植物乳酸菌发酵熟成米在慢性肾脏病营养治疗中的作用

Application of lactic acid bacteria-fermented rice in nutritional treatment for patients with chronic kidney disease

目的比较以植物乳酸菌发酵熟成米和麦淀粉作为低蛋白饮食的主食在慢性肾脏病(chronic kidney disease,CKD)营养学治疗中的效果。方法选取慢性肾脏病未透析患者109例,随机分为植物乳酸菌发酵熟成米(LAFR)组和麦淀粉(WS)组,根据CKD饮食治疗指南设计营养学治疗计划并实施。以24 h膳食回顾法得到估计的蛋白质摄入量,评估患者对治疗饮食的依从性及估计的每日营养素平均摄入量。分别于饮食干预前后收集清晨空腹血,检测BUN、Scr、TC、TG、TP、ALB、Pre-ALB、TF及Hs CRP等指标。结果 LAFR组和WS组对低蛋白饮食的依从性分别为81.5%和41.9%,差异有统计学意义(P<0.01)。LAFR组每日能量摄入量(8 512.3±206.2)k J显著高于WS组(7 448.4±169.9)k J(P<0.05)。饮食干预后,LAFR组Scr为(257.4±80.5)μmol/L,较干预前(393.6±71.1)μmol/L显著减低(P<0.01);饮食干预前、后,WS组Scr分别为(367.4±75.1)、(381.1±76.5)μmol/L,差异无统计学意义(P>0.05);饮食干预后,两组Scr水平差异有统计学意义(P<0.01)。饮食干预前、后,LAFR组Pre-ALB分别为(29.4±5.6)、(31.7±6.1)mg/L,差异无统计学意义(P>0.05);WS组分别为(30.9±6.3)、(24.8±6.3)mg/L,干预后显著降低(P<0.01);干预后,WS组Pre-ALB值显著低于LAFR组(P<0.01)。饮食干预前、后,两组Ca、P、TG、TP、ALB、TF值及Hs CRP值组内及组间差异均无统计学意义(P>0.05)。结论以乳酸菌发酵熟成米作为低蛋白饮食的主食可以显著提高CKD患者对营养学治疗计划的依从性,提高估计的每日能量平均摄入量,显著减低Scr水平,维持Pre-ALB水平及体质量。

Objective To compare the effects of lactic acid bacteria-fermented rice（ LAFR） and wheat starch（ WS） as lowprotein diet in nutritional treatment for patients with chronic kidney disease（ CKD）. Methods One hundred and nine CKD patients were randomly divided into LAFR and WS groups. Nutrition treatment plan was designed according to the National Renal Diet guidelines.Compliance and the estimated daily average dietary intake were obtained by 24 h dietary recall. Blood samples were collected before and after diet intervention to determine BUN,Scr,TC,TG,TP,ALB,Pre-ALB,TF and Hs CRP. Results The compliance of LAFR and WS groups was 81. 5% and41. 9%,respectively（ P〈0. 01）. The average daily energy intake in LAFR group was significantly higher than that in WS group[（ 8 512. 3 ± 206. 2） vs（ 7 448. 4 ± 169. 9） k J,P〈0. 05]. There was no significant difference in BUN level between two groups. The Scr level in LAFR group after intervention was（ 257. 4 ± 80. 5） μmol / L,significantly lower than that before intervention（ 393. 6 ±71. 1） μmol / L（ P〈0. 01）. There was no significant difference in Scr level between before（ 367. 4 ±75. 1） μmol / L and after（ 381. 1 ± 76. 5） μmol / L intervention in WS group. The Pre-Alb levels before and after intervention in LAFR group were（ 29. 4 ± 5. 6） and（ 31. 7 ± 6. 1） mg / L（ P〉0. 05）,but preALB level before intervention in WS group was significantly higher than that after intervention[（ 30. 9 ± 6. 3） vs（ 24. 8 ± 6. 3） mg /L,P〈0. 01]. There were no significant changes in body weight of LAFR group before and after intervention,but in WS group the body weight after intervention（ 58. 6 ± 4. 7） kg was significantly lower than that before intervention（ 52. 7 ± 6. 4） kg（ P〈0. 05）.There were no significant differences in level of Ca,P,TG,TP,ALB,TF and Hs CRP between two groups before and after intervention. Conclusion Compared to wheat starch,lowprotein diet with rice fermented by lactic acid bacteria as staple food can significantly improve the compliance and the average daily energy intake,decrease the Scr level,and maintain serum Pre-Alb level and body weight in nutritional treatment for patients with chronic kidney disease.