低蛋白饮食治疗维持性血液透析患者高磷血症的临床研究

发布时间：2018-08-26 17:21

【摘要】：高磷血症是维持性血液透析患者常见并发症，可导致血管及软组织钙化，是死亡率增加的独立危险因素。高磷血症的治疗方法主要有磷结合剂的应用、充分透析及低磷饮食。因磷的摄入与蛋白的摄入相平行，通过低蛋白饮食实现低磷饮食，从而达到降低血磷的目的。但透析患者营养不良发病率高，给予低蛋白饮食有可能造成患者营养不良的风险。本研究首先对透析患者进行营养状况调查，了解透析患者营养状况，在此基础上选出营养状况良好的高磷血症患者进入试验，在严格监测营养状况的情况下给予低蛋白饮食，观察患者血磷水平的变化，若患者出现因蛋白摄入减少引起的营养不良加重，立即终止试验并给予积极治疗。本研究分别应用营养不良-炎症量表（MIS）、人体成分分析仪、人体测量、生化指标、营养物质摄入量几个方面对74例患者进行营养状况评估。患者MIS评分平均为（3.42±0.27）分，，营养不良发病率（MIS5分）为12.16%（9/74）；按MIS评分将患者分为3组，≥5分组患者与0～2分组患者相比，体蛋白指数、体脂肪指数均较低，差异有统计学意义（P0.05）；将患者按不同性别、年龄段分组，分别与北京城乡同性别年龄种族人群比较，青年、中年、老年男性患者及中年、老年女性患者体蛋白指数均低于健康人，中年男性患者体脂肪指数低于健康人，老年男性患者体脂肪指数高于健康人,差异均有统计学意义（P0.05）。可见在透析患者中，随着营养状况变差，肌肉、脂肪均消耗；与健康人比较，透析患者营养状况差主要体现为蛋白质消耗。从MIS评分5分的患者中筛选出高磷血症患者28例，随机分为低蛋白饮食组（16例，DPI0.8g·kg-1·d-1）、常规蛋白饮食组（12例，DPI1.2g·kg-1·d-1），治疗6个月，观察2组患者治疗前、治疗3个月、6个月时血清磷、矫正钙、钙磷乘积、全段甲状旁腺激素水平及营养状况变化。治疗前两组患者的血清磷水平、钙磷乘积差异均无统计学意义（P0.05）；治疗3、6个月时，低蛋白饮食组患者血清磷水平、钙磷乘积较治疗前明显降低，差异有统计学意义（P0.05）；治疗6个月时低蛋白饮食组血清磷水平、钙磷乘积均较常规饮食组低，差异有统计学意义（P0.01）。低蛋白饮食组患者治疗后营养指标稳定，与常规蛋白饮食组比较，差异无统计学意义（P0.05）。可见低蛋白饮食可有效降低维持性血液透析患者血磷水平，对营养状况无显著影响。
[Abstract]:Hyperphosphatemia is a common complication in maintenance hemodialysis patients, which can lead to calcification of blood vessels and soft tissues, and is an independent risk factor for increased mortality. The treatment of hyperphosphatemia mainly includes the application of phosphorus binder, full dialysis and low-phosphorus diet. Because phosphorus intake is parallel to protein intake, low phosphorus diet is achieved by low protein diet, thus reducing blood phosphorus. However, the incidence of malnutrition in dialysis patients is high, and low-protein diet may result in the risk of malnutrition. In this study, the nutritional status of dialysis patients was investigated to understand the nutritional status of dialysis patients. On this basis, patients with hyperphosphatemia who had good nutritional status were selected to enter the trial and were given a low-protein diet under the condition of strict monitoring of nutritional status. Observe the change of blood phosphorus level, if the patients suffer from malnutrition due to reduced protein intake, immediately stop the test and give active treatment. In this study, the nutritional status of 74 patients was evaluated by (MIS), anthropometric analyzer, anthropometry, biochemical indexes and nutrient intake. The average score of MIS was (3.42 卤0.27) and the incidence of malnutrition (MIS5) was 12.16% (9 / 74). The patients were divided into three groups according to MIS score. The difference was statistically significant (P0.05). The patients were divided into different sex and age groups, and compared with the same age and ethnic groups in urban and rural areas of Beijing, young, middle-aged, elderly male patients and middle age, The body protein index of elderly women was lower than that of healthy people, the body fat index of middle-aged men was lower than that of healthy people, and the body fat index of elderly men was higher than that of healthy people (P0.05). It can be seen that in dialysis patients, with the deterioration of nutritional status, muscle, fat consumption; compared with healthy people, the nutritional status of dialysis patients is mainly reflected in protein consumption. Twenty-eight patients with hyperphosphatemia were selected from the patients with MIS score of 5. They were randomly divided into low protein diet group (16 cases) and routine protein diet group (12 cases) treated with DPI1.2 g kg-1 d-1 for 6 months. Serum phosphorus was observed at 3 months and 6 months before treatment in both groups. The changes of calcium, calcium and phosphorus product, parathyroid hormone level and nutritional status were corrected. Before treatment, there was no significant difference in serum phosphorus level and calcium phosphorus product between the two groups (P0.05); after 3 and 6 months of treatment, the serum phosphorus level and calcium phosphorus product of patients in low protein diet group were significantly lower than those before treatment (P0.05). The serum phosphorus level and calcium and phosphorus product were significantly lower in the low protein diet group than in the conventional diet group at 6 months (P0.01). The nutritional index of low protein diet group was stable after treatment, and there was no significant difference compared with conventional protein diet group (P0.05). The results showed that low protein diet could effectively reduce the level of blood phosphorus in maintenance hemodialysis patients, but had no significant effect on nutritional status.
【学位授予单位】：河北北方学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.5

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