饮食中不同来源蛋白质对无尿路结石的健康成人24h尿液成分及过饱和度的影响

Effects of dietary animal or plant protein on risk of kidney stone formation in adults without urinary calculi

目的探讨饮食中动物或植物来源蛋白质对无尿路结石的健康成人24 h尿液成分及结石形成风险的影响。方法本研究为一项前瞻性、单中心、随机交叉对照试验。向社会公开招募无尿路结石的健康成年男性,通过简单随机抽样将其分为A、B两组,A组先予以动物蛋白饮食7 d,给予7 d普通饮食洗脱期,再予以植物蛋白饮食7 d,B组饮食方案与A组相反。分别于研究的第7天、第21天收集24 h尿液。检测24 h尿电解质、尿素氮、肌酐、尿酸、枸橼酸、草酸、尿pH,使用EQUIL 2软件计算尿液成分过饱和度。结果相较基线饮食及植物蛋白饮食,受试者接受动物蛋白饮食后,24 h尿钙[(4.75±1.29)μmol比(2.96±1.66)μmol]、尿镁[(3.70±1.35)μmol比(3.16±1.22)μmol]、尿酸[(4184±1032)μmol比(2997±616)μmol]、尿肌酐[(14163±3685)μmol比(7668±2569)μmol]排泄显著增高。相较基线饮食,受试者接受植物蛋白饮食后,24 h尿钠[(74.86±36.26)μmol比(117.46±49.28)μmol]、尿氯[(89.00±35.67)μmol比(117.11±47.20)μmol]排泄显著减少。受试者接受不同来源蛋白质饮食后,尿草酸钙、二水合磷酸氢钙、尿酸、尿酸钠过饱和度均差异无统计学意义。结论健康成年男性中,饮食中动物来源蛋白质引起尿钙、尿酸和尿镁排泄增加,植物来源蛋白质引起尿钠排泄减少,两种不同来源蛋白质对常见结石成分过饱和度无影响。

Objective To investigate whether dietary animal or plant protein can affect the propensity for kidney stone formation.Methods The study was a prospective,single-center,randomized cross-over controlled trial.Seven healthy male adults were recruited and randomized into groups A and B.Group A received an animal protein diet for 7 days,followed by 7-day,free-living diet wash-out period and plant protein diet for another 7 days.The dietary scheme of group B was opposite to that of group A.24 h urine collections were obtained at Day 7/21.24 h urinary excretion of sodium(Na),potassium(K),calcium(Ca),phosphorus(P),magnesium(Mg),urea nitrogen,creatinine,uric acid,sulfate,citrate,oxalate and urinary pH were measured.The supersaturation of urinary CaOx,Brushite,uric acid and sodium uric acid were calculated by EQUIL 2 software.Results Compared with baseline and plant protein diet,24 ho urinary Ca[(4.75±1.29)μmol vs(2.96±1.66)μmol]and Mg[(3.70±1.35)μmol vs(3.16±1.22)μmol],uric acid[(4184±1032)μmol vs(2997±616)μmol]and creatinine[(14163±3685)μmol vs(7668±2569)μmol]significantly spiked after an animal protein diet.Urinary Na[(74.86±36.26)μmol vs(117.46±49.28)μmol]and Cl[(89.00±35.67)μmol vs(117.11±47.20)μmol]dramatically declined on a plant protein diet.After receiving protein diets from different sources,no significant differences existed in urinary SS CaOx,SS Bru,SS UA and SS SUA between animal and plant protein diets.Conclusion Animal protein intake produces an elevation of urinary calcium,uric acid and magnesium excretion.Dietary plant protein decreases urinary sodium excretion.However,no variations exist in urinary CaOx,Brushite,UA supersaturation on either animal protein or plant protein diet.