6g·kg-1·d-1(n =2 6 )比较 ,Alb为 (2 7 7± 6 1) g·L-1、(35 3± 8 9) g·L-1,TF为 (1 5 8± 0 31) g·L-1、(2 74± 0 5 6 ) g·L-1,pre Alb为 (0 2 3± 0 0 8) g·L-1、(0 33± 0 10 ) g·L-1,P <0 0 1;IGF 1(1 36± 0 30 )nmol·L-1、(2 2 4± 0 6 2 )nmol·L-1,P<0 0 5。结论 大多数中、晚期CRF患者在透析前已发生营养不良 ,而伴有低饮食蛋白摄入患者更为明显。

Objective To evaluate dietary protein intake (DPI) and the nutritional status of patients with moderate to severe chronic renal failure (CRF)on unrestricted diet. Methods DPI and nutritional indices such as serum albumin(Alb),transferrin (TF),pre albumin (pre Alb)and insulin like growth factor 1(IGF 1) weremeasured in 36 patients with moderate to severe CRF and 20 normal controls (N). Results Mean DPI was 0 78±0 25 g·kg -1 ·d -1 in CRF and 1 04±0 31 g·kg -1 ·d -1 in N ( P <0 01). DPI was lower than 0 6 g·kg -1 ·d -1 in 10 CRF patients(28%).Alb and TF were significantly lower in CRF patients than in N( P <0 01),Nutritional indices of CRF patients with lower DPI(<0 6 g·kg -1 ·d -1 , n =10) were significantly worse than higher DPI (≥0 6 g·kg -1 ·d -1 , n =26),Alb (27 7±6 1) g·L -1 vs (35 3±8 9) g·L -1 , TF (1 58±0 31) g·L -1 vs (2 74±0 56) g·L -1 , pre Alb (0 23±0 08) g·L -1 vs (0 33±0 10) g·L -1 , P <0 01; IGF 1 (1 36±0 30) nmol·L -1 vs (2 24±0 62) nmol·L -1 , P <0 05. Conclusion Malnutrition is present in a significant proportion of patients with pre dialysis moderate to severe CRF, especially with low protein intake. The effort to detect and correct malnutrition should be made in patients with CRF even before initiation of maintenance of dialysis.