不同低蛋白饮食延缓CRF进程的临床研究

目的：观察大豆蛋白为主的低蛋白饮食（LVPD）和动物蛋白为主的低蛋白饮食（LAPD）延缓CKD3～4期患者肾功能减退的疗效和安全性。方法：42例CKD3～4期（eGFR15～59ml/min）患者分成LVPD（22例）和LAPD（20例）两组,其人口学、疾病程度、治疗状况、蛋白质与热量摄入均具可比性,但LAPD组要求动物蛋白摄入占总蛋白的50%,LVPD组要求动、植物蛋白之比30%和70%,且植物蛋白中大豆蛋白占50%以上。研究周期为12个月。主要观察u-pro、eGFR、Scr、BUN、TC、TG、LDL、HDL、Alb、PA、TF、Ca2＋、P3-及人体测量指数等。结果：两组患者均能改善eGFR、减少u-pro,其中LVPD组自身前后对比差异有统计学意义（P〈0.05～P〈0.01）,LAPD组差异无统计学意义（P〉0.05）,两组间对比差异亦无统计学（P〉0.05）;LVPD组治后较治前血PA、TF、HDL、Ca2＋增高,LDL、P3-降低（P〈0.05～P〈0.01）,其中对HDL、Ca2＋、P3-的疗效优于LAPD组（P〈0.01）;两组血Alb、TC、TG以及人体测量指数基本稳定。结论：LVPD和LAPD对CKD3～4期患者均有一定的减少尿蛋白,延缓肾功能减退的作用,但LVPD在调节脂质及钙磷代谢方面更具有优势。

Clinical Study of Different Low Patient Diet to Delay Process of CRF

Objective：To observe the efficacy and safety of soy protein-based vegetable low-protein diet （LVPD） and animal protein-based low-protein diet （LAPD） to delay the renal dysfunction of CKD 3～4 patients.Methods：42 cases,stage CKD 3～4 （eGFR 15～59 ml/min）,were divided into two groups,LVPD （n=22） and the LAPD （n=20）,their demographic,disease and treatment status,protein and calorie intake were comparable.But LAPD group consumed a diet containing at least 50% animal proteins,LVPD group consumed diet containing 70% vegetable proteins and 30% animal proteins,and soy protein is more than 50% ratio of the vegetable protein.The study lasted 12 months.Collected data of u-pro,eGFR,Scr,BUN,TH,TG,LDL,HDL,Alb,PA,TF,Ca2＋,P3-and anthropometry.Results：All patients can improve eGFR,reduce u-pro,which LVPD group have a significant different before and after the study （P0.05～P0.01）,LAPD group was no significant difference （P0.05）,and no significant difference between the two groups （P0.05）;LVPD group serum PA,TF,HDL,Ca2＋ increased,and LDL,P3-decreased after the study （P0.05～P0.01）,furthermore LVPD group＇s HDL,Ca2＋,P3-have significant difference,compared with the LAPD group（P0.01）;The serum Alb,TC,TG and anthropometry were stable.Conclusion：There are certain reduction with urinary protein and delay of renal dysfunction in patients with LVPD and the LAPD on CKD 3～4,but LVPD in regulation of lipid,calcium and phosphorus metabolism have more advantages.