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膳食碳水化合物摄入控制对腹膜透析患者血脂和血糖的影响

Effect of controlling dietary carbohydrate intake on blood lipids and glucose of peritoneal dialysis patients

  • 摘要:
    目的 观察减少腹膜透析(腹透)患者饮食中碳水化合物摄入量后,其血脂和血糖水平变化。
    方法 选择2016年8月至2017年4月复旦大学附属华山医院收治的长期腹透患者35例,根据其24 h腹透液中葡萄糖的丢失量(患者从腹透液中吸收葡萄糖的量),个体化指导其饮食中碳水化合物的摄入量,跟踪指导6个月。
    结果 干预后三酰甘油(triglycerides,TG)明显下降,血清总胆固醇(serum total cholesterol,TC)、低密度脂蛋白(low-density lipoprotein,LDL)和脂联素升高,抵抗素和铁蛋白均降低,空腹血糖(fasting blood glucose,FBG)、糖化血红蛋白(hemoglobin A1c,HbA1c)、胰岛素水平和胰岛素抵抗指数(homeostatic model assessment-insulin resistance,HOMA-IR)均下降,血总蛋白(total protein,TP)升高(P < 0.05)。患者干预前后体质量、三头肌皮褶厚度(triceps skin fold thickness,TSF)、上臂围及白蛋白(albumin,Alb)等差异无统计学意义。
    结论 根据长期腹透患者从腹透液中吸收的葡萄糖的量,相应减少其饮食中碳水化合物的摄入量,有助于降低血脂,改善葡萄糖代谢,并保持患者良好的营养状况。

     

    Abstract:
    Objective To observe the change of blood lipids and glucose after reducing the intake of carbohydrates in the diet of peritoneal dialysis patients.
    Methods From August 2016 to April 2017, 35 patients who undenwent long-term peritoneal dialysis in Huashan Hospital, Fudan University were selected. According to the lost amount of glucose in 24 h peritoneal dialysis fluid of patients, which was the amount of glucose absorbed from the peritoneal dialysis fluid, the dietary carbohydrate intake was personally guided, and followed up for 6 months.
    Results After the intervention, triglycerides (TG) was reduced, serum total cholesterol (TC)、low-density lipoprotein (LDL) and adiponectin were all increased, resistin and ferritin were reduced, fasting blood glucose (FBG), hemoglobin A1c (HbA1c), insulin levels and homeostatic model assessment-insulin resistance (HOMA-IR) index were decreased, and serum total protein (TP) was increased (P < 0.05). There was no significant difference in body weight, triceps skin fold thickness (TSF), upper arm circumference (AC), and serum albumin (Alb) before and after intervention in peritoneal dialysis patients.
    Conclusion According to the amount of glucose absorbed by long-term peritoneal dialysis patients from the peritoneal dialysis fluid, the corresponding reduction in the intake of carbohydrates in their diet would help them reduce blood lipids, improve glucose metabolism, and maintain the nutritional status.

     

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