复方α酮酸配伍低蛋白饮食对长期腹膜透析患者微炎症的影响及其与营养状态关系的随机对照研究_临床医学论文.docVIP

复方α酮酸配伍低蛋白饮食对长期腹膜透析患者微炎症的影响及其与营养状态关系的随机对照研究_临床医学论文 复方α酮酸配伍低蛋白饮食对长期腹膜透析患者微炎症的影响及其与营养状态关系的随机对照研究_临床医学论文 作者：谌卫, 郭志勇, 吴灏, 孙莉静, 蔡莉莉, 徐海燕 【摘要】 观察复方α酮酸配伍低蛋白饮食对长期持续性不卧床腹膜透析（continuous ambulatory peritoneal dialysis, CAPD）患者血浆炎症因子水平变化的影响及其与营养状态的关系。 【关键词】 低蛋白质膳食; 酮酸类; 腹膜透析; 炎症; 营养不良 　　Objective: To investigate the effects of the combination of α. 　　Methods: Eighty routineprotein diet group. The levels of serum albumin (Alb), prealbumin (PA), retinolbinding protein (RBP), transferrin (TRF), cholesterol (TC), triglycerides (TG), leptin, and triceps skinfold thickness (TSF), midarm muscle circumference (MAMC), body mass index (BMI) were measured. The changes of serum interleukin1α (IL1α), interleukin6 (IL6), tumor necrosis factorα (TNFα) and Creactive protein (CRP) were also detected. 　　Results: Compared with lowd TRF were significantly increased both in lowprotein diet plus αketo acid and routineprotein diet groups (0.01), however, there was no significant difference in the levels of PA, RBP and TRF between lowprotein diet plus αketo acid group and routineprotein diet group. There was an increased tendency in the content of Alb, TC, TG, BMI, TSF and MAMC, but there were no significant differences. The plasma levels of IL1α, IL6 and TNFα in lowprotein diet plus αketo acid group were decreased as compared with the routineprotein diet group, but there were no significant differences. The plasma level of CRP in lowprotein diet plus αketo acid group was lower than that in the routineprotein diet group (0.01). 　　Conclusion: The combination of αnd lowprotein diet can ameliorate malnutrition and microinflammation in CAPD patients. 　　Keywords: low 　　近年来，营养状态作为影响透析患者生存质量的一个重要指标逐渐受到重视。一方面，透析患者营养不良的发生发展主要与体内微炎症状态密切相关［1］，另一方面，营养不良可导致机体防御功能下降而增加患者发生各种感染的机率。更进一步，炎症促使白细胞介素6（interleukin）和肿瘤坏死因子α（tumor necrosis factor）等细胞因子释放，导致肌肉蛋白质分解代谢增强，最终机体出现低蛋白血症和消瘦。增加饮食中蛋白摄入量［1.2～1.3 g/（kg·d）］，并确保足够热能［146 kJ/（kg·d）］是防止营养不良发生的理想途径，但过多蛋白质的摄入会促进蛋白的分解，加重酸中毒及毒素潴留，反而影响蛋白质和氨基酸的合成及利用，且蛋