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目的:观察低蛋白饮食加α-酮酸(LPD+α-KA)这一终末期肾功能衰竭(ESRD)病人营养治疗方法对减轻血管钙化的作用。方法:将18只大鼠随机分为正常对照组、正常蛋白-慢性肾功能衰竭(NPD-CRF)组和LPD+α-KA-CRF组。两组CRF大鼠饲料中含0.75%腺嘌呤。于喂养6周后留取血标本和腹主动脉,测定血钙、磷等生化指标,并采用H-E和Von-Kossa染色,观察各组动物腹主动脉血管壁的钙化程度。结果:与正常对照组比,两组CRF大鼠血肌酐水平均显著升高。NPD-CRF组表现为低钙高磷;LPD+α-KA-CRF组仅血钙显著升高,两组大鼠钙磷乘积均高于正常对照组。NPD-CRF组H-E染色示腹主动脉中层弹力纤维层数减少,排列紊乱,且弹力纤维迂曲断裂。经Von-Kossa染色可见弥漫的蓝黑色颗粒沉积,普遍发生钙化;而LPD+α-KA-CRF组大鼠血管壁中层弹力纤维结构尚完整,仅偶见蓝黑色颗粒沉积,钙化程度较轻。结论:腺嘌呤CRF大鼠模型存在钙磷代谢异常、血管钙化现象。LPD+α-KA可改善低钙高磷血症,并有助于减轻血管钙化程度。
OBJECTIVE: To observe the effects of low-protein diet plus alpha-keto acid (LPD + α-KA), a nutritional therapy for patients with end-stage renal failure (ESRD), on reducing vascular calcification. Methods: Eighteen rats were randomly divided into normal control group, normal protein - chronic renal failure (NPD-CRF) group and LPD + α-KA-CRF group. The two groups of CRF rats contained 0.75% adenine. Blood samples and abdominal aorta were collected 6 weeks after feeding, and the biochemical indexes such as serum calcium and phosphorus were determined. H-E and Von-Kossa staining were used to observe the calcification of abdominal aorta wall. Results: Compared with the normal control group, serum creatinine levels were significantly increased in both CRF rats. NPD-CRF group showed low calcium and high phosphorus; LPD + α-KA-CRF group only increased serum calcium, calcium and phosphorus products in both groups were higher than the normal control group. H-E staining in the NPD-CRF group showed that the number of middle-layer elastic fibers in the abdominal aorta decreased, disorganized, and the elastic fibers were tortuous and ruptured. The Von-Kossa staining showed diffuse deposition of blue-black particles and calcification. In the LPD + α-KA-CRF group, the middle layer of elastic fibers in the vessel wall was still intact, and only occasional blue-black particles were deposited with a little calcification. Conclusion: There is abnormal calcium and phosphorus metabolism and vascular calcification in adenine CRF rat model. LPD + α-KA can improve hypocalcemia and help to reduce the degree of vascular calcification.