多学科协作的膳食管理团队在糖尿病肾病透析患者中的应用效果

Application effect of a multidisciplinary dietary management team in diabetic nephropathy patients undergoing dialysis

目的 分析对行透析治疗的糖尿病肾病患者应用多学科协作的膳食管理团队干预的效果。方法 回顾性分析2020年1~12月于华中科技大学同济医学院附属协和医院行透析治疗的108例糖尿病肾病患者的临床资料,将纳入对象按照不同的膳食管理方式分为常规组(52例)和多学科协作组(56例)。常规组采用常规膳食管理,多学科协作组采用多学科协作的膳食管理。比较2组患者在干预前、干预3个月后的血糖指标、营养状态及肾功能。结果 干预3个月后,2组的空腹血糖(FBG)、餐后2h血糖(2hPBG)及糖化血红蛋白(HbA1c)水平均较干预前降低(P均<0.05);2组的血清总蛋白(TP)、转铁蛋白(TRF)、白蛋白(ALB)水平及营养风险筛查简表(NRS2002)评分均较干预前升高(P均<0.05);2组的尿白蛋白/肌酐比值(UACR)均较干预前下降,肾小球滤过率(GFR)均较干预前上升(P均<0.05);多学科协作组的上述指标均优于常规组(P均<0.05)。结论 将多学科协作的膳食管理团队应用于糖尿病肾病患者的透析治疗中,可有效控制其血糖水平,改善其营养状态及肾功能。

Objective To analyze the intervention effect of a multidisciplinary dietary management team on the diabetic nephropathy patients undergoing dialysis. Methods The clinical data of 108 patients with diabetic nephropathy who underwent dialysis at Union Hospital,Tongji Medical College,Huazhong University of Science and Technology from January to December 2020 were retrospectively analyzed. The included subjects were divided into a routine group(52 cases)and a multidisciplinary collaboration group(56 cases)according to different dietary management methods. The routine group adopted routine dietary management,and the multidisciplinary collaboration group adopted multidisciplinary dietary management.The blood glucose indicators,nutritional status,and renal function of the two groups were compared before the intervention and after 3 months of intervention. Results After 3 months of intervention,the levels of fasting blood glucose(FBG), 2 hr postprandial blood glucose(2 hPBG),and glycosylated hemoglobin(HbA1c)in the two groups were lower than those before the intervention(all P<0. 05). The levels of serum total protein(TP),transferrin(TRF),and albumin(ALB)and the Nutritional Risk Screening 2002(NRS2002)scores in the two groups were higher than those before the intervention(all P<0. 05). The urinary albumin-to-creatinine ratio(UACR)of the two groups was lower than that before the intervention,and the glomerular filtration rate(GFR)was higher than that before the intervention(all P<0. 05). The above indicators in the multidisciplinary collaboration group were better than those in the routine group(all P< 0. 05). Conclusion The application of a multidisciplinary dietary management team in the dialysis of diabetic nephropathy patients can effectively control their blood glucose levels and improve their nutritional status and renal function.