α-酮酸联合极低蛋白饮食对2型糖尿病肾病的影响

The effect of α-ketoacid combined with very low protein diet on type 2 diabetic nephropathy

目的研究α-酮酸联合极低蛋白饮食对2型糖尿病肾病患者肾功能、LC3蛋白及P62抗体阳性率的影响.方法选择2018年11月至2020年1月本院接诊的2型糖尿病肾病患者120例纳入研究,依据随机数表法分为对照组和观察组,每组各60例.对照组患者给予非严格控制低蛋白饮食+α-酮酸治疗,观察组患者给予α-酮酸联合极低蛋白饮食治疗.比较两组患者治疗前、治疗后3个月的24 h尿白蛋白排泄率(24 h UAER)、24 h尿蛋白定量(24 h Upro)、血清尿素氮(BUN)、肌酐(SCr)、肾小球滤过率、LC3蛋白以及P62抗体阳性率.结果治疗后3个月,两组患者的24 h UAER、24 h Upro、BUN、SCr指标均降低,且观察组比对照组低(P<0.05);两组肾小球滤过率水平均升高,且观察组高于对照组(P<0.05);LC3蛋白表达亦升高,观察组LC3蛋白表达高于对照组(P<0.05);则P62抗体阳性率降低,观察组阳性率低于对照组(P<0.05).结论α-酮酸联合极低蛋白饮食能够有效增加2型糖尿病肾病患者细胞自噬作用,降低尿蛋白流失,保护患者肾功能.

Objective To study the effect of α-keto acid combined with very low protein diet on renal flinction, LC3 protein and P62 antibody positive rates in patients with type 2 diabetic nephropathy. Methods 120 cases of patients with type 2 diabetic nephropathy admitted to our hospital from November 2018 to January 2020 were selected as the subjects of this study. All patients were divided into control group and study group according to the random number table method, with 60 cases in each group. The patients in the control group were treated with non-strictly controlled low-protein diet+α-keto acid, and the patients in the study group were treated with α-eto acid combined with very low protein diet. The 24 h urinary albumin excretion rate ( 24 h UAER ) , 24 h urinary protein quantification ( 24 h Upro ) , scrum urea nitrogen ( Blood ) , urea nitrogen ( BUN ) , creatinine ( Semm Creatinine, SCr ) , glomerular filtration, LC3 protein, and P62 antibody positive rates were compared before and .ifter treatment. Results 3 months after treatment, the 24 h UAER, 24 h Upro, BUN , SCr indexes of the two groups of patients were all reduced, and the study group were lower than those in the control group ( P<0.05 ) . The glomerular filtration rate of patients in the two groups were all increased, and the study group was higher than that in the control group ( P<0.05 ) . The expression of LC3 protein were also increased, the study group was higher than that in the control group( P<0.05 );and the positive rate of P62 antibody were decreased, the study group was lower than in the control group ( P<0.05 ) . Conclusion The α-keto acid combined with very low protein diet can effectively increase cell .uitophagy in parients with type 2 diabetic nephropathy, reduce urinary protein loss, help protect renal flinction.