去蛋白大米治疗晚期慢性肾脏病患者的安全性、有效性的前瞻性对照研究

发布时间：2019-01-26 17:12

【摘要】：目的探讨去蛋白大米对晚期慢性肾脏病患者治疗的依从性、安全性及有效性。方法从2014年10月至2016年1月在广州市红十字会医院门诊部随诊的晚期慢性肾脏病(CKD)患者中按入选标准纳入41例,其中36例最终完成12个月随访治疗。随机数字表法分为2组,去蛋白大米(dislodged protein rice,DPR)组和麦淀粉组作为对照(control,Contr)组。两组均进行营养教育,给予a-酮酸(0.12g/kg/d),在足够热量(30-35kcal/kg/d)基础上,按要求将蛋白质摄入量调整至0.6 g/kg/d,随访时间点为0,1,3,6,12月,随访记录患者饮食情况、主诉、一般资料、血常规、血生化、超敏C反应蛋白(HsCRP)、甲状旁腺激素(PTH)、尿尿素氮、24小时尿蛋白及治疗药物等。以推测肾小球滤过率(eGFR)、血肌酐、血尿素氮、尿蛋白以及其他生化指标变化评价有效性;以营养状况评价安全性;以按标准摄入能量、蛋白质比例以及坚持的低蛋白饮食(LPD)治疗人数比例评价依从性。结果(1)两组患者基线值包括基础疾病构成比、年龄、性别、体重、体重指数(BMI)、血红蛋白、eGFR,肌酐、尿素氮、尿酸、24小时尿蛋白、热量摄入、HsCRP、治疗药物使用情况无明显统计学差异、资料匹配。完成全部随访患者中未见明显不良反应。(2)两组间热量无明显差别(p0.05),两组组内各自的热量水平治疗后较治疗前均无明显差异(p0.05)。DPR组90%的患者坚持低蛋白饮食治疗,Contr组86%的患者坚持低蛋白饮食治疗,无统计学差异(P0.05),蛋白质摄入达到目标值的比率DPR组(83%)明显高于Contr组(33%)(P0.05)。(3)治疗后DPR组eGFR明显高于Contr组(P0.05);DPR组血肌酐、血尿素氮稍低于Contr组,但无统计学差异(P0.05),两组间尿酸水平无统计学差异(P0.05)。DPR组治疗后eGFR较治疗前下降,血肌酐、血尿素氮较治疗前升高,但均无统计学差异(P0.05),尿酸较治疗前升高但无统计学差异(P0.05);Contr组eGFR在第6月后开始较治疗前下降(P0.05),治疗后血肌酐、血尿素氮较治疗前明显升高(P0.05),尿酸较治疗前升高,无统计学差异(P0.05)。(4)DPR组在第3月后24小时尿蛋白明显低于Contr组(P0.05);DPR组24小时尿蛋白治疗后比治疗前明显下降(P0.05);Contr组24小时尿蛋白较治疗无明显下降(P0.05)。(5)DPR组第3月后二氧化碳结合力明显高于Contr组(P0.05);DPR组二氧化碳结合力治疗后较治疗前下降,但无统计学差异(P0.05);Contr组二氧化碳结合力治疗后较治疗前明显下降(P0.05)。(6)DPR组第3月后血钙明显高于Contr组(P0.05),治疗后血磷明显低于Contr组(P0.05),PTH两组间无明显差异(P0.05);DPR组治疗第6月开始血钙明显高于治疗前(P0.05),而血磷无明显升高(P0.05),PTH无明显升高(P0.05);Contr组血钙治疗前后无明显改变(P0.05),血磷、PTH较治疗前升高明显(P0.05)。(7)HsCRP两组相比无统计学差异(P0.05);DPR组治疗后HsCRP较治疗前下降,但无统计学差异(P0.05);Contr组治疗后HsCRP较治疗前下降,无统计学差异(P0.05)。(8)DPR组和Contr组两组组内、组间比较:体重、BMI、血清白蛋白、血清前白蛋白、甘油三酯、胆固醇、血红蛋白保持相对稳定,均无统计学差异(P0.05)。结论1.去蛋白大米可提高晚期CKD患者对低蛋白饮食治疗的依从性。2.去蛋白大米可延缓晚期CKD进展。3.去蛋白大米可减少晚期CKD患者尿蛋白、改善代谢性酸中毒、钙磷代谢4.去蛋白大米治疗晚期CKD患者具有良好的安全性。
[Abstract]:Objective To study the compliance, safety and efficacy of deproteinized rice to the treatment of patients with advanced chronic kidney disease. Methods 41 cases of advanced chronic kidney disease (CKD) were included in the outpatient department of Guangzhou Red Cross Hospital from October 2014 to January 2016, and 36 of them had completed 12-month follow-up treatment. The random number table method was divided into 2 groups, the deproteinized protein rice (DPR) group and the wheat starch group as control (control, Conr) group. The nutrition education was carried out in both groups, a-keto acid (0.12g/ kg/ day) was given, and the protein intake was adjusted to 0.6 g/ kg/ day on the basis of sufficient heat (30-35kcal/ kg/ d), and the follow-up time was 0, 1, 3, 6, and 12 months. The follow-up recorded the patient's diet, complaints, general information, blood routine, blood biochemistry, hypersensitive C-reactive protein (HsCRP), parathyroid hormone (PTH), urea nitrogen, 24-hour urine protein, and therapeutic agent. To evaluate the efficacy of changes in glomerular filtration rate (eGFR), blood myoglobin, blood urea nitrogen, urinary protein and other biochemical indicators; to evaluate the safety in nutritional status; to intake energy in accordance with the criteria, The proportion of protein and the adherence to the persistent low-protein diet (LPD) were evaluated. Results (1) The baseline values of the two groups included basic disease composition ratio, age, sex, body weight, body weight index (BMI), hemoglobin, eGFR, myoglobin, urea nitrogen, uric acid, 24-hour urine protein, caloric intake, HsCRP, and no statistically significant difference in the use of the drug. Data matching. No significant adverse reactions were seen in the complete follow-up. (2) There was no significant difference between the two groups (p0.05). There was no significant difference in the level of heat in the two groups (p0.05). 