蛋白质摄入水平与糖尿病肾脏病预后相关性研究

Study on the Correlation Between Protein Intake Level and Prognosis of Diabetic Kidney Disease

目的:探究糖尿病肾脏病(diabetic kidney disease,DKD)患者蛋白质摄入量(dietary protein intake,DPI)与肾脏不良预后之间的关系。方法:回顾性分析2014年01月—2021年01月于北京中医药大学东直门医院肾内科住院两次以上的DKD患者资料,根据24 h尿尿素氮评估DPI,将DKD患者分为极低蛋白摄入(very low protein intake,VLPI)、低蛋白摄入(low protein intake,LPI)、中等蛋白摄入(moderate protein intake,MPI)三组(<0.6 g·kg^(-1)·d^(-1),0.6~0.8 g·kg^(-1)·d^(-1),>0.8 g·kg^(-1)·d^(-1)),比较三组间基线资料的差异。应用Kaplan Meier生存分析及Cox回归分析不同DPI对肾脏不良预后的影响。结果:纳入DKD患者81例,VLPI组22例,LPI组30例,MPI组29例,中位随访22.5(15.8,36.0)个月,其中21例(17.24%)出现肾脏终点事件,VLPI组6例、LPI组6例、MPI组9例。Kaplan Meier生存分析结果显示,患者DPI越高,累积生存率越低(Log rank检验χ^(2)=1.078,P=0.025)。多因素Cox回归模型显示,VLPI及MPI均为DKD患者肾脏不良预后的独立影响因素(HR=1.90,95%CI 0.78~2.18,P=0.037;HR=0.98,95%CI 0.64~6.26,P=0.042)。结论:VLPI及MPI均是DKD患者肾脏不良预后的影响因素。

Objective:To investigate the relationship between dietary protein intake(DPI)and poor prognosis of kidney in diabetic kidney disease(DKD)patients.Methods:The clinical data of DKD patients hospitalized at least twice in the Department of Nephrology,Dongzhimen Hospital,Beijing University of Chinese Medicine from January 2014 to January 2021 were retrospectively analyzed.DPI was calculated based on 24-hour urine urea nitrogen,and all DKD patients were classified as having very low protein intake(VLPI),low protein intake(LPI),and Moderate protein intake(MPI)(<0.6 g·kg^(-1)·d^(-1),0.6~0.8 g·kg^(-1)·d^(-1),>0.8 g·kg^(-1)·d^(-1)).The clinical baseline data were compared among the three groups.Kaplan Meier survival analysis and Cox regression were used to analyze the influence of DPI on renal adverse prognosis.Results:A total of 81 DKD patients were included,including 22 in the VLPI group,30 in the LPI group,and 29 in the MPI group.The median follow-up was 22.5(15.8,36.0)months,in which 21 patients(17.24%)developed renal endpoint events,6 in the VLPI group,6 in the LPI group,and 9 in the MPI group.Kaplan Meier survival analysis showed that the higher the DPI,the lower the cumulative survival rate(Log rank testχ^(2)=1.078,P=0.025).Multivariate Cox regression model showed that VLPI and MPI were independent influencing factors of poor prognosis in DKD patients(HR=1.90,95%CI 0.78~2.18,P=0.037;HR=0.98,95%CI 0.64~6.26,P=0.042).Conclusion:VLPI and LPI are the influencing factors of poor prognosis of kidney in DKD patients.