低蛋白及適量B-維生素配方補充品對慢性腎臟病患者的腎功能、同半胱胺酸濃度、氧化壓力及抗氧化能力之影響

The effect of low protein with moderate B-vitamin formula on renal function, homocysteine, oxidative stress and antioxidant capacities in patients with chronic kidney disease

蕭郁樺(Yu-Hua Hsiao)

指導教授 ： 黃怡嘉

中山醫學大學/健康管理學院/營養學研究所/碩士(2015年)

https://doi.org/10.6834/CSMU.2015.00068

摘要

慢性腎臟病患者常見有高同半胱胺酸濃度及高氧化壓力，進一步可能影響其腎功能及抗氧化能力。因此本研究給予慢性腎臟病患者補充低蛋白及適量B-維生素配方後觀察是否會影響其腎功能、同半胱胺酸、氧化壓力及抗氧化能力。於臺中榮民總醫院腎臟科門診招募100位第二或三期慢性腎臟病受試者，隨機分派至觀察組或配方組，配方組受試者於24週介入期間每日以兩包低蛋白及適量B-維生素配方替代早餐或點心的飲料。並於第 0、12及24 週收集受試者血液及尿液進行分析。觀察組第24週的同半胱胺酸濃度顯著高於第0週，但配方組沒有顯著變化。兩組第24週的腎絲球過濾率數值及丙二醛濃度（氧化壓力指標）皆顯著低於第0週。兩組的血清肌酸酐濃度、榖胱甘肽還原酶活性於介入期間皆無顯著變化，但榖胱甘肽硫轉移酶、榖胱甘肽過氧化酶及超氧歧化酶在第24週的活性皆顯著高於第0週。比較兩組於第24週及第0週各項生化值的變化（#week 24 – week 0），配方組的榖胱甘肽過氧化酶活性變化顯著高於觀察組，但榖胱甘肽及氧化型榖胱甘肽濃度變化顯著降低。調整年齡、性別、身體質量指數、有無糖尿病及高血壓、抽菸及喝酒習慣後發現配方介入會顯著降低榖胱甘肽（B = -59.75, p < 0.01）及氧化型榖胱甘肽濃度（B = -56.80, p < 0.01）變化以及增加榖胱甘肽過氧化酶活性的變化（B = 59.94, p < 0.01）。雖然慢性腎臟病患者補充低蛋白及適量B-維生素配方後不會顯著改善腎功能、同半胱胺酸濃度及氧化壓力，但可以顯著增加榖胱甘肽過氧化酶活性及降低榖胱甘肽和氧化型榖胱甘肽的濃度。

關鍵字

慢性腎臟病 ； 低蛋白及適量B-維生素配方 ； 同半胱胺酸 ； 氧化壓力 ； 抗氧化能力

並列摘要

Hyperhomocysteinemia and increased oxidative stress have been observed in patients with chronic kidney disease (CKD), both may further affect pateints’ renal function and antioxidant capacities. The purpose of this study was to evaluate the effect of low protein and moderate B-vitamin formula on renal function, homocysteine concentration, oxidative stress and antioxidant capacities in patients with stage 2-3 CKD. We recruited 100 stage 2-3 CKD patients from the outpatient clinic of the division of nephrology of Taichung Veterans General Hospital. Subjects were randomly assigned to a intervention group or observation group. Subjects in intervention group were asked to take 2 packs of low protein with moderate B-vitamin formula to replace their drink of breakfast or snack for 24 weeks. The hematological and urine samples were measured at the 0, 12th, and 24th week. Subjects in the observation group had significantly higher plasma homocysteine concentration at the 24th week when compared to the value at week 0; while plasma homocysteine concentration had no significant changes during the study period in the observation group. The levels of estimated glomerular filtration rate and malondialdehyde (oxidative stress indicators) at week 24 were significantly lower than week 0 in both groups. Serum creatinine concentration and glutathione reductase activity had no significant changes during the intervention study period in both groups, but the activities of the glutathione transferase, glutathione peroxidase and superoxide dismutase were significantly higher at week 24 when compare with activities at week 0. The change of glutathione peroxidase activity between week 24 and week 0 (#week 24-week 0) was significantly higher in the intervention group when compared to the value of the observation group. The change of glutathione and oxidized glutathione concentration between week 24 and week 0 (#week 24-week 0) was significantly lower in the intervention group when compared to the value of the observation group. After adjusting for age, gender, body mass index, diabetes mellitus, hypertension, smoking and drinking habits, formula hade significant effect on reducing the change of glutathione concentration (B = -59.75, p < 0.01) and oxidized glutathione concentration (B = -56.80, p < 0.01) and increasing the change of glutathione peroxidase activity (B = 59.94, p < 0.01). The intervention of low protein with moderate B-vitamin formula had no significant beneficial effect on changing renal function, homocysteine concentration and oxidative stress; however it could significantly increase the activity of glutathione peroxidase and decrease glutathione and oxidized glutathione concentration.

並列關鍵字

chronic kidney disease ； low protein with moderate B- vitamin formula ； homocysteine ； oxidative stress ； antioxidant capacity

參考文獻

Araki A, Sako Y. Determination of free and total homocysteine in human plasma by high-performance liquid chromatographywith fluorescence detection. J Chromatography. 1987; 422: 43-52.

Arnadottir M, Hultberg B, Nilsson-Ehle P, Thysell H. The effect of reduced glomerular filtration rate on plasma total homocysteine concentration. Scand J Clin Lab Invest. 1996; 56: 41-46.

Arnao MB, Cano A, Hernández-Ruiz J, García-Cánovas F, Acosta M. Inhibition by L-ascorbic acid and other atioxidants of the 2,2’-azino-bis(3-ethylbenzthiazoline-6-sulfonic acid)oxidation catalyzed by peroxidase: anew approach for determining total antioxidant status of foods. Anal Biochem. 1996; 236: 255-261.

Austen SK, Coombes JS, Fassett RG. Homocysteine and cardiovascular disease in renal disease. Nephrology. 2003; 8: 285-295.

Aviram M, Rosenblat M, Bisgaier CL, Newton RS, Primo Parmo SL, La Du BN. Paraoxonase inhibits high-density lipoprotein oxidation and preserves its functions: a possible peroxidative role for paraoxonase. J Clin Invest. 1998; 101: 1581-1590.