糖尿病肾病蛋白质摄入水平与患者肾脏功能损害进展及预后的关联性  

Association of Protein Intake Level with Progression of Renal Function Impairment and Prognosis in Diabetic Kidney Disease

作　　者：沈晴明 戚洪 陈珍珍 袁玲 SHEN Qing-ming;QI Hong;CHEN Zhen-zhen;YUAN Ling(Department of Nephrology,First Affiliated Hospital of Anhui University of Science and Technology(Huainan First People's Hospital),Huainan 232000,China)

机构地区：[1]安徽理工大学第一附属医院(淮南市第一人民医院)肾脏内科,安徽淮南232000

出　　处：《中国食物与营养》2024年第8期78-83,共6页Food and Nutrition in China

摘　　要：目的:探讨不同的蛋白质摄入水平与糖尿病肾病(DKD)患者肾功能损伤程度进展的关系。方法:采用前瞻性队列研究方法,选取早期DN患者进行随访观察,根据患者入组前1周监控的24小时尿尿素氮评估蛋白质摄入量,参考2020年肾病预后质量建议(KDOQI)标准,符合低蛋白饮食标准的早期DN患者53例[蛋白质摄入量0.6~0.8 g/(kg·d)(低蛋白组)]、符合高蛋白饮食标准的早期DN患者54例[蛋白质摄入量>0.8 g/(kg·d)(高蛋白组)],对两组患者进行连续随访12个月,对比肾功能相关指标的变化及预后差异。结果:在入组时,低蛋白组和高蛋白组的FPG、HbA1c、SBP、DBP、TG、TC水平比较,差异均无统计学意义(P>0.05);随访24个月,低蛋白组的FPG、HbA1c、SBP、DBP、TG、TC水平与高蛋白组比较,差异均无统计学意义(P>0.05);在入组时,低蛋白组和高蛋白组的BUN、Scr、24小时尿蛋白、ALB、血尿酸、β2-MG水平比较,差异均无统计学意义(P>0.05);随访24个月,低蛋白组的BUN、Scr、24小时尿蛋白、血尿酸、β2-MG水平均低于高蛋白组,差异均具有统计学意义(P<0.05);随访24个月,低蛋白组有7例患者发生终点事件,高蛋白组有17例患者发生终点事件,低蛋白组的终点事件发生率显著低于高蛋白组(P<0.05)。对两组患者进行生存分析,低蛋白组患者的无疾病进展生存时间长于高蛋白组(χ^(2)=3.953、P=0.047<0.05)。结论:对于早期DKD患者,采取低蛋白饮食控制干预,有利于延缓肾功能损伤进展,降低临床期DKD的发生率。【Objective】To investigate the relationship between different protein intake levels and the progression of renal function impairment in diabetic kidney disease(DKD)patients.【Method】A prospective cohort study was used to select patients with early DN for follow-up observation.Protein intake was assessed according to 24-hour urinary urea nitrogen monitoring 1 week before enrollment,and the 2020 Quality Recommendations for Renal Outcomes(KDOQI)criteria were used.There were 53 patients with early DN who met the low protein diet standard[protein intake 0.6—0.8 g(/kg·d)(low protein group)]and 54 patients with early DN who met the high protein diet standard[protein intake>0.8 g(/kg·d)(high protein group)].Both groups were followed up for 12 months.The changes of renal function and prognosis were compared.【Result】There was no significant difference in FPG,HbA1c,SBP,DBP,TG and TC levels between low protein group and high protein group(P>0.05).After 24 months of follow-up,there were no significant differences in FPG,HbA1c,SBP,DBP,TG and TC levels between the low protein group and the high protein group(P>0.05).There were no significant differences in BUN,Scr,24-hour urinary protein,ALB,blood uric acid and β2-MG levels between low protein group and high protein group at the time of enrollment(P>0.05).After 24 months of follow-up,BUN,Scr,24-hour urinary protein,blood uric acid and β2-MG levels in the low protein group were lower than those in the high protein group,with statistical significance(P<0.05).After 24 months of follow-up,7 patients in the low protein group had endpoint events,and 17 patients in the high protein group had endpoint events.The incidence of endpoint events in the low protein group was significantly lower than that in the high protein group(P<0.05).Survival analysis of the two groups showed that the survival time without disease progression was longer in the low protein group than in the high protein group(χ^(2)=3.953,P=0.047<0.05).【Conclusion】For patients with early DKD,low-protei

关 键 词：蛋白质 糖尿病肾病 肾功能损伤 预后 尿素氮 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]