低蛋白饮食对3/4期慢性肾脏病患者肾功能及营养状况的影响

目的 评估低蛋白饮食对3/4期慢性肾脏病(CKD)患者肾功能水平及营养状况的影响.方法 将34例3/4期CKD患者随机分为A组(n=14)和B组(n=20),分别给予0.6 g·kg~(-1)·d~(-1) 和0.8 g·kg~(-1)·d~(-1)蛋白质摄入量,对两组患者个体化跟踪指导6个月,测定治疗前后人体测量指标及血生化指标,进行人体营养状况整体评价和24 h膳食回顾调查.结果 A组治疗后血肌酐值水平明显下降(P=0.010),白蛋白水平明显升高(P=0.042),热能(P=0.018)和碳水化合物(P<0.001)的摄入均较治疗前明显提高.通过营养干预,整体、A组和B组患者营养不良发生率比治疗前分别下降了14.7%、7.2%和21.1%.结论 0.6 g·kg~(-1)·d~(-1)蛋白质摄入量及用小麦淀粉代替部分主食的饮食方案可明显提高3/4期CKD患者碳水化合物和热能的摄入量,改善其营养状况和肾功能.

Influences of low-protein diet on renal function and nutritional status in patients with stage 3/4 chronic kidney diseases

Objective To assess the influences of low-protein diet on the renal function and nutritional status in patients with stage 3/4 chronic kidney diseases (CKD).Methods Totally 34 patients with stage 3/4 CKD were randomly divided into group A (protein intake:0.6 g·kg~(-1)·d~(-1);n=14) and B (protein intake:0.8 g·kg~(-1)·d~(-1);n=20).Anthropometric measurement and blood biochemical tests were performed,nutri-tional status was assessed,and 24-hour dietary recall survey was conducted before and after the treatment.Patients were followed up for 6 months.Results In group A,the creatinine level significantly decreased (P=0.010),while albumin level (P=0.042) and the intake of energy (P=0.018) and carbohydrate (P<0.001) signifi-cantly increased after the treatment In all the 34 patients,in group A and group B,the malnutrition rates were de-creased by 14.7%,7.2%,and 21.1% after nutritional intervention.Conclusion The low-protein diet (protein intake 0.6 g·kg~(-1)·d~(-1)),in which part of the staple food was replaced by wheat starch,can increase the in-takes of carbohydrate and energy and improve renal function and nutritional status in patients with stage 3/4 CKD.