CAJ | 학술논문

目的探讨调整三大供能营养素比例及构成兼减轻体重对痛风伴超重者血尿酸、血脂水平及肾功能和结局的影响.方法将6个月前至少经历1次痛风发作的非糖尿病男性伴超重的痛风患者67例纳入研究,按照随机数字表法将患者分为高蛋白研究组(每日给予能量6276 kJ,其中碳水化合物40％、蛋白质30％、脂肪30％,复合碳水化合物替代精制碳水化合物,单不饱和脂肪、多不饱和脂肪酸替代饱和脂肪酸,不计嘌呤含量)及低嘌呤对照组(热量同高蛋白研究组,其中碳水化合物60％、蛋白质10％、脂肪30％,嘌呤＜150 mg/d),研究开始及6个月后分别取血样检测血尿酸(UA)、血清总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、血肌酐(SCr)、血尿素氮(BUN)、白蛋白(ALB)、血清总蛋白(TP)、血红蛋白(Hb)水平及6个月内痛风发作次数.结果 61例患者完成研究(脱落率9.0％).膳食干预6个月后,患者体重减轻[(65.75±3.26)比(69.31±7.78)kg,P=0.043]、痛风发作次数减少(17比28次,P=0.000).与低嘌呤对照组比较,高蛋白研究组UA[(420.25±36.78)比(466.81±41.97)μmol/L,P=0.000)]、TC[(5.69±0.46)比(6.49±1.04)mmol/L,P=0.007)]、TG[(2.15±0.54)比(3.13±0.62)mmol/L,P=0.000)]和FBG[(5.63±0.82)比(6.49±0.64)mmol/L,P=0.000)]显著下降,HDL-C[(1.24 ±0.22)比(0.89±0.26)mmol/L,P=0.000)]、ALB[(41.56±5.37)比(37.08±5.94)g/L,P=0.014)]、TP[(72.97±5.41)比(67.27±7.87)g/L,P=0.005)]和Hb[(142.86±12.31)比(114.25±12.98)g/L,P=0.001)]显著升高.两组LDL-C[(3.55 ±0.80)比(3.73±0.72)mmol/L,P=0.445)]、SCr[(96.63±16.97)比(94.28±13.35)μmol/L,P=0.597)]和BUN[(4.89±1.25)比(4.46±1.21)mmol/L,P=0.208)]差异无统计学意义.干预后高蛋白研究组和低嘌呤对照组痛风发作次数分别下降48.48％和22.22％,两组痛风发作次数差异具有统计学意义(P=0.000).结论调整痛风患者宏量营养素摄入比例兼减轻体重有利于降低患者UA水平、调节血脂、改善营养状况并减少痛风发作次数. 目的探討調整三大供能營養素比例及構成兼減輕體重對痛風伴超重者血尿痠、血脂水平及腎功能和結跼的影響.方法將6箇月前至少經歷1次痛風髮作的非糖尿病男性伴超重的痛風患者67例納入研究,按照隨機數字錶法將患者分為高蛋白研究組(每日給予能量6276 kJ,其中碳水化閤物40％、蛋白質30％、脂肪30％,複閤碳水化閤物替代精製碳水化閤物,單不飽和脂肪、多不飽和脂肪痠替代飽和脂肪痠,不計嘌呤含量)及低嘌呤對照組(熱量同高蛋白研究組,其中碳水化閤物60％、蛋白質10％、脂肪30％,嘌呤＜150 mg/d),研究開始及6箇月後分彆取血樣檢測血尿痠(UA)、血清總膽固醇(TC)、三酰甘油(TG)、低密度脂蛋白膽固醇(LDL-C)、高密度脂蛋白膽固醇(HDL-C)、空腹血糖(FBG)、血肌酐(SCr)、血尿素氮(BUN)、白蛋白(ALB)、血清總蛋白(TP)、血紅蛋白(Hb)水平及6箇月內痛風髮作次數.結果 61例患者完成研究(脫落率9.0％).膳食榦預6箇月後,患者體重減輕[(65.75±3.26)比(69.31±7.78)kg,P=0.043]、痛風髮作次數減少(17比28次,P=0.000).與低嘌呤對照組比較,高蛋白研究組UA[(420.25±36.78)比(466.81±41.97)μmol/L,P=0.000)]、TC[(5.69±0.46)比(6.49±1.04)mmol/L,P=0.007)]、TG[(2.15±0.54)比(3.13±0.62)mmol/L,P=0.000)]和FBG[(5.63±0.82)比(6.49±0.64)mmol/L,P=0.000)]顯著下降,HDL-C[(1.24 ±0.22)比(0.89±0.26)mmol/L,P=0.000)]、ALB[(41.56±5.37)比(37.08±5.94)g/L,P=0.014)]、TP[(72.97±5.41)比(67.27±7.87)g/L,P=0.005)]和Hb[(142.86±12.31)比(114.25±12.98)g/L,P=0.001)]顯著升高.兩組LDL-C[(3.55 ±0.80)比(3.73±0.72)mmol/L,P=0.445)]、SCr[(96.63±16.97)比(94.28±13.35)μmol/L,P=0.597)]和BUN[(4.89±1.25)比(4.46±1.21)mmol/L,P=0.208)]差異無統計學意義.榦預後高蛋白研究組和低嘌呤對照組痛風髮作次數分彆下降48.48％和22.22％,兩組痛風髮作次數差異具有統計學意義(P=0.000).結論調整痛風患者宏量營養素攝入比例兼減輕體重有利于降低患者UA水平、調節血脂、改善營養狀況併減少痛風髮作次數.
