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目的通过极低蛋白饮食联合复方α-酮酸(开同)和常规低蛋白饮食在慢性肾脏病(chronic kidney disease,CKD)IV期中的作用,评估其对钙磷代谢和PTH的影响。方法采用前瞻、随机、对照临床研究,对24例CKD患者,肌酐清除率低于30ml/min,随机分为两组,极低蛋白饮食+开同组(VLPD+Ket组)和低蛋白饮食组(LPD组),每组12例患者,观察4个月。结果所有患者营养状态均得到充分维持,游离钙在VLPD+Ket组无明显变化,LPD组趋于下降;血磷在VLPD+Ket组下降[(1.48±0.16)mmol/L和(1.29±0.36)mmol/L,P<0.05],LPD组无变化。LPD组甲状旁腺激素明显升高[(241±138)pg/ml和(494±390)pg/ml,P<0.01],该参数与钙呈负相关(r=-0.75,P=0.02),而与磷呈正相关(r=0.71,P=0.03)。结论 VLPD+Ket能维持CKD IV期患者正常的营养状况,同时还具有改善钙磷代谢、降低尿素氮和稳定PTH的作用,进一步预防和降低肾性骨病的发生,有明显底预防和降低肾性骨病发生的作用。
OBJECTIVE: To evaluate the effect of combination of α-ketoacid (combination) and conventional low-protein diet on stage IV of chronic kidney disease (CKD) by using very low protein diet. Methods A prospective, randomized, controlled clinical study of 24 CKD patients with creatinine clearance of less than 30 ml / min was randomly divided into two groups: low protein diet + VLPD + Ket group and low protein diet group (LPD group), each group of 12 patients, observed for 4 months. Results The nutritional status of all patients was well maintained. There was no significant change in free calcium in VLPD + Ket group and LPD group. Phosphorus decreased in [(1.48 ± 0.16) mmol / L and (1.29 ± 0.36) mmol / L, P <0.05], no change in LPD group. P <0.01). The level of parathyroid hormone in LPD group was significantly higher than that in LP group [(241 ± 138) pg / ml and (494 ± 390) pg / ml, , But positively correlated with phosphorus (r = 0.71, P = 0.03). Conclusion VLPD + Ket can maintain the normal nutritional status of patients with CKD stage IV, and also can improve the metabolism of calcium and phosphorus, reduce the role of urea nitrogen and stabilize PTH, and further prevent and reduce the incidence of renal osteodystrophy. The role of osteodystrophy.