90% of the patients in the DPR group insisted on low-protein diet therapy, and 86% of the patients in the Conr group insisted on low-protein diet treatment without statistical difference (P0.05). The ratio of the protein intake to the target value was significantly higher in the DPR group (83%) than in the Conr group (33%) (P0.05). (3) The eGFR of the DPR group was significantly higher in the DPR group than in the control group (P0.05). There was no statistical difference between the two groups (P0.05), but there was no statistical difference between the two groups (P0.05). However, there was no statistical difference (P0.05), but there was no statistical difference before the treatment (P0.05). The eGFR of the conr group was lower than that before the treatment (P0.05). After the treatment, the blood muscle strength and the blood urea nitrogen increased significantly (P0.05), and the uric acid increased before the treatment. There was no statistical difference (P0.05). (4) The 24-hour urinary protein in the DPR group was significantly lower than that in the control group (P0.05). The 24-hour urinary protein in the DPR group was significantly lower than that before the treatment (P0.05). (5) The binding force of carbon dioxide in the DPR group after the third month was significantly higher than that in the Conr group (P0.05); the carbon dioxide binding force in the DPR group decreased before the treatment, but there was no statistical difference (P0.05); and the carbon dioxide binding force in the Conr group was significantly lower than that before the treatment (P0.05). (6) After the third month of the DPR group, the serum calcium was significantly higher than that of the Conr group (P0.05). The blood phosphorus in the treatment group was significantly lower than that of the control group (P0.05), and there was no significant difference between the two groups (P0.05). In the treatment of the DPR group, the blood calcium was significantly higher than that before the treatment (P0.05), and the blood phosphorus was not significantly increased (P0.05). There was no significant increase in PTH (P0.05). There was no significant change before and after the treatment of serum calcium in the Conr group (P0.05). (7) There was no statistical difference between the two groups (P0.05). (8) In the two groups of DPR and Conr group, the body weight, BMI, serum albumin, serum prealbumin, triglyceride, cholesterol and hemoglobin remained relatively stable and there was no statistical difference (P0.05). Conclusion 1. Deproteinized rice can improve the compliance of patients with advanced CKD with low-protein diet. Deproteinized rice can delay advanced CKD progression. The deproteinized rice can reduce the urinary protein of patients with advanced CKD, improve the metabolic acidosis and the metabolism of calcium and phosphorus. The deproteinized rice has good safety in the treatment of advanced CKD patients.
【学位授予单位】：暨南大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R692

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