严格限盐对慢性肾小球肾炎患者血压及尿蛋白的影响

目的 评价严格饮食限盐对慢性肾小球.肾炎(CGN)患者血压及尿蛋白的影响.方法 选取2007年10月至2009年4月于北京大学第一医院肾内科住院且病情稳定的CGN患者32例,其中15例为试验组,17例为对照组,分别给予7 d严格限盐饮食(钠100 mmol/d,钾50 mmol/d,蛋白质0.8～1.0 g·kg~(-1)·d~(-1),热卡105～125 kJ·kg~(-1)·d~(-1))和医院普通饮食,应用24 h尿钠(24h-UNa)监测饮食钠摄入,观察两组患者血压、尿蛋白的变化.研究期间所有治疗维持不变.结果 入选时试验组24h-UNa为(135.1 4±50.4)mmol/d,与对照组(137.4 4±28.6)mmol/d 比较差异无统计学意义(P=0.743).试验组研究期间每天测定24h-UNa,为(97.2 ±8.6)mmol/d.限盐后患者收缩压由(117.7 ±10.0)mm Hg(1 mm Hg=0.133 kPa)降至(106.2 ±9.9)mm Hg(P<0.001),舒张压由(76.3 ±6.1)mm Hg降至(67.5 ±5.5)mm Hg(P<0.001),尿蛋自由1.57(0.3～3.0)g/d降至0.57(0.16～2.72)g/d(P=0.006).收缩压下降与尿钠减少呈正相关(r=0.572,P=0.026);尿蛋白减少与收缩压下降(r=0.568,P=0.027)及尿钠减少(r=0.525,P=0.044)均呈正相关.对照组仅收缩压由(122.6 ±15.5)mm Hg降低至(115.8 ±10.4)mm Hg(P=0.02),舒张压和尿蛋白呈下降趋势,但差异无统计学意义.两组中使用血管紧张素转换酶抑制剂和(或)血管紧张素Ⅱ受体拮抗剂的患者亚组比较显示,血压变化值无统计学差异,试验组尿蛋白的减少显著优于对照组-0.4(-0.95～0.07)比0.07(-0.39～0.42),P=0.014].结论 严格饮食限盐有助于CGN患者更好地降低血压及尿蛋白.

The effects of strict dietary salt restriction on blood pressure and proteinuria in chronic glomerulonephritis patients

Objective To evaluate the effects of strict dietary salt restriction on blood pressure and proteinuria in chronic glomerulonephritis (CGN) patients. Methods From October 2007 to April 2009, 32 CGN inpatients were enrolled. Among them, 15 patients followed a strict dietary salt restriction menu (sodium 100 mmol/d, potassium 50 mmol/d, protein (0. 8-1. 0) g · kg~(-1) · d~(-1) , calorie (105-125) KJ · kg~(-1) · d~(-1) ) for 7 days, while the other 17 patients were fed freely offered by hospital as controls. 24 h urinary sodium excretion (24h-UNa) was used to monitor the salt intake. No changes of drug therapy were made during the study. Blood pressure was monitored every day. 24-hour urinary protein and serum biochemical parameter were measured before and after the study. Results There was no significant difference of baseline 24h-UNa between the two groups (135.1 ±50.4) mmol/d vs (137.4 ±28.6) mmol/d) ]. During the study, the average 24h-UNa of patients with strict dietary intervention was (97. 2 ± 8.6) mmol/d. Both SBP (117. 7 ± 10. 0) mm Hg( 1 mm Hg=0. 133 kPa) vs (106.2 ±9.9) mm Hg] and DBP (76. 3 ± 6. 1 ) mm Hg vs (67. 5 ± 5. 5 ) mm Hg] decreased significantly ( P < 0. 001 ) . Proteinuria decreased significantly too 1. 57 (0. 3-3. 0) g/d vs 0. 57 (0. 16-2. 72) g/d,P = 0. 006]. The reduction of SBP was positively correlated with the reduction of 24h-UNa (r =0. 572, P =0. 026) , while the reduction of proteinuria correlated with both the reduction of SBP (r = 0. 568, P = 0. 027) and 24h-UNa (r =0. 525, P =0. 044). In the control group, only SBP decreased significantly ( 122. 6 ± 15. 5) mm Hg vs (115.8 ±10.4) mm Hg, P = 0.02] without significant changes of DBP and proteinuria When comparing the subgroups who took ACEI/ARB from both groups, the reduction of proteinuria wasmore prominent of those from the study group than the control group - 0. 4 ( -0. 95-0. 07) vs 0. 07 ( - 0. 39-0. 42), P = 0. 014 ]. Conclusion Strict dietary salt restriction is effective in reducing blood pressure and proteinuria in CGN patients.