摘要
目的：观察分别以低蛋白面粉（含蛋白质0．9％，热卡344Kcal／100g）为主食和普通大米、面粉为主食的不同低蛋白饮食治疗早期慢性肾功能不全的疗效。方法：病情稳定的慢性肾功能不全患者60例，均符合以下条件：（1）原发病为原发性肾小球疾病，血清肌酐（SCr）1．3～3．0mg／dl；（2）年龄18～70岁，性别不限；（3）原发疾病无明显活动迹象，双肾缩小；（4）尿蛋白〈1．5g／24h，尿红细胞〈50万／ml；（5）血压控制低于140／90mmHg。原发疾病仍有活动或伴有严重贫血、营养不良、感染、出血、肝功能不全、心功能不全及糖尿病患者不入选。患者随机分为低蛋白面粉饮食组（n=30）和普通低蛋白饮食组（n=30），观察6个月。两组蛋白质摄入量0．6g／（kg·d），以鸡蛋、牛奶、瘦肉等优质蛋白质，补充主食以外摄入不足的蛋白质部分，保证热卡摄入量30～35Kcal／（kg·d）（按理想体重计算）。由专人个体化制订每周食谱，定期饮食指导，并通过每月连续3日饮食记录表，调查和计算患者的实际营养素摄入量。观察两组治疗前后人体测量参数、血生化、尿蛋白定量等指标，计算饮食蛋白质摄入量（DPI）和肾小球滤过率（GFR）。结果：（1）病例退出原因：两组各有5例患者退出研究，其中治疗组2例不耐受长期服用面食、要求改用大米，2例常不能在家中就餐、无条件按要求烹调低蛋白面粉，另1例外地患者因面粉携带不便、拒用；对照组4例未能按制订的食谱控制饮食，蛋白质摄入过多，另1例未按要求随访；（2）两组各有25例完成研究，治疗组和对照组DPI分别为（0．61±0．02）g/（kg·d）和（0．63±0．04）g/（kg·d），两组无差异；（3）两组患者治疗前后体重、体重指数、臂中肌周径和上臂围均无显著变化；（4）对照组总蛋白、白蛋白和前白蛋白轻度下降（P〉0．05），治疗组保持稳定；（5）治疗组BUN下降明显（P〈0．01），对照组无下降。治疗组SCr显著下降，对照组在2个月和4个月时SCr上升（P〈0．05），但至6个月时与基础值无差异；治疗组GFR上升（P〈0．05），而对照组在2个月和4个月时GFR下降（P〈0．05），但在6个月时与基础值无差异；两组GFR下降的速率分别为-0．31（ml／min·1．73m^2）／月和0．28（ml／min·1．73m^2。）／月。（6）治疗组尿蛋白定量下降，对照组无明显变化，治疗前尿蛋白定量升高的患者中治疗组和对照组分别有7／13（53．8％）和4／15例（26．7％）降至正常范围（P〉0．05）。结论：6个月的初步研究表明，以低蛋白面粉为主食的优质低蛋白饮食对肾功能和尿蛋白的疗效优于普通低蛋白饮食，营养状况稳定，患者的顺应性和耐受性好。
Objective：To evaluate the clinical efficacy of low protein diet （LPD） with low-protein flour as staple food in the treatment of early chronic renal failure. Methodology ： Sixty non·diabetic patients with early chronic renal failure （serum creatinine level of 1.3 -3.0 mg/dl） were divided into two groups. They were group 1, treatment group （n =30）, treated with low-protein flour （protein 0. 9% ,344 Kcal/100g） as staple food, and group 2, control group （n = 30）, with common rice or flour as staple food. All of patients were observed for 6 months, the suggested diet protein intake （DPI） was 0. 6 g/（kg·d） ,energy intake was 30 - 35 Kcal/（kg·d） （ according to optimal body weight）. Somatometric in- dex and serum chemistry was measured. 24 hour urine was collected for the calculation of DPI. GFR was calculated with simplified MDRD equation. Results： （ 1 ） Compliance of patients ： there were 5 cases withdrawal from treatment group,and also 5 cases withdrawal from control group. There were 25 patients completed the observation in each group, the calculated DPI was （0.63 ±0.04） g/（kg·d） in control and （0.61 ±0.02） g/（kg·d） in treatment group. （2） Body weight, body mass index （BMi） , arm middle circumference （AMC） and arm circumference （AC） were not significantly changed in both groups. （3） The levels of serum total protein, albumin and prealbumin were slightly decreased in control group （ P 〉 0.05 ）, while those nutritional makers maintained stable in treatment group. （4） BUN was not significantly changed in control group but markedly decreased in treatment group （P 〈 0.01 ）. The level of serum creatinine （SCr） was significantly increased in control group in the 2^nd and 4^th month （ P 〈 0. 05 ） , but decreased to baseline in the 6＇h month, while it was significantly decreased （ P 〈 0. 05 ） in treatment group. GFR was decreased in control group in the 2^nd and 4^th month （ P 〈 0.05） but elevated to baseline in the 6^th month, while it was significantly increased in treatment group （ P 〈 0. 05 ）. The decreasing rate of GFR were - 0. 31 （ ml/min. 1.73m^2 ）/month in treatment group and 0. 28 （ ml/min. 1.73m^2 ）/month in control group. （5） The level of urinary protein excretion was decreased （ P 〈 0.05 ） in treatment group but unchanged in control group, it was decreased to normal range in 7/13（53.8% ）cases in treatment group, 4/15（26. 7% ）cases in control group （ P 〉 0. 05 ）. ConcLusion ：This six-month study indicated that, LPD with low-protein flour was much better tolerated than the common LPD, and it could delay the progression of renal dysfunction and maintain the nutritional status in patients with early chronic renal failure.
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
2006年第5期422-427,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
