不同蛋白质摄入对进展期慢性肾脏病患者肾脏预后的影响  

Retrospective analysis of influence of differential protein intake on renal prognosis for progressive chronic kidney disease

作　　者：代文迪[1] 尹道鑫 崔文英[1] 刘文虎[1] 

机构地区：[1]首都医科大学附属北京友谊医院肾内科首都医科大学肾病学系,100050

出　　处：《中华医学杂志》2014年第4期256-259,共4页National Medical Journal of China

基　　金：北京市科学技术委员会科技计划重大项目（D09050704310903）

摘　　要：目的分析不同蛋白质饮食对慢性肾脏病（CKD）患者肾功能的影响。方法通过问卷调查和收集临床资料相结合的方法，对2009年1月一2012年7月在北京友谊医院肾内科CKD门诊就诊的159例2～4期CKD患者资料进行回顾性分析。利用门诊登记随访系统每个月对患者进行临床随访，记录患者的门诊随访资料，包括原发病、血压、体质指数（BMI）、生化指标、蛋白质能量营养不良（PEM）评估、饮食回顾等，计算饮食中每日蛋白质摄入量（DPI）评估明确营养状态，应用简化的MDRD公式计算估算。肾小球滤过率（eGFR）。根据不同的DPI将CKD患者分为极低蛋白饮食（VLPD）组：DPI≤0．6g·kg-1·d-1；低蛋白饮食（LPD）组：DPI〉0．6～〈0．8g·kg-1·d-1；正常蛋白饮食（NPD）组：DPI≥0．8g·kg-1·d-1。结果（1）159例患者中，4例（2．50％）进展到尿毒症期行肾脏替代治疗，2例（1．25％）出现肾功能迅速下降住院，9例（5．66％）因心脑血管疾病住院，2年。肾存活率97．5％。（2）研究结束时共发生PEM9例，其中血浆白蛋白〈32S／L共2例，BMI〈20kg／m2共7例，CKD各期相比发生PEM差异均无统计学意义（均P〉0．05）。（3）Pearson相关分析显示不同DPI与AeGFR无显著相关性，且不同DPI对AeGFR影响差异无统计学意义，各组间比较均P〉0．05。结论在一定范围内，不同蛋白质摄人量对CKD患者肾脏预后可能无明显影响。Objective To explore retrospectively the influence of differential protein intake on renal prognosis for progressive chronic kidney disease （CKD）. Methods A total of 159 chronic kidney disease patients at stages 2, 3 and 4 were enrolled and a questionnaire survey was conducted from January 2009 to July 2012. They were followed monthly and their clinical data collected, including primary disease, blood pressure, body mass index and adverse events. Laboratory tests were performed every 3 months, including biochemical parameters, protein-energy malnutrition （PEM）, diet reviews and daily protein intake （DPI）. A simplified MDRD formula was employed to evaluate the level of estimated glomerular filtration rate （eGFR）. According to the level of DPI, they were divided into 3 groups of very low protein diet （VLPD） ： DPI≤0. 6 g · kg-1 · d-1, low-protein diet （LPD） ： DPI 〉0. 6 - 〈0. 8 g · kg-1 · d-1 and normal-protein diet （NPD） ： DPI ≥0. 8 g · kg-1 ·d-1. Results Among them, 4 cases （2. 50% ） progressed to uremia stage and received renal replacement therapy, 2 （ 1.25% ） experienced rapid decline in renal function, 9 （5.66%） were hospitalized from eardio-eerebral diseases and the 2-year kidney survival rate was 97.5%. At the end of study, among 9 patients of PEM, 2 subjects had a serum level of albumin under 32 g/L and another 7 with a BMI 〈 20 kg/m2. No significant difference existed in PEM among different stages of CKD. There was no significant correlation between DPI and A GFR （ all P 〉 0. 05）. Conclusion Within a certain range, differential protein intake may not significantly affect the prognosis of kidney for progressive CKD patients.

关 键 词：肾机能不全 慢性 膳食 限制蛋白质 蛋白质能量营养不良 

分 类 号：R692[医药卫生—泌尿科学]