低蛋白饮食对慢性肾脏病进展的影响—系统回顾及荟萃分析

发布时间：2018-05-11 04:17

本文选题：慢性肾脏病 + 低蛋白饮食　；参考：《山西医科大学》2017年硕士论文

【摘要】：背景:一直以来,低蛋白饮食被认为在慢性肾脏病(Chronic Kidney Disease,CKD)进展中发挥着重要作用,而它对肾功能下降速率的影响却仍存在争议。目的:系统评价不同蛋白质摄入对成人慢性肾脏病患者肾功能进展速率及相关预后的影响。方法:在register网站注册,并按照预先制定的检索策略对Ovid MEDLINE,EMBASE,及Cochrane Library进行检索,筛选对比不同蛋白质摄入对成人CKD患者影响的随机对照试验,随访时间大于24周。评价的结局包括肾衰竭事件、估测的肾小球滤过率(estimated glomerular filtration rate,eGFR)每年的下降速率、蛋白尿变化,血清磷浓度、血清白蛋白浓度及身体质量指数(BMI)的变化。结果:共19项研究包括2492例患者被纳入研究。分析结果显示:限蛋白质摄入能减少CKD患者肾衰竭及终末期肾病(end-stage renal disease,ESRD)发生的风险(OR=0.59,OR=0.64),但不能降低全因死亡的发生。低蛋白饮食能明显减慢eGFR下降速率(MD:1.85,P=0.001),并降低蛋白尿水平(MD:-0.44,P=0.02)。与对照组相比,限制蛋白质的饮食干预能同时降低血磷水平,而不会引起营养不良。结论:低蛋白饮食降低了CKD患者肾功能下降速率以及肾衰竭的风险,这些积极性作用在非糖尿病肾病患者中更显著。低蛋白饮食是既有效又安全的CKD干预措施。
[Abstract]:Background: low protein diet has long been considered to play an important role in the progression of chronic kidney disease (Chronic Kidney diseaseate CKD), but its effect on the rate of renal function decline is still controversial. Objective: to evaluate the effects of different protein intake on renal function progression rate and prognosis in adult patients with chronic kidney disease. Methods: Ovid MEDLINE EMBASE and Cochrane Library were searched according to the pre-established search strategy on the register website. The randomized controlled trials were selected to compare the effects of different protein intake on adult CKD patients. The follow-up time was more than 24 weeks. The outcomes included events of renal failure, estimated annual rate of decline in glomerular filtration rate (GFR), changes in proteinuria, changes in serum phosphorus, serum albumin and body mass index (BMI). Results: a total of 19 studies, including 2492 patients were included in the study. The results showed that limited protein intake could reduce the risk of renal failure and end-stage renal disease in patients with CKD, but could not reduce the incidence of all-cause death. Low protein diet could significantly slow down the decrease rate of eGFR and reduce the level of protein urine. Compared with the control group, protein-restricted dietary intervention also reduced blood phosphorus levels without causing malnutrition. Conclusion: low protein diet reduces the rate of renal function decline and the risk of renal failure in CKD patients, and these positive effects are more significant in patients with non diabetic nephropathy. Low protein diet is an effective and safe intervention for CKD.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692

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