富立群+乔静+蔡骏

[摘要] 目的 探讨低脂低蛋白膳食在老年慢性肾脏病患者中的应用效果。 方法 选取本院老年慢性肾脏病患者106例，应用SGA对患者进行营养评价，然后根据患者的依从性分为两组，观察组给予蛋白质0.6～0.8 g/（kg·d）、脂肪≤40 g/d，对照组给予蛋白质1.0 g/（kg·d）、脂肪占总热能的18%～20%，营养干预3个月后，观察两组的营养不良发生率、空腹血糖（FBG）、血浆白蛋白（ALB）、前白蛋白（PA）、血红蛋白（Hb）、胆固醇（TC）、三酰甘油（TG）、尿素氮（BUN）、肌酐（SCr）、估算肾小球滤过率（c-aGFR）。 结果 两组治疗后的营养不良发生率比较差异无统计学意义（P＞0.05）。两组的FBG、ALB、PA、HB、TC及TG治疗前后及组间比较，差异无统计学意义（P＞0.05）。观察组治疗后的BUN、SCr低于治疗前及对照组，c-aGFR高于治疗前，差异有统计学意义（P＜0.05）。 结论 低脂低蛋白膳食是老年慢性肾脏病综合治疗中的基础之一。

[关键词] 低脂低蛋白饮食；老年；慢性肾脏病

[中图分类号] R692[文献标识码] A[文章编号] 1674-4721（2014）04（c）-0055-03

Clinical application of low fat and low protein diet in elderly patient with chronic kidney disease

FU Li-qun1 QIAO Jing2 CAI Jun3▲

1.Department of Clinical Nutrition,Zhoupu Hospital of Pudong New Area in Shanghai City,Shanghai201318,China;2.Department of Nephrology,Zhoupu Hospital of Pudong New Area in Shanghai City,Shanghai201318,China;3.Department of Clinical Nutrition,Longhua Hospital in Shanghai City,Shanghai200032,China

[Abstract] Objective To discuss application effect of low fat and low protein diet in elderly patient with chronic kidney disease. Methods 106 cases of elderly patients with chronic kidney disease in our hospital were selected.SGA was used to assess the nutritional status of patients and the patients were divided into two groups according to the compliance.Observation group was given a low protein from 0.6 to 0.8 g/(kg·d),fat≤40 g/d,control group was given 1.0 g/(kg·d)protein and fat(18%-20% of the total thermal energy).After 3 months of nutrition intervention,the incidence rate of malnutrition,fasting blood glucose(FBG),serum albumin(ALB),prealbumin(PA),hemoglobin(Hb),cholesterol(TC),triglyceride(TG),bloodureanitrogen(BUN),serum creatinine(SCr),estimated glomerular filtration rate (c-aGFR) in two groups was compared respectively. Results The incidence of malnutrition in two groups was compared,with no statistical difference(P＞0.05).FBG,ALB,PA,HB,TC and TG in two groups before and after treatment was compared respectively,FBG,ALB,PA,HB,TC and TG in two groups was compared respectively,with no statistical difference(P＞0.05).After treatment,BUN,SCr in observation group was lower than that in control group and before treatment respectively,c-aGFR was higher than before treatment,with statistical difference(P＜0.05). Conclusion Low fat and low protein diet is one of the basic treatments in comprehensive treatment of elderly patients with chronic kidney disease.

[Key words] Low fat and low protein diet;Elderly;Chronic kidney disease

近年来，慢性肾脏病（chronic kidney disease，CKD）的发病率呈迅速增长趋势，中国CKD流行病学调查数据显示，＞40岁人群CKD的患病率为8%～9%，随着人口老龄化，老年CKD患者增加迅猛，尤其是终末期肾病对家庭及社会造成巨大的经济负担。在CKD治疗中，营养膳食干预是一体化综合治疗中的基础治疗，本研究针对本院老年CKD患者进行低脂低蛋白营养干预，观察其在延缓疾病进展、减轻肾脏负担、改善症状等方面的效果。

1 资料与方法

1.1 一般资料

根据WHO对老年人的定义，选取年龄＞65岁，2012年10月～2013年12月确诊的老年CKD 3～4期住院患者106例，男性62例，女性44例；年龄65～85岁，平均（67.55±20.12）岁；病程6～10年；慢性肾盂肾炎肾病45例，慢性肾小球肾炎肾病48例，高血压肾病13例。……