不同蛋白质摄入对慢性肾脏病3期患者肾功能的影响  

Retrospective analysis of influences of different protein intake on renal function in patients with stage 3 chronic kidney disease

作　　者：王小琪[1] 代文迪[1] 刁宗礼[1] 王丽妍[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,北京100050

出　　处：《首都医科大学学报》2015年第6期953-957,共5页Journal of Capital Medical University

基　　金：国家自然科学基金(81300607);十二五国家科技支撑计划项目(Z001BAI10B08);北京市科学技术委员会科技计划重大项目(D131100004713001)~~

摘　　要：目的分析饮食中不同平均每日蛋白质摄入水平对慢性肾脏病（chronic kidney disease,CKD）3期患者肾功能的影响。方法选择2013年1月至2015年5月在首都医科大学附属北京友谊医院CKD门诊规律随访时间超过24个月的CKD3期患者进行回顾性分析,收集患者的一般资料,包括原发病、实验室检查、饮食回顾等,计算出患者饮食中平均每日蛋白质摄入量（dietary protein intake,DPI）。将按平均DPI分为3组：DPI≤0.6 g·kg^-1·d^-1为极低蛋白饮食（very low protein diet,VLPD）组;DPI在0.6~0.8 g·kg^-1·d^-1为低蛋白饮食（low protein diet,LPD）组;DPI〉0.8 g·kg^-1·d^-1为高蛋白饮食（normal protein diet,NPD）组。应用简化肾脏病饮食改良（modification of diet in renal disease,MDRD）公式估算肾小球滤过率（estimated glomerular filtration rate,e GFR）,并比较不同DPI分组下肾功能随时间的下降情况。结果本研究共入选221例患者,其中VLPD组61例、LPD组118例、NPD组42例患者;经过重复测量的方差分析比较发现,基线水平下3组患者e GFR差异无统计学意义（P〉0.05）,随访过程中,VLPD组和NPD组CKD患者e GFR较基线水平有逐步下降趋势,二者下降速率相似,但随访至第24个月时差异无统计学意义（P=0.050,P=0.054）,而随访过程中LPD组e GFR与基线相比则无明显降低。随访至24个月,VLPD组与LPD组相比e GFR有所降低,差异有统计学意义（P=0.024）,而NPD组e GFR与LPD组相比虽有所下降,但差异无统计学意义（P=0.068）。结论对CKD3期患者而言,低蛋白摄入对延缓肾功能进展可能存在一定的保护作用,但极低蛋白摄入则可能会增加肾功能恶化的风险。Objective To explore retrospectively the influence of different protein intake on renal prognosis in patients with stage 3chronic kidney disease（ CKD）. Methods Follow up data was successfully obtained in the 221 patients with stage 3 CKD who followed more than 24 months from January 2013 to May 2015,the clinical data and laboratory tests were collected,including primary disease,body mass index,diet reviews,daily protein intake（ DPI） and laboratory tests. A simplified modification of diet in renal disease（ MDRD）formula was adopted to calculate the level of estimated glomemlar filtration rate（ e GFR）. The patients were divided into 3 groups according to the level of DPI： very low protein diet（ VLPD） as DPI≤0. 6 g·kg^-1·d^-1（ n=61）,low protein diet（ LPD） as DPI from 0. 6 to 0. 8 g·kg^-1·d^-1（ n=118） and normal protein diet（ NPD） as DPI0. 8 g·kg^-1·d^-1（ n=42）. Results There were no significant difference between 3 groups in e GFR level at the baseline（ P〈0. 05）. However,the e GFR of VLPD and NPD group tend to decrease progressively in a similar rate with the prolonging of time,both were merely missed the statistically significance compared with each baseline level at the end of the observation（ P = 0. 050,P = 0. 054）,and no decrease was observed in NPD group. Compared with LPD group,the e GFR level of VLPD group significantly decreased on month 24（ P = 0. 024）. Conclusion The low-protein diet（ DPI between 0. 6-0. 8 g· kg^-1·d^-1） may contribute to delaying the deterioration of renal function,but the very low protein diet（ DPI≤0. 6 g·kg^-1·d^-1） may increase the risk of the progress of CKD.

关 键 词：慢性肾脏病 肾功能不全 每日蛋白质摄入 低蛋白饮食 

分 类 号：R692[医药卫生—泌尿科学]