钟冬赐 詹思延

[摘要] 目的 系统评价国内外采用生酮饮食治疗糖尿病患者的效果，从而更好地为糖尿病患者的饮食管理和综合治疗提供循证依据。 方法 通过检索PubMed、Cochrane Library、EMbase、Sinomed、万方医学网、维普网等数据库，收集国内外对糖尿病患者使用生酮饮食治疗的随机对照试验（RCT），试验组给予低碳生酮饮食，对照组给予低卡路里食物或者平板健康餐，对所纳入的文献采用Jadad评分进行质量评价，使用Review Manager5.3软件进行Meta分析。将试验组和对照组的糖化血红蛋白含量、体重、甘油三酯水平等结局指标进行比较。 结果 该次Meta分析共纳入文献7篇，其中试验组200例病例，对照组155例病例。Meta分析结果显示，试验组糖化血红蛋白含量低于对照组[MD=-0.50，95%CI（-0.70，-0.30），P<0.01];试验组体重低于对照组[MD=-8.07，95%CI（-10.73，-5.40），P<0.01];试验组甘油三酯水平低于对照组[MD=-29.05，95%CI（-45.50，-12.71），P<0.01]。 结论 生酮饮食是一种能够有效降低糖尿病患者糖化血红蛋白含量，减轻体重，降低甘油三酯水平的膳食疗法。

[关键词] 糖尿病;生酮饮食;Meta分析

[中图分类号] R587.2          [文献标识码] A          [文章编号] 1672-4062（2020）01（b）-0032-05

[Abstract] Objective To systematically evaluate the efficacy of ketogenic diet in the treatment of diabetic patients at home and abroad， so as to provide evidence-based evidence for dietary management and comprehensive treatment of diabetic patients. Methods A randomized controlled trial （RCT） of ketogenic diet for diabetic patients was collected by searching PubMed， Cochrane Library， EMbase， Sinomed， Wanfang Medical Network， and VIP. The trial group was given a low-carbon ketogenic diet. The control group was given low-calorie food or flat-table healthy meal， and the included literature was evaluated by Jadad score， and the review was performed using Review Manager5.3 software. The outcome measures such as glycated hemoglobin content， body weight， and triglyceride levels in the test group and the control group were compared. Results A total of 7 articles were included in the meta-analysis， including 200 cases in the experimental group and 155 cases in the control group. Meta-analysis showed that the glycated hemoglobin content of the experimental group was lower than that of the control group [MD=-0.50， 95% CI（-0.70， -0.30）， P<0.01]; the weight of the experimental group was lower than that of the control group [MD=-8.07， 95 %CI（-10.73，-5.40）， P<0.01]; the triglyceride level in the test group was lower than that in the control group [MD=-29.05， 95% CI（-45.50， -12.71）， P<0.01]. Conclusion ketogenic diet is a dietary therapy that can effectively reduce glycated hemoglobin levels， reduce body weight， and lower triglyceride levels in diabetic patients.

[Key words] Diabetes; Ketone diet; Meta-analysis

糖尿病作為一组以高血糖为特征的代谢性疾病，现在已经逐渐发展成为全球三大导致过早死亡的健康危害因素之一[1]。糖尿病的发病原因和发生机制较为复杂，其并发症较多，且后果较为严重[2-3]，因此糖尿病患者非常需要早期治疗和早期干预。现在糖尿病的治疗方式包括药物治疗、运动治疗、生活方式干预、饮食治疗等。尽管今年来在药物治疗方面取得了较大的进展，药物的不良反应和潜在危害仍然使得人们对药物治疗的安全性保持很大的警惕。非药物治疗方案也逐渐受到人们的欢迎，比如采用低碳水化合物、高脂肪、适量蛋白质组成的生酮饮食（ketogenic diet）治疗。生酮饮食作为难治性癫痫[4-5]（refractory epilepsy，RE）疾病的非药物治疗方式之一，已有近百年的应用历史。……