低蛋白饮食对老年糖尿病肾病肾功能的保护作用

观察低蛋白饮食对老年非胰岛素依赖性糖尿病肾病伴有轻度肾功能不全患者肾小球滤过率 (GFR)的影响。对 2 4例患者随机分组观察 8周 ,前 4周为第一期 ,低蛋白饮食I组 (LPDI组n =8) ,蛋白质摄入量 0 .6g·kg-1·2 4h-1;低蛋白饮食Ⅱ组 (LPDⅡ组n =8)蛋白质摄入量 0 .8g·kg-1·2 4h-1;正常蛋白质饮食组 (NPD组n=8)蛋白质摄入量如常。自第 5周 8周为第二期 ,所有患者均恢复正常饮食。在饮食治疗前、治疗后 4周及 8周分别检测饮食蛋白的摄入量 ,血清肌酐 (SCr)、肌酐清除率 (CCr) ,12h尿白蛋白排泄率及动脉血压。结果显示第一期 ,LPDI组及LPDⅡ组SCr、CCr及 12h尿白蛋白排泄率均较基础值有明显下降 (P <0 .0 5 ) ;LPDI组CCr下降较LPDⅡ组显著 (P <0 .0 5 ) ;NPD组各项指标无明显改变 ;3组血压、血浆白蛋白及体重指数均无显著改变。第二期 ,LPDI组和LPDⅡ组两组CCr及尿白蛋白排泄率均恢复至基础水平。表明老年非胰岛素依赖性糖尿病肾病伴有轻度肾功能不全患者 ,低蛋白饮食 4周可出现可逆性GFR及尿白蛋白排泄率下降 ,而血压无明显变化 ,提示SCr、CCr及尿白蛋白排泄率与减低食入蛋白量有明确相关性

LOW-PROTEIN DIET AND KIDNEY FUNCTION IN NON-INSULIN-DEPENDENT DIABETIC NEPHROPATHY

This study tried to investigate the change in the glomerular filtration rate in initiation of a low-protein diet (LPD) in the elderly patients with diabetic nephropathy, and to elucidate whether this initial phenomenon is reversible or irreversible. 24 non-insulin-dependent diabetic patients with renal failure patients were randomized to LPDⅠgroup (0.6g *kg-1*24h-1), LPDⅡgroup (0.8g*kg-1*24h-1), and NPD group for four weeks (phaseⅠ). Between weeks 4 and 8, all patients received NPS (phaseⅡ). Dietary protein intake (g*kg-1*24h-1), SCr, Ccr, albuminuria excretion rate and arterial blood pressure were measured at baseline and after four- and eight-weeks of follow-up, respectively. During phaseⅠ, a significant decline in dietary protein intake, Ccr, Scr, and albuminuria excretion rate were observed in the LPDⅠgroup and LPDⅡgroup. There was not any change in the NPD group. Conversely, during phase Ⅱ, with a significant increase in dietary protein intake, Ccr, Scr and albuminuria excretion rate increased in LPDⅠ group and LPD Ⅱ group compared with the NPD group. It suggested that dietary protein restriction for four weeks induces a reversible decline in GFR, Scr and albuminuria excretion rate in noinsulin-dependent diabetic nephropathy patients with renal failure, whereas systemic blood pressure remains unchanged.