α-酮酸配伍低蛋白饮食对长期腹膜透析营养不良患者肾脏功能、钙磷代谢及腺苷脱氨酶活性的影响

Effect of α-keto acid combined with low protein diet on kidney function,calcium-phosphorus metabolism and adenosine deaminase activity in malnourished patients with long term peritoneal dialysis

目的探讨α-酮酸配伍低蛋白饮食对长期腹膜透析营养不良患者肾脏功能、钙磷代谢及腺苷脱氨酶(adenosine deaminase,ADA)活性影响及其意义。方法选取2013年5月~2014年8月于海口市人民医院透析中心行长期腹膜透析患者46例,根据随机数字表法随机分为2组:对照组(n=23)予临床常规治疗,每天蛋白质摄入量为1.2 g/(kg·d);实验组(n=23)在常规治疗基础上应用α-酮酸配伍低蛋白饮食方案,每天蛋白质摄入量为0.8 g/(kg·d)。连续治疗3个月为一疗程。观察并比较2组患者血钙、血磷、营养状态、肾脏功能及腺苷脱氨酶活性变化。结果治疗3个月后,与对照组比较,实验组患者血肌酐、尿素氮、血尿酸较低(P<0.05);血钙水平较高(P<0.05),血磷水平较低(P<0.05),ADA活性和白细胞计数较低(P<0.05),但2组营养不良发生率比较,差异无统计学意义(χ2=3.136,P>0.05)。结论α-酮酸配伍低蛋白饮食能有效升高长期腹膜透析患者血钙水平、降低血磷水平,并能降低患者腺苷脱氨酶活性和白细胞计数,改善患者营养状态,对临床长期腹膜透析患者的治疗具有重要意义。

Objective To investigate the effect of α-keto acid combined with low protein diet on kidney function, calcium-phosphorus metabolism and adenosine deaminase activity in malnourished patients with long term peritoneal dialysis.Methods Forty-six cases malnourished patients with long term peritoneal dialysis were selected from May 2013 to August 2014 in the hospital and divided into two groups.The control group (n=23) were treated by conventional therapy, acceptable daily intake of protein 1.2 g/(kg? d).The experiment group (n=23) were treated by α-keto acid combined with low protein diet, acceptable daily intake of protein 0.8 g/(kg? d).Two groups were treated for three months.Serum calcium, phosphorus, nutritional status assessment, adenosine deaminase activity and renal function were observed and compared after treatment.ResuIts After twelve months ’ treatment, compared with control group, serum creatinine, blood urea nitrogen, serum uric acid of experiment group were lower ( P<0.05); serum calcium level was higher (P<0.05), serum phosphorus level was lower (P<0.05);ADA activity and white blood cell count were lower (P<0.05). The incidence of malnutrition rate had no significant difference between two groups(χ2 =3.136,P>0.05).ConcIusion α-keto acid combined with low protein diet could effectively increase serum calcium level, reduce serum phosphorus level, ADA activity and WBC count, and improve nutritional status in long-term peritoneal dialysis patients, which has important significance.