慢性肾衰血透患者营养不良治疗与高磷血症防治的临床研究  

Prevention and treatment of hyperphosphatemia associated with nutritional therapy in maintenance hemodialysis patients

作　　者：马彬[1] 栾韶东[1] 何永成[1] 

机构地区：[1]深圳市第二人民医院肾内科,广东深圳518035

出　　处：《西北国防医学杂志》2009年第3期184-186,共3页Medical Journal of National Defending Forces in Northwest China

基　　金：深圳市科技计划科研资助项目(JH200507120839A)

摘　　要：目的:探讨慢性肾衰(CRF)维持性血透患者营养不良治疗中高磷血症及其并发症的防治。方法:将CRF维持性血透患者60例随机分为A、B两组,每组30人。A组采用低磷全乳清蛋白饮食,B组采用普通高生物价蛋白饮食。测定血红蛋白、血清白蛋白、前白蛋白、转铁蛋白、尿素氮、肌酐、血钙、磷及全段甲状旁腺激素(iPTH)、颈动脉硬化情况,并用主观综合营养评估法(SGA)进行主观营养评判。结果:两种蛋白质饮食治疗均能减少营养不良发生率,但B组患者血磷及iPTH水平升高,钙磷乘积增高,肾性骨病及颈动脉硬化发病例数明显增加。结论:普通高生物价蛋白饮食增加高磷血症,并与继发性甲状旁腺功能亢进(SHPT)、肾性骨病及血管硬化密切相关。低磷全乳清蛋白饮食有效防治患者营养不良并减少高磷血症。Objective：To study the prevention and treatment of hyperphosphatemia during nutritional therapy in maintenance hemodialysis patients （MHD）. Methods： 60 cases of MHD were enrolled in this study and divided into 2 groups： group A and group B, which have 30 cases each. In group A, low phosphorus lactalbumin was prescribed to each patient. In group B, high quality protein diet was conducted. Hemoglobin, serum albumin and prealbumin, transferrin, blood urea nitrogen （BUN）, creatinine, calcium, phosphorus and intact parathyroid hormone （iPTH） were examined and the degree of carotid calcification was evaluated. Subject gross assessment （SGA） was applied at the same time. Results：Improvement in nutritional status to same extent in each group was observed by the end of the study. Significant elevation of serum phosphorus, calcium/phosphorus product and iPTH were observed in group B. Cases of renal osteopathy and carotid calcification in group B were significantly more than that in group A. Conclusion： High quality protein diet is closely related with hyperphosphatemia, secondary hyperparathyroidism （SHPT） , renal osteopathy and vessel calcification in MHD patients. Low phosphorus lactalbumin diet could improve nutrition status and prevent hyperphosphatemia in these patients.

关 键 词：慢性肾衰 血液透析 营养不良 高蛋白饮食 高磷血症 

分 类 号：R692.5[医药卫生—泌尿科学]