低蛋白饮食及联合α-酮酸治疗在慢性肾功能衰竭中的疗效评价

Evaluation of the effect of low-protein diet and combination diet with α-ketoacid therapy in chronic renal failure

目的 评价低蛋白饮食及联合α 酮酸治疗延缓慢性肾功能衰竭 (CRF)、改善CRF患者营养状况中的疗效。方法 中度CRF患者 34例 (血肌酐 2 0 0～ 35 0 μmol/L) ,随机分为低蛋白饮食联合α 酮酸治疗组 (α 酮酸组 ) 18例及单独低蛋白饮食组 (低蛋白组 ) 16例 ,每 2个月进行营养和生化指标评估 ,两组患者均随访 8个月。结果 治疗后两组患者的体重、上臂围 (AC)、血清总蛋白 (TP)、白蛋白 (ALB)、前白蛋白 (Pre ALB)、转铁蛋白 (TF)水平呈上升趋势 ,无营养不良。α 酮酸组治疗后血胆固醇 (CH )、三酰甘油 (TG)、甲状旁腺激素水平(PTH)呈下降趋势 ,脂蛋白 (Lp)a、磷显著降低 (P <0 .0 5 ) ,血钙呈上升趋势 ;支链氨基酸短期内仍维持在原有水平。两组患者治疗后血肌酐、尿素氮、内生肌酐清除率 (Ccr)、肾小球滤过率 (GFR)在随访期间均保持稳定。结论 ①低蛋白饮食联合α 酮酸治疗在短期内具有稳定肾功能和改善营养状况的作用 ;②α 酮酸治疗对改善血脂和钙磷代谢紊乱 。

Objective To evaluate the role of low protein diet and combination with α ketoacid therapy in slowing the progression of chronic renal failure and improving nutrition status. Methods Thirty four patients with moderate renal failure (Scr: 200～350 μmol/L) were randomly assigned to a low protein diet (diet L) group or a low protein diet supplemented with α ketoacid (diet K) group. After entry into the study, assessment of nutritional status and biochemical factors were performed every two months and follow up to 8 months. Results After treatment, there was an incremental tendency in body weight, arm circumference, serum levels of TP, ALB, Pre ALB, TF and no malnutrition occured in both groups. The serum levels of CH, TG, Lp(a), PTH declined in diet K group and Lp(a) had a significant change. In both groups, the levels of Scr, BUN, Ccr and GFR remained stable status during 8 months of follow up. In diet K group, the level of plasma branched chain amino acids had no change after treatment. Conclusions ① Low protein diet and combination with α ketoacid therapy have a tendency of stabilizing renal function and short term improved nutritional status. ② α ketoacid therapy may play a role in improving abnormal metabolism of lipid, calcium, phosphate and correct the abnormality of amino acid metabolism as well.