低蛋白质饮食联合复方α酮酸对糖尿病肾脏疾病患者血管内皮功能的影响  

Effect of low protein diet combined with compound with α-keto acid on function of vascular endothelial cells in diabetic kidney disease

作　　者：乐岭[1] 向光大[1] 赵林双[1] 朱广平[1] 孙慧伶[1] 谢峻[1] 汪嘉琪 

机构地区：[1]广州军区武汉总医院,武汉430070 [2]解放军61726部队门诊部,武汉430074

出　　处：《临床肾脏病杂志》2013年第11期506-510,共5页Journal Of Clinical Nephrology

基　　金：全军＂十一五＂计划面上项目 （NO.06MB166）

摘　　要：目的 观察合并大量蛋白尿的2型糖尿病患者在不同方法干预后的血管内皮功能的变化.方法 60例2型糖尿病合并大量蛋白尿患者血糖控制达标后在低蛋白质饮食（食物中蛋白质含量0.8 g·kg-1·d-1）的基础上随机分为治疗组和对照组,分别给予复方α酮酸和缬沙坦,共治疗12周.于治疗前后空腹采血测定血糖（FPG）、糖化血红蛋白（HbA1c）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、超敏C反应蛋白（hsCRP）,留取24 h尿测定白蛋白,并通过超声测定其肱动脉血管内径、基础血流、内皮依赖性血管内径变化（EDD）率及硝酸甘油介导的血管内径变化率,通过99mTc-二已三胺乙酸ECT法测定肾小球滤过率（GFR）,并进行比较.结果 治疗前两组基线资料无显著性差异,组内比较治疗后与治疗前比较FBS、HbA1c、HDL-C水平相似,hs-CRP、24 h尿白蛋白下降（P〈0.05）,GFR、EDD升高（P〈0.05）,检测指标的组间比较无显著性差异.结论 低蛋白质饮食联合复方α酮酸可改善合并大量蛋白尿的糖尿病患者的血管内皮功能,减少尿白蛋白漏出,效果与缬沙坦相似,并且复方α酮酸治疗无低血压、头昏及高钾血症等不良反应.Objective To observe the change of vascular endothelial function in type 2 diabetic patients with massive proteinuria after different interventions. Methods On the basis of well-controlled blood sugar and low protein diet, 64 type 2 diabetic patients with massive proteinuria were ran- domly divided into experimental group （compound α-keto） and control group （valsartan）. Both groups were treated for 12 weeks. Fasting blood sugar （FBS）, glycosylated hemoglobin （HbAlc）, low density lipoprotein cholesterol （LDL-C）, high density lipoprotein cholesterol （HDL-C） and high-sensitivity C-reactive protein （hsCRP） were determined before and after the treatment. 24 h urine was kept to determine albumiva Inner diameter, baseline blood flow, endothelium-dependent diameter change rate and nitroglycerin-mediated diameter change rate of bracbial artery were detected by ultrasound. Glo- merular filtration rate （GFR） was detected by 99mTc-ECT assay. Those results were compared between two groups. Results The baseline data were similar in two groups before the treatment. FBS, HbAlc and HDL-C levels were similar in two groups before and after the treatment, hsCRP and 24-h urinary albumin were decreased （P〈0. 05）, and GFR and EDD were increased （P〈0. 05）, but there was no significant difference between the two groups. Conclusions Protein-restricted diet combined with compound α-keto acid could improve vascular endothelial function in type 2 diabetic patients with massive proteinuria and decrease urinary albumin leakage. Those effects were similar as compared to valsartan. Low protein diet combined with compound α-keto acid would not enhance dizziness, lowblood pressure and hyperkalemia.

关 键 词：糖尿病 内皮功能 低蛋白质饮食 复方Α酮酸 

分 类 号：R5[医药卫生—内科学]