口服均衡營養補充品對血液透析患者發炎反應與氧化壓力之影響

Effects of oral balanced nutritional supplement on inflammation and oxidative stress in hemodialytic patients

阮庭洪(Teng-Hong Un)

指導教授 ： 趙振瑞

臺北醫學大學/營養學院/保健營養學研究所/碩士(2017年)

摘要

美國腎臟病資料登錄系統 （The United States Renal Data System, USRDS） 2015年提出，台灣末期腎臟病 （end stage renal disease, ESRD）的發生率及盛行率皆位居世界第一，近年來臺灣地區透析患者的死亡率有不斷上升之趨勢，且心血管疾病為其主要死亡原因。發炎反應與氧化壓力皆為ESRD患者罹患心血管疾病的危險因子。過去研究皆為針對口服均衡營養補充品能否改善體內營養不良指標為主，故本實驗將再深入探討口服均衡營養補充品，對於血液透析患者體內發炎反應與氧化壓力之影響。100位血液透析患者平均分為2組，控制組維制正常飲食，實驗組根據每日建議熱量攝取量，每日補充一或兩包均衡營養補充品（每包含：熱量200大卡, 48% 碳水化合物, 32% 脂肪、20% 蛋白質、0.7%, w/w精胺酸，及4.8%, w/w麩醯胺酸 ） ，實驗期為12週。結果顯示實驗組補充均衡營養補充品 12 週後會顯著降低介白素6 （interleukin 6, IL-6）、腫瘤壞死因子-α （tumor necrosis factor alpha, TNF-α）、C-反應性蛋白 （C-reactive protein, CRP）、及丙二醛 （malondialdehyde, MDA） 之濃度，顯著增加介白素10 （interleukin 10, IL-10） 與及總抗氧化能力 （Total antioxidant capacity, TAC）之濃度。比較控制組與實驗組之第 12週間變化量，實驗組會使TNF-α與CRP 之濃度下降量顯著增加，IL-10之濃度增加量顯著上升，故補充均衡營養補充品12 週後可有效改善血液透析患者之發炎與氧化壓力指標。

關鍵字

均衡營養補充品 ； 發炎反應 ； 氧化壓力 ； 血液透析

並列摘要

According to the United States Renal Data System 2015 Data Report, Taiwan had the highest prevalence of end-stage renal disease （ESRD） in the world. Inflammation and oxidative stress are risk factors of cardiovascular disease in ESRD patients. Insufficient data show whether intake of oral balanced nutritional supplement can improve inflammation and oxidative stress in hemodialytic patients. Therefore, this study evaluated the effect of oral balanced nutritional supplement on inflammation and oxidative stress in hemodialytic patients. One hundred hemodialytic patients were recruited and divided evenly into two groups. The subjects in the control group were kept on their regular diet without supplement. The subjects in the treatment group were assigned one or two packages （43 g per package） of oral balanced nutritional supplement （200 kcal energy, 48% carbohydrate, 32% fat and 20% protein per package） containing arginine （0.7%, w/w） and glutamine （4.8%, w/w） daily for 12 weeks based on the recommended energy requirement. Serum interlukin-10 （IL-10） and total antioxidant capacity （TAC） levels in the treatment groupwere increased significantly at week 12. Moreover, serum interleukin-6 （IL-6）, tumor necrosis factor-α （TNF-α）, C-reactive protein （CRP） and malondialdehyde （MDA） levels in the treatment group were decreased significantly at week 12. There were no significant differences for inflammatory and oxidative stress markers in the control group at weeks 0, 6, and 12. Increases in serum IL-10 level in the treatment group were significantly greater than those in the control group at week 12 compared with the baseline. Furthermore, decreases in serum TNF-α and CRP levels in the treatment group were significantly greater than those in the control group at week 12 compared with the baseline. Our results suggest that oral balanced nutritional supplement containing arginine and glutamine is effective for anti-inflammation and anti-oxidation in hemodialytic patients.

並列關鍵字

oral balanced supplement ； inflammation ； oxidative stress ； hemodialysis

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