【摘 要】
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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：随机将41例广州市红十字会医院门诊部随诊的晚期慢性肾脏病(CKD)患者分为2组：去蛋白大米(dislodged protein rice,DPR)组和对照组(control,Contr),其中36例(每组各18例)最终完成12个月随访治疗.DPR组主食为去蛋白大米,Contr组主食为麦淀粉,两组的饮食处方均按照KDOQI
【机 构】
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暨南大学医学院附属广州红十字会医院临床病态营养研究所营养科 暨南大学医学院附属广州红十字会医院临床
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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：随机将41例广州市红十字会医院门诊部随诊的晚期慢性肾脏病(CKD)患者分为2组：去蛋白大米(dislodged protein rice,DPR)组和对照组(control,Contr),其中36例(每组各18例)最终完成12个月随访治疗.DPR组主食为去蛋白大米,Contr组主食为麦淀粉,两组的饮食处方均按照KDOQI指南设定低蛋白饮食(LPD)处方,并进行营养教育,随访12个月.并在第0、1月、3月、6月、12月时分别监测其饮食记录、坚持LPD的人数、24小时尿尿素氮来评估其依从性,肾功能、血清钙磷水平、二氧化碳结合力(C02CP)、超敏C反应蛋白(HsCRP)、24小时尿蛋白定量等来评估其有效性,血清蛋白、血脂谱等营养指标来评估其安全性.结果：DPR组的蛋白质摄入在第12月时明显低于Contr组,蛋白质摄入达到目标值的比率DPR组(83％)明显高于Contr组(33％)(P＜0.05).DPR组治疗后肾功能虽较治疗前有所进展,但无统计学差异(p＞0.05).DPR组的24小时尿蛋白定量在治疗后第3月后明显低于Contr组,P＜0.05.其中DPR组在治疗第3个月后24小时尿蛋白定量明显低于治疗前(P＜0.05).DPR组的二氧化碳结合力在第3个月后明显高于Contr组,P＜0.05.在干预第3个月后,DPR组的血清钙水平明显高于Contr组(P＜0.05),血磷则明显低于Contr组(P＜0.05).两组间试验前后的体重、BMI、血清白蛋白、血清前白蛋白、甘油三酯、胆固醇、血红蛋白、HsCRP均无明显变化(p＞0.05).结论：去蛋白大米可提高晚期CKD患者LPD的依从性,延缓CKD进展,减少尿蛋白,改善钙磷代谢,代谢性酸中毒,且安全性良好.
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