低蛋白饮食状态下尿蛋白对临床期2型糖尿病肾病肾功能的影响  

Influence of Urine Protein under Condition of Low Protein Diet on Nephric Function of Type-Ⅱ-diabetic Nephropathy

作　　者：韩家强[1] 宋伟娜[1] 刘锋[2] 王金萍[3] 

机构地区：[1]解放军第210医院干部二科,辽宁大连116021 [2]解放军第210医院403临床部,辽宁大连116021 [3]解放军第210医院大连大学附属医院,辽宁大连116021

出　　处：《临床军医杂志》2008年第4期502-506,共5页Clinical Journal of Medical Officers

基　　金：日中世川医学奖学金资助(200204-200303)

摘　　要：目的观察低蛋白饮食对临床期2型糖尿病肾病肾功能减退的抑制作用与尿蛋白水平和尿蛋白变化的关系。方法106例2型糖尿病患者,内生肌酐清除率（Ccr）在45ml/min以下,尿蛋白定量均〉0.3g/24h,血压靶目标值控制在130/80mmHg（1mmHg=0.133kPa）,饮食指导内容,摄入热量平均为（125.10±8.37）kJ/d,蛋白质为（0.66±0.05）g/d,钠（6.9±0.3）g/d,观察时间平均为（23±14）个月。根据观察期间蛋白质摄入量的平均值（DPI）的不同,把观察对象分为三组：Ⅰ组0.7g/（kg·d）以下,Ⅱ组0.7-0.9g/（kg·d）,Ⅲ组0.9g/（kg·d）以上。结果（1）比较好地遵守低蛋白饮食的Ⅰ组与Ⅱ、Ⅲ组比较,肾功能减退速度减慢,尿蛋白减少;（2）在尿蛋白水平相对一致的对象中,没有发现低蛋白饮食对肾功能减退有抑制作用;相反与蛋白质摄入量无关,尿蛋白量多的患者肾功能减退速度加快;（3）在观察开始时尿蛋白水平相对一致的基础上,不管是否比较好地遵守了低蛋白饮食,尿蛋白减少的幅度没有明显差异;（4）与DPI无关,观察开始时尿蛋白量与观察期间最小尿蛋白量之间的变化率和D-Ccr具有负相关关系。结论临床期2型糖尿病肾病肾功能不全患者,与饮食中低蛋白水平无关,尿蛋白水平和尿蛋白减少对肾功能的进展有影响;在评价低蛋白饮食对糖尿病肾病肾功能的影响时,要考察到尿蛋白在其中的作用。Objective To observe the restraint impacts of low protein diet （LPD） and urine protein level on the deterioration of nephric function of clinical type-Ⅱ-diabetic nephropathy. Methods A total of 106 patients with type-Ⅱ diabetese were enrolled into the observation. All the patients complied with the request that clearance of creatinine （Ccr） was lower than 45 ml/min, that urine protein amount was higher than 0.3 g/24 h, and that blood pressure target was controlled at 130/80 mmHg. As for the diet intake instruction, the quantity of heat （or calorie） was averagely at 125.10±8.37 KJ/d, the protein was at 0.66±0.05 g/d, and the sodium was at 6.9±0.3 g/d. The observation lasted for 23±14 months. According to the dietary protein intake （DPI） during the observation duration, the subjects were divided into three groups, i.e. Group Ⅰ with a DPI under 0.7 g/d, Group Ⅱ with a DPI under 0.7-0.9 g/d, and Group Ⅲ with a DPI over 0.9 g/d. Results （1） The deterioration of nephric function was slower and the urine protein level was lower in Group Ⅰ that tried to obeyed to LPD than in Group Ⅱ and Group Ⅲ. （2） In those whose urine protein levels were accordant, LPD had no restraint impact on the deterioration of nephric function; in those whose urine protein levels were high, the nephric function deteriorated faster, unrelated with protein intake. （3） On the basis of comparatively accordant urine protein level at the beginning of the observation, there were no significant differences in the reduction of urine protein regardless of obedience to LPD. （4） Unrelated with DPI, the change rate between urine protein amount at the beginning of the observation and the least urine protein amount during the observation was negatively correlative with the speed of the decrease in Ccr. Conclusion In the patients with nephric insufficiency due to clinical type-Ⅱ-diabetic nephropathy, urine protein level and urine protein reduction exert influence on nephric function, unrelated with LPD. The r

关 键 词：糖尿病肾病 低蛋白饮食 肾功能减退 尿蛋白 

分 类 号：R587.1[医药卫生—内分泌]