【摘要】 目的评估限蛋白质摄入联合α酮酸治疗对Ⅲ、Ⅳ期2型糖尿病肾病在营养状况和胰岛素抵抗方面的影响。方法选择住院治疗的Ⅲ、Ⅳ期2型糖尿病肾病患者66例,分为三组,分别予以普通饮食、单独低蛋白低磷饮食(A组)和低蛋白低磷饮食联合α酮酸-必需氨基酸制剂(B组)治疗12个月,定期测定患者的糖化血红蛋白、血脂、肾功能、血红蛋白、白蛋白、24 h尿白蛋白、肌酐清除率、空腹胰岛素及血糖,测量血压、体重指数、体脂百分比,三头肌皮褶厚度、上臂肌围等。结果三组病人体重指数(BM I)、三头肌皮褶厚度(TSF)、上臂肌围(MAMC)、糖化血红蛋白、血清白蛋白、肾功能、血红蛋白、血脂治疗前后差异无统计学意义(P>0.05)。而24 h尿白蛋白A、B组治疗后均低于治疗前(P<0.05),而且B组的24 h尿白蛋白的降低优于A组(P<0.05)。肌酐清除率(CCr)A、B组治疗后均高于治疗前(P<0.05)。治疗后B组的胰岛素抵抗指数、空腹胰岛素低于A组和对照组(P<0.05)。结论低蛋白饮食联合α酮酸治疗可以显著减少Ⅲ、Ⅳ期2型糖尿病肾病病人24 h尿白蛋白排出量,增加肌酐清除率及其胰岛素敏感性,从而减缓肾病的进程,减少慢性肾功能衰竭的发生,而且可以防止糖尿病其他并发症的发展,对血糖、血脂等的控制均是有利的。更多还原

【Abstract】 Objective To evaluate the effect of low-protein-diet associate with keto/amino acid on the resist of insulin and nutritional status in Ⅲ and Ⅳ period diabetic nephropathy of type 2 diabetes mellitus.Methods Sixty-six patients with Ⅲ and Ⅳ period diabetic nephropathy were divided into three groups : group A was given low protein and low phosphorus diet(LPD) for 12 months;B group was given LPD supplemented with α-keto acids for 12 months;control group was given routine diet for 12 months.Body mass index(BMI),glycosglated hemoglobin,lipids,renal function,hemoglobin,serum albumin,24 h urine albumin excretion,creatinine clearance ratio(CCr) and fasting plasm a glucose(FPG),fasting serum insulin(FINS),triceps skin-flod thickness(TSF),aim muscle cricumference(MAMC) were determined every 3 months.Results Body mass index(BMI),glycosglated hemoglobin,lipids,renal function,hemoglobin,serum albumin had no significant differece existed in 3 groups neither before nor after treatment(P>0.05).There were significant different in 24 h urine albumin excretion and CCr after treated than before at groups A and B(P<0.05).The level of group B insulin resistance index and FINS were lower than that in group A(P<0.05).Conclusion LPD supplemented withαketo acids could lessen 24 h urine albumin excretion and increase CCr and insulin sensitivity.There were benefit to patients with Ⅲ,Ⅳ period diabetic nephropathy of type 2 diabetes mellitus.更多还原