【摘要】 低蛋白饮食是临床上常用的延缓慢性肾脏病进展的营养治疗方法,当蛋白摄入量进一步减少时常合并酮酸制剂以保证患者稳定的营养状态。低蛋白饮食或合并酮酸制剂能使患者推迟进入终末期肾衰竭的时间,显著改善进入肾脏替代治疗后的生存预后。近来众多临床试验证实该疗法还能显著降低慢性肾脏病患者的蛋白尿和血压、改善钙磷代谢和肾性骨病、代谢性酸中毒、氨基酸代谢紊乱、胰岛素抵抗和血脂异常。基础研究也证实低蛋白饮食或合并酮酸治疗既能通过改善高灌注高滤过的异常血流动力学来延缓肾功能恶化的进展,还能通过降低肾素表达、改善氧化应激、减少转化生长因子(TGF-β1)表达和减轻系膜细胞分泌细胞外基质等非血流动力学效应发挥肾脏保护作用。为提高临床医生对这方面的认识,本文综述了低蛋白饮食或合并酮酸制剂在慢性肾脏病中的应用及研究进展。更多还原

【Abstract】 Low protein diet was often used as nutritional therapy for slowing the progressing of chronic kidney disease.Keto-acids was usually added when protein intake was further reduced to guarantee the stable nutritional status.Both delaying to the end-stage renal disease and improving survival prognosis of renal replacement therapy could be achieved by low protein diet(and) keto-acids.Masses of clinical trials had demonstrated the clinical benefits of this regimen,including decreasing proteinuria and blood pressure,improving a series of metabolic disturbances,such as renal osteodystrophy,metabolic acidosis,amino acid metabolic disturbances,insulin resistance,lipid disorder and so on.Foundation research also suggested that low protein diet(and) keto-acids produced renal protective effects not only through the hemodynamic effect of extenuation of high infusion and high pressure in glomeruli,but also through the non-hemodynamic effects,such as reducing the expression of renin and TGF-β1,ameliorating of oxidative stress and lessening the excretion of cellular matrix of mesangial cell.We reviewed the progress in application of low protein diet combined with keto-acids in patients with chronic kidney disease.更多还原