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糖尿病肾病是糖尿病的严重并发症之一,正随着糖尿病患病率的不断上升而成为终末期肾功能衰竭的最常见原因。近年来关于摄入蛋白质对糖尿病肾病病理生理的影响日益受到重视,多项研究表明限蛋白摄入可以有效延缓肾功能衰竭的进展,减轻尿毒症的症状,对 DN 产生良好的预后。本文就限制蛋白质摄入与肾血流动力学的关系;与 DN 进展的关系以及对营养状态的影响进行讨论。我们提倡在DN 早期,肾脏病变尚处于可逆阶段给予限蛋白饮食,摄入0.6～0.8g/kg·d 或占热能10%的蛋白质是安全的,蛋白的主要来源是动物性和植物性食品,优质蛋白应占50%以上,同时补充适量必需氨基酸或α-酮酸制剂。由于低蛋白饮食的长期安全性还未完全证实,因此在实施过程中需密切监视病人的营养状态和氮平衡。
Diabetic nephropathy, one of the serious complications of diabetes, is becoming the most common cause of end-stage renal failure as the prevalence of diabetes is on the rise. In recent years, the effect of protein intake on pathophysiology of diabetic nephropathy has been paid more and more attention. A number of studies have shown that limited protein intake can effectively delay the progression of renal failure, reduce the symptoms of uremia and have a good prognosis for DN. This article discusses the relationship between limiting protein intake and renal hemodynamics, the relationship with DN progression, and the effects on nutritional status. We advocate in the early stages of DN, nephropathy is still in a reversible phase to give limited protein diet, intake of 0.6 ~ 0.8g / kg · d or 10% of protein heat is safe, the main source of protein is animal and plant foods, High-quality protein should account for more than 50%, while adding the right amount of essential amino acids or α-keto acid preparations. Since the long-term safety of a low-protein diet has not yet been fully confirmed, the patient’s nutritional status and nitrogen balance need to be closely monitored during implementation.