新型低蛋白肠内营养制剂对慢性肾脏疾病患者效果研究  

Study on the effect of new low-protein enteral nutritional preparation onpatients with chronic kidney disease

作　　者：郭鉴葵 周子琪 柳园[2] 陈懿[3] 黄月阳 胡雯 GUO Jian-kui;ZHOU Zi-qi;LIU Yuan;CHEN Yi;HUANG Yue-yang;HU Wen(Department of Nutrition and Food Hygiene,West China School of Public Health,Sichuan University/West China Fourth Hospital,Chengdu,Sichuan 610041,China)

机构地区：[1]四川大学华西公共卫生学院/华西第四医院营养与食品卫生学系,四川成都610041 [2]四川大学华西医院临床营养科,四川成都610041 [3]四川大学华西医院肾内科

出　　处：《现代预防医学》2024年第3期564-571,共8页Modern Preventive Medicine

基　　金：2017年食品安全国家标准制定、修订项目(spaq-2017-015);广东省重点领域研发计划(2019B020213002)。

摘　　要：目的 探索个体化饮食指导下,新型低蛋白肠内营养制剂对慢性肾脏病3~4期患者营养状况的影响。方法 选取四川大学华西医院随访门诊患者60例,随机分为试验组与对照组,两组在个体化饮食指导的基础上使用新型低蛋白肠内营养制剂或特殊医学用途全营养型配方食品,在干预第0、45和90 d各随访一次。根据意向性分析原则,采用广义估计方程分析不同营养制剂干预患者的组间差异、时间变化趋势及其交互作用,并采用符合方案数据分析原则进一步验证试验结果的稳定性。结果 试验组与对照组在营养充足性、临床有效性及人体测量指标上均不存在组间差异(P>0.05)。干预期间,两组患者在能量摄入稳定情况下蛋白质(χ^(2)=17.680, P<0.001)、钠盐(χ^(2)=21.427, P<0.001)摄入量显著降低,而总蛋白(χ^(2)=18.075, P<0.001)、钙(χ^(2)=9.438, P=0.009)、磷(χ^(2)=13.866, P=0.001)、尿酸(χ^(2)=9.005, P=0.011)在正常范围内波动。符合方案数据分析结果与意向性分析结果基本一致,仅有上臂肌围的时间变化趋势(χ^(2)=6.435, P=0.040)及能量比率的组间比较(χ^(2)=4.478, P=0.034)存在显著性差异。结论 该新型低蛋白肠内营养制剂在改善患者营养状况,延缓疾病进展方面不劣于特殊医学用途全营养型配方食品。饮食指导下使用肠内营养制剂有利于慢性肾脏疾病患者的临床营养管理。Objective To explore the effect of a new type of low-protein enteral nutrition on the nutritional status of patients with chronic kidney disease in stage 3-4 under the guidance of individualized diet.Methods Sixty follow-up outpatients in West China Hospital of Sichuan University were randomly divided into the experimental group and the control group.The two groups were followed up on intervention day 0,day 45,and day 90.According to the principle of intentional analysis,the generalized estimation equation was used to analyze the between-group differences,time change trend,and interaction effect,and the principle of data analysis in accordance with the scheme was used to further verify the stability of results.Results There was no significant difference in nutritional adequacy,clinical effectiveness,and anthropometric indexes between the test group and the control group(P>0.05).During the intervention period,when the energy intake was stable,the intake of protein(χ^(2)=17.680,P<0.001)and sodium salt(χ^(2)=21.427,P<0.001)decreased significantly,while the total protein(χ^(2)=18.075,P<0.001),calcium(χ^(2)=9.438,P=0.009),phosphorus(χ^(2)=13.866,P=0.001),and uric acid(χ^(2)=9.005,P=0.011)fluctuated within the normal range.The results of data analysis in accordance with the scheme were basically consistent with those of intentionality analysis.Only the time change trend of upper arm muscle circumference(χ^(2)=6.435,P=0.040)and the comparison of energy ratio between groups(χ^(2)=4.478,P=0.034)were significantly different.Conclusion The new low-protein enteral nutrition preparation is not inferior to the total nutritional formula food for special medical use in improving the nutritional status of patients and delaying the progression of the disease.The use of enteral nutrition under dietary guidance is beneficial to the clinical nutrition management of patients with chronic kidney disease.

关 键 词：慢性肾脏病 饮食指导 低蛋白饮食 肠内营养制剂 特殊医学用途配方食品 

分 类 号：R459.3[医药卫生—治疗学] R151.41[医药卫生—临床医学] R692.5