维持性血液透析患者饮食蛋白摄入与营养状况的相关研究  

Relationship between dietary protein intake and nutritional status in maintenance hemodialysis patients

作　　者：张瑜凌 王梦婧[1] 俞苹[1] 邵莲菁[1] 陶艳菊[1] 姚瑶[1] 袁立[1] 李海明[1] 陈靖[1] 

机构地区：[1]复旦大学附属华山医院肾内科,上海200040

出　　处：《中华肾脏病杂志》2016年第3期161-166,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金（81170684）;上海市优秀学科带头人培养计划（XBR2013080）;上海市科技人才计划项目（15XDl501000）

摘　　要：目的评估不同蛋白量饮食对维持性血液透析（MHD）患者营养情况及骨矿物质代谢的影响。方法本研究包括横断面研究及前瞻性队列研究两部分，患者分成每日蛋白摄入量（DPI）≥1．2g·kg-1·d-1组（HP组）和DPI〈1．2g·kg-1·d-1组（NP组），队列研究以研究起点的DPI进行分组。横断面研究收集华山医院血液净化中心126例MHD患者的一般情况、饮食情况及生化指标，评估不同蛋白摄入量的MHD患者营养及骨矿物质代谢情况。前瞻性队列研究入选本血透中心饮食稳定的MHD患者32例，随访两年，每3月随访患者饮食情况，同时检测血生化指标，并于研究起点及终点行人体测量，评估长期不同蛋白量饮食对MHD患者营养情况及骨矿物质代谢的影响。结果横断面研究中HP组患者DPI为（1．36±0．14）g·kg-1·d-1，NP组DPI为（1．04±0．09）g·kg-1·d-1，HP组患者DPI、每日能量摄入（DEI）、标准化氮表现率相当蛋白（nPNA）、血磷均显著高于NP组，二氧化碳结合力（CO2CP）显著低于NP组（均P〈0．05）。两组患者血红蛋白、总蛋白、白蛋白、总胆固醇、血钙、全段甲状旁腺素（iPTH）差异均无统计学意义。前瞻性队列研究中HP组患者DPI为（1．35±0．13）g·kg-1·d-1，NP组DPI为（1．05±0．11）g·kg-1·d-1。随访期间各项目不同时间点差异均无统计学意义（均P分组〉0．05），HP组患者DPI、nPNA、血磷显著高于NP组，CO2CP显著低于NP组（均P分组〈0．05）。但两组患者血红蛋白、总蛋白、白蛋白、总胆固醇、体重指数（BMI）、上臂肌围、三头肌皮脂厚差异均无统计学意义。结论对营养情况良好的MHD患者，DPI控制在1．05g·kg-1·d-1左右能满足患者营养的一般需求，并能减轻高磷血症及酸中毒。Objective To assess the influence of protein intake on nutritional status and mineral metabolism in patients with maintenance hemodialysis （MHD）. Methods A cross-sectional study and a prospective cohort study were conducted. According to dietary protein intake （DPI）, patients were divided into two groups： DPI≥ 1.2 g·kg-1·d-1 group （HP group） and DPI 〈 1.2g·kg-1·d-1 group （NP group）. One hundred and twenty-six MHD patients were enrolled in the cross-sectional study and their datum of dietary intake, as well as laboratory examinations were recorded. In the prospective cohort study lasted 2 years, 32 MHD patients were enrolled, with their dietary and laboratory examinations being collected every 3 months, and somatometric measurements being recorded at the beginning and the end of the study. Results In the cross-sectional study, the average DPI of HP group was （1.36±0.14）g·kg-1·d-1 and the average DPI of NP group was （1.04±0.09） g·kg-1·d-1. Compared with patients in NP group, patients in HP group had higher DPI, daily energy intake （DEI）, normalized protein equivalent of nitrogen appearance rate （nPNA） and serum phosphate, and lower carbon dioxide combining power （CO2CP） （all P 〈 0.05） . There was no difference between two groups in hemoglobin, total protein, albumin, total cholestoral, blood calcium and intact parathyroid hormone （iPTH）. In the prospective cohort study, the average DPI of HP group was （1.35±0.13） g·kg-1·d-1 and the average DPI of NP group was （1.05±0.11）g·kg-1·d-1. During the follow-up period, there were no significant differences in times comparison （all Ptime 〉 0.05）. There was higher DPI, nPNA and serum phosphate, and lower CO2CP in HP group, than those in NP group （all Pgroup 〈 0.05）. In terms of hemoglobin, total protein, albumin, total cholestoral and somatometric measurements, there was no difference between two groups （all Pgroup 〉 0.05）. Conclusions DPI around 1.05g·kg-1·d-1 can satisfy the nutr

关 键 词：肾透析 营养状况 高磷血症 酸中毒 

分 类 号：R692.5[医药卫生—泌尿科学]