목적 탐토조정삼대공능영양소비례급구성겸감경체중대통풍반초중자혈뇨산、혈지수평급신공능화결국적영향.방법 장6개월전지소경력1차통풍발작적비당뇨병남성반초중적통풍환자67례납입연구,안조수궤수자표법장환자분위고단백연구조(매일급여능량6276 kJ,기중탄수화합물40％、단백질30％、지방30％,복합탄수화합물체대정제탄수화합물,단불포화지방、다불포화지방산체대포화지방산,불계표령함량)급저표령대조조(열량동고단백연구조,기중탄수화합물60％、단백질10％、지방30％,표령＜150 mg/d),연구개시급6개월후분별취혈양검측혈뇨산(UA)、혈청총담고순(TC)、삼선감유(TG)、저밀도지단백담고순(LDL-C)、고밀도지단백담고순(HDL-C)、공복혈당(FBG)、혈기항(SCr)、혈뇨소담(BUN)、백단백(ALB)、혈청총단백(TP)、혈홍단백(Hb)수평급6개월내통풍발작차수.결과 61례환자완성연구(탈락솔9.0％).선식간예6개월후,환자체중감경[(65.75±3.26)비(69.31±7.78)kg,P=0.043]、통풍발작차수감소(17비28차,P=0.000).여저표령대조조비교,고단백연구조UA[(420.25±36.78)비(466.81±41.97)μmol/L,P=0.000)]、TC[(5.69±0.46)비(6.49±1.04)mmol/L,P=0.007)]、TG[(2.15±0.54)비(3.13±0.62)mmol/L,P=0.000)]화FBG[(5.63±0.82)비(6.49±0.64)mmol/L,P=0.000)]현저하강,HDL-C[(1.24 ±0.22)비(0.89±0.26)mmol/L,P=0.000)]、ALB[(41.56±5.37)비(37.08±5.94)g/L,P=0.014)]、TP[(72.97±5.41)비(67.27±7.87)g/L,P=0.005)]화Hb[(142.86±12.31)비(114.25±12.98)g/L,P=0.001)]현저승고.량조LDL-C[(3.55 ±0.80)비(3.73±0.72)mmol/L,P=0.445)]、SCr[(96.63±16.97)비(94.28±13.35)μmol/L,P=0.597)]화BUN[(4.89±1.25)비(4.46±1.21)mmol/L,P=0.208)]차이무통계학의의.간예후고단백연구조화저표령대조조통풍발작차수분별하강48.48％화22.22％,량조통풍발작차수차이구유통계학의의(P=0.000).결론 조정통풍환자굉량영양소섭입비례겸감경체중유리우강저환자UA수평、조절혈지、개선영양상황병감소통풍발작차수.
Objective To study the effects of adjusted proportional macronutrient intake on serum uric acid,blood lipids,renal function,and nutritional status of patients with gout and overweight.Methods Sixtyseven patients with gout and overweight were randomized into high protein group and low purine group for 6 months.Each patient had had at least one gouty attacks during the six months before enrollment.Dietary recommendations consisted of calorie restriction to 6276 kJ per day with 40％ derived from carbohydrate,30％ from protein,and 30％ from fat,and the refined carbohydrates were replaced with complex ones and saturated fats with mono-and polyunsaturated ones.High protein group didn't limit purine intake.The two dietary consisted of isoenergetic (6276 kJ).Dietary of low purine group consisted of 60％ derived from carbohydrate,10％ from protein,and 30％ from fat,and limited of parine ＜ 150 mg/d.At onset and 6 months after intervention,fasting blood samples were taken for determination of uric acid(UA),total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),fasting plasma glucose(FBG),serum creatinine(SCr),blood urea nitrogen(BUN),albumin(ALB),total protein(TP),and hemoglobin(Hb);the number of gout attacks was recorded.Results Sixty-one persons completed the study.Dietary measures resulted in weight loss[(65.75 ± 3.26)vs(69.31 ± 7.78)kg,P =0.043)and a decrease in the frequency of sixmonth gout attacks(17 vs 28,P =0.000).After the trial,compared to low-purine group,UA[(420.25 ±36.78)vs(466.81 ±41.97)μmol/L,P=0.000],TC[(5.69±0.46)vs(6.49±1.04)mmol/L,P=0.007),TG[(2.15 ±0.54)vs(3.13 ±0.62)mmol/L,P =0.000]and FBG[(5.63 ±0.82)vs(6.49 ±0.64)mmol/L,P =0.000]decreased significantly in the high protein group.There were no significant differences in LDL-C[(3.55 ±0.80)vs(3.73 ±0.72)mmol/L,P =0.445],SCr[(96.63 ± 16.97)vs(94.28 ±13.35)μmol/L,P =0.597],and BUN[(4.89 ± 1.25)vs(4.46 ± 1.21)mmol/L,P =0.208]between two groups.HDL-C[(1.24±0.22)vs(0.89±0.26)mmol/L,P=0.000],ALB[(41.56±5.37)vs(37.08±5.94)mmol/L,P=0.014],TP(72.97 ±5.41)vs(67.27±7.87)g/L,P=0.005],and Hb[(142.86±12.31)vs(114.25 ± 12.98)g/L,P =0.001]increased significantly in the high protein group.Gouty attacks were reduced and decreased by 48.48％ and 22.22％ in high protein group and low purine group,respectively.The differences between the two group was statistically significant(P =0.000)Conclusion Change in proportional macronutrient intake is helpful to reduce body weight and thus is beneficial for lowering UA,improving lipid metabolism and nutritional status,and decreasing the frequency of gout attacks.