【摘要】：目的探討去蛋白大米對(duì)晚期慢性腎臟病患者治療的依從性、安全性及有效性。方法從2014年10月至2016年1月在廣州市紅十字會(huì)醫(yī)院門診部隨診的晚期慢性腎臟病(CKD)患者中按入選標(biāo)準(zhǔn)納入41例,其中36例最終完成12個(gè)月隨訪治療。隨機(jī)數(shù)字表法分為2組,去蛋白大米(dislodged protein rice,DPR)組和麥淀粉組作為對(duì)照(control,Contr)組。兩組均進(jìn)行營(yíng)養(yǎng)教育,給予a-酮酸(0.12g/kg/d),在足夠熱量(30-35kcal/kg/d)基礎(chǔ)上,按要求將蛋白質(zhì)攝入量調(diào)整至0.6 g/kg/d,隨訪時(shí)間點(diǎn)為0,1,3,6,12月,隨訪記錄患者飲食情況、主訴、一般資料、血常規(guī)、血生化、超敏C反應(yīng)蛋白(HsCRP)、甲狀旁腺激素(PTH)、尿尿素氮、24小時(shí)尿蛋白及治療藥物等。以推測(cè)腎小球?yàn)V過(guò)率(eGFR)、血肌酐、血尿素氮、尿蛋白以及其他生化指標(biāo)變化評(píng)價(jià)有效性;以營(yíng)養(yǎng)狀況評(píng)價(jià)安全性;以按標(biāo)準(zhǔn)攝入能量、蛋白質(zhì)比例以及堅(jiān)持的低蛋白飲食(LPD)治療人數(shù)比例評(píng)價(jià)依從性。結(jié)果(1)兩組患者基線值包括基礎(chǔ)疾病構(gòu)成比、年齡、性別、體重、體重指數(shù)(BMI)、血紅蛋白、eGFR,肌酐、尿素氮、尿酸、24小時(shí)尿蛋白、熱量攝入、HsCRP、治療藥物使用情況無(wú)明顯統(tǒng)計(jì)學(xué)差異、資料匹配。完成全部隨訪患者中未見(jiàn)明顯不良反應(yīng)。(2)兩組間熱量無(wú)明顯差別(p0.05),兩組組內(nèi)各自的熱量水平治療后較治療前均無(wú)明顯差異(p0.05)。DPR組90%的患者堅(jiān)持低蛋白飲食治療,Contr組86%的患者堅(jiān)持低蛋白飲食治療,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),蛋白質(zhì)攝入達(dá)到目標(biāo)值的比率DPR組(83%)明顯高于Contr組(33%)(P0.05)。(3)治療后DPR組eGFR明顯高于Contr組(P0.05);DPR組血肌酐、血尿素氮稍低于Contr組,但無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),兩組間尿酸水平無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。DPR組治療后eGFR較治療前下降,血肌酐、血尿素氮較治療前升高,但均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),尿酸較治療前升高但無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);Contr組eGFR在第6月后開(kāi)始較治療前下降(P0.05),治療后血肌酐、血尿素氮較治療前明顯升高(P0.05),尿酸較治療前升高,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(4)DPR組在第3月后24小時(shí)尿蛋白明顯低于Contr組(P0.05);DPR組24小時(shí)尿蛋白治療后比治療前明顯下降(P0.05);Contr組24小時(shí)尿蛋白較治療無(wú)明顯下降(P0.05)。(5)DPR組第3月后二氧化碳結(jié)合力明顯高于Contr組(P0.05);DPR組二氧化碳結(jié)合力治療后較治療前下降,但無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);Contr組二氧化碳結(jié)合力治療后較治療前明顯下降(P0.05)。(6)DPR組第3月后血鈣明顯高于Contr組(P0.05),治療后血磷明顯低于Contr組(P0.05),PTH兩組間無(wú)明顯差異(P0.05);DPR組治療第6月開(kāi)始血鈣明顯高于治療前(P0.05),而血磷無(wú)明顯升高(P0.05),PTH無(wú)明顯升高(P0.05);Contr組血鈣治療前后無(wú)明顯改變(P0.05),血磷、PTH較治療前升高明顯(P0.05)。(7)HsCRP兩組相比無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);DPR組治療后HsCRP較治療前下降,但無(wú)統(tǒng)計(jì)學(xué)差異(P0.05);Contr組治療后HsCRP較治療前下降,無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。(8)DPR組和Contr組兩組組內(nèi)、組間比較:體重、BMI、血清白蛋白、血清前白蛋白、甘油三酯、膽固醇、血紅蛋白保持相對(duì)穩(wěn)定,均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論1.去蛋白大米可提高晚期CKD患者對(duì)低蛋白飲食治療的依從性。2.去蛋白大米可延緩?fù)砥贑KD進(jìn)展。3.去蛋白大米可減少晚期CKD患者尿蛋白、改善代謝性酸中毒、鈣磷代謝4.去蛋白大米治療晚期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.
【學(xué)位授予單位】：暨南大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R692

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