维持性血液透析患者低蛋白饮食治疗高磷血症的有效性与安全性研究

Efficacy and Safety of Low Protein Diet on Hyperphosphatemia in Patients Undergoing Hemodialysis

目的探讨低蛋白饮食治疗维持性血液透析(MHD)患者高磷血症的有效性与安全性。方法选取2012年10月—2013年8月中国人民解放军空军总医院血液净化中心行MHD的高磷血症患者28例,采用随机数字表法分为低蛋白饮食组〔16例,每日蛋白摄入量(DPI)为0.8 g·kg-1·d-1〕、常规蛋白饮食组(12例,DPI为1.2 g·kg-1·d-1),治疗6个月。观察两组患者治疗前及治疗3、6个月时血清磷、血清矫正钙、钙磷乘积、全段甲状旁腺激素水平、营养状况及人体测量学指标变化。结果治疗前两组患者的血清磷水平、钙磷乘积差异均无统计学意义(P>0.05);治疗3、6个月时,两组患者血清磷水平、钙磷乘积间差异均有统计学意义(P<0.05)。低蛋白饮食组患者治疗3、6个月时血清磷水平、钙磷乘积较治疗前降低,差异有统计学意义(P<0.05),而常规蛋白饮食组患者血清磷水平及钙磷乘积治疗前后差异无统计学意义(P>0.05)。两组患者治疗前后清蛋白、前清蛋白、转铁蛋白、总胆固醇水平、营养不良-炎症评分及人体测量学指标间差异均无统计学意义(P>0.05)。结论 DPI为0.8 g·kg-1·d-1可降低我国MHD患者血清磷水平及钙磷乘积,且对营养状况无明显影响。

Objective To investigate the efficacy and safety of long- term use of low protein diet in treating hyperphosphatemia patients having maintenance hemodialysis（MHD）.Methods A total of 28 hyperphosphatemia patients having MHD at blood purificationf centre in Air Force General Hospital,PLA from October 2012 to August 2013 were randomized into groups A〔n = 16,diatary protein intake（DPI） = 0.8 g·kg- 1·d- 1〕,B（n =12,DPI =1.2 g·kg- 1·d- 1）.The changes of serum phosphorus,corrected calcium,phosphorus product,intact parathyroid hormone,nutritional status and anthropometric indicators were observed in 2 groups before and after treatment.Results There were no significant differences in serum phosphorus,calcium- phosphorus products between 2 groups before treatment（P〉 0.05）.There were differences in serum phosphorus,calcium- phosphorus products 3,6 months after treatment（P〈0.05）,and lower in group A than in group B（P〈0.05）,but there was no difference between pre- and post- treatments in group B（P 〉0.05）.There were no significant differences in albumin,prealbumin,transferrin,total cholesterol levels,malnutrition- inflammation score and anthropometric indicators between 2 groups before and after treatment（P 〉0.05）.Conclusion DPI of 0.8 g·kg- 1·d- 1can reduce serum phosphorus and phosphorus product in Chinese MHD patients,not effecting nutritional status remarkably.