CAJ | 학술논문

目的观察饮食蛋白的限制对老年慢性肾脏病（ CKD ）患者营养状况及肾功能进展的影响。方法对168例高龄（75～94岁）男性CKD 3期患者的低蛋白饮食（ LPD）治疗情况进行回顾性分析。采用Maroni公式估算患者平均每日蛋白质入量（ eDPI）以评估患者对LPD的依从性，并依据eDPI水平及是否服用复方α-酮酸制剂（ KA）治疗将患者分为单纯限制蛋白组、限制蛋白＋KA组、未限制蛋白组及未限制蛋白＋KA组，比较分析18个月病程中四组患者的营养状况和肾功能的进展。结果单纯限制蛋白组患者的血清白蛋白水平和前白蛋白水平降低（P＜0.05）；未限制蛋白组患者的血磷水平明显升高（P＜0.05），服用KA制剂两组患者的血钙水平明显升高（ P＜0.05）；较未限制蛋白组及单纯限制蛋白组，限制蛋白＋KA组患者的eGFR下降幅度最小（ P＜0.05）。结论高龄CKD患者单纯给予限制蛋白治疗，可能会导致营养不良；KA可以改善CKD患者的营养状况和血钙水平；限制蛋白并辅以KA治疗可以有效延缓老年CKD进展。
목적관찰음식단백적한제대노년만성신장병（ CKD ）환자영양상황급신공능진전적영향。방법대168례고령（75～94세）남성CKD 3기환자적저단백음식（ LPD）치료정황진행회고성분석。채용Maroni공식고산환자평균매일단백질입량（ eDPI）이평고환자대LPD적의종성，병의거eDPI수평급시부복용복방α-동산제제（ KA）치료장환자분위단순한제단백조、한제단백＋KA조、미한제단백조급미한제단백＋KA조，비교분석18개월병정중사조환자적영양상황화신공능적진전。결과단순한제단백조환자적혈청백단백수평화전백단백수평강저（P＜0.05）；미한제단백조환자적혈린수평명현승고（P＜0.05），복용KA제제량조환자적혈개수평명현승고（ P＜0.05）；교미한제단백조급단순한제단백조，한제단백＋KA조환자적eGFR하강폭도최소（ P＜0.05）。결론고령CKD환자단순급여한제단백치료，가능회도치영양불량；KA가이개선CKD환자적영양상황화혈개수평；한제단백병보이KA치료가이유효연완노년CKD진전。
Objective To investigate the effects of dietary protein restriction supplemented with or without α-ketoacids(KA)on nutritional status and renal function in the very elderly with chronic kidney disease (CKD). Methods The clinical data of 168 elderly patients with CKD stage 3 were analyzed in this retrospective cohortstudy.The compliance to LPD was evaluated using estimated daily protein intake (eDPI).According to the level ofeDPI and supplementation with or without KA,the patients were divided into four groups including protein-restrictionalone,protein-restriction +KA,non protein-restriction and non protein-restriction +KA.The nutritional status and thechanges of eGFR were recorded and followed up for 18 months.Results The levels of serum albumin,serum pre-albumin and serum calcium in protein-restriction +KA group and non protein-restriction +KA group were higher thanthat in protein-restriction alone group and non protein-restriction group(P <0.05).Protein-restriction +KA grouphad a slower decline in eGFR than other groups during the 18 months of follow-up.Conclusions Dietary proteinrestriction therapy alone may lead to malnutrition in the very elderly with CKD .Dietary protein restrictionsupplemented with α-ketoacids can improve the nutritional condition and slow the progression of CKD in the veryelderly.