CN110279114A - 一种结核病患者的肠内营养组合物及应用 - Google Patents
一种结核病患者的肠内营养组合物及应用 Download PDFInfo
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Abstract
本发明属于特殊医学用途配方食品的技术领域，具体是结核病患者的肠内营养组合物及其应用。本发明公开了一种结核患者的肠内营养组合物，所述营养组合物包含蛋白质、脂肪、碳水化合物、膳食纤维、谷氨酰胺、水溶性维生素、脂溶性维生素、矿物质和水。按重量份数计，所含营养组合物包含：蛋白质19000~69000份、脂肪10000~20000份、碳水化合物40000~93000份、膳食纤维1000~5000份、水溶性维生素10~700份、脂溶性维生素0.2~400份、矿物质40~7000份。在肺结核患者的营养治疗中采用以上肠内营养组合物，能够有效改善患者的肠道症状，提高患者的营养水平，应用前景广阔。
Description
技术领域
本发明涉及特殊医学用途配方食品的技术领域，特别是指一种用于结核病患者的肠内营养组合物。
背景技术
结核病是由结核分支杆菌感染引起的慢性传染性疾病，严重危害人类健康。据世界卫生组织估计，2013年，全球新发结核900万例，死亡150万例。我国是全球结核病和耐多药结核病双重高负担国家之一，活动性结核病例数多，结核分支杆菌感染人数多。全国第五次结核病流行病学抽样调查资料显示，我国结核分支杆菌感染人数超过5亿，占全国总人数的45％。
结核病是一种慢性、消耗性疾病，病原菌不断排除毒素，使机体的营养状态受到损害，导致中毒和全身性反应，机体长期不规则发热，消耗增多，蛋白质分解代谢显著增强，造成蛋白质丢失过多，可出现负氮平衡。同时，在结核病活动期间，全身毒血症使患者食欲减退、腹痛、腹泻、恶心、呕吐等，将影响到患者的摄入量而增加丢失量，多数患者都伴有蛋白质-能量营养不良。营养不良导致患者免疫力下降，淋巴细胞减少、萎缩，机体容易遭受感染，同时因缺乏病灶修复时所需的纤维蛋白、多糖和弹性纤维等综合基质，使对病原菌的包围和病灶的修复延缓。此外，抗结核药物的肝肾毒性、胃肠道紊乱等多种不良反应使结核患者面临病程长、营养风险系数高，治疗难度大灯问题。
结核病患者的治疗正趋向综合治疗方向发展，其中，营养治疗逐渐被认可。对结核病患者实行营养支持治疗，并指导患者掌握合理的营养治疗方法是实现结核病患者自身有效控制病情的关键。营养支持治疗是结核病患者综合治疗中的重要一环。随着临床研究的不断深入，肠内营养(enteral nutrition,EN)在临床中的应用日益受到重视，营养支持不仅能够满足结核病患者的能量需求，符合生理需要，能预防肠粘膜萎缩，有利于维护肠粘膜屏障功能和全身免疫系统功能，减少肠道菌群易位，不易出现严重并发症，且费用少，还能促进结核病灶的修复，因此，EN是临床上首选的营养支持方式和营养治疗手段。
发明内容
针对现有技术的不足，本发明目的提供适合结核患者的营养组合物及其制备方法，以满足结核患者对营养素的特殊需求。
为了解决上述技术问题，本发明的技术方案如下：
一种结核患者的肠内营养组合物，所述营养组合物包含蛋白质、脂肪、碳水化合物、膳食纤维、谷氨酰胺、水溶性维生素、脂溶性维生素、矿物质和水。
优选地，按重量份数计，所含营养组合物包含：蛋白质19000～69000份、脂肪10000～20000份、碳水化合物40000～93000份、膳食纤维1000～5000份、水溶性维生素10～700份、脂溶性维生素0.2～400份、矿物质40～7000份。
优选地，所述蛋白质为乳清蛋白，所述脂肪来源于氢化植物油、MCT中的一种或两种，所述碳水化合物来源于麦芽糊精，所述膳食纤维为聚葡萄糖、抗性糊精、低聚果糖、低聚木糖中的一种或几种，所述水溶性维生素为维生素B1、维生素B2、维生素B6、维生素B12、维生素C、泛酸、烟酸、叶酸、胆碱、生物素中的一种或几种，所述脂溶性维生素包含维生素A、维生素D、维生素E、维生素K中的一种或几种，所述矿物质包含磷、钠、氯、镁、钾、钙、铁、锌、铜、锰、碘、铬、钼、硒中的一种或几种。
优选地，按重量份数计，所述脂肪来源于MCT 10000～20000份、氢化植物油10000～20000份。
优选地，按重量份数计，所述膳食纤维包含聚葡萄糖1000～5000份、抗性糊精1000～5000份、低聚果糖1000～5000份、低聚木糖1000～5000份。
优选地，按重量份数计，所述水溶性维生素包含维生素B1 0.1～3.0份、维生素B20.7～4.0份、维生素B6 0.4～5份、维生素B12 0.001～0.015份、维生素C 50～170份、泛酸1.8～8.0份、烟酸4～50份、叶酸0.4～0.9份、胆碱60～450份、生物素0.006～0.020份。
优选地，按重量份数计，所述脂溶性维生素包含维生素A 0.01～0.8份、维生素D0.007～0.015份、维生素E 14～40份、维生素K 0.035～0.060份。
优选地，按重量份数计，所述矿物质包含磷140～170份、镁30～100份、钾100～900份、钙200～300份、铁1～30份、锌20～30份、铜1～190份、锰0.003～0.004份、铬0.020～0.065份、钼0.010～0.020份、硒0.050-0.060份、钠200～500份、氯90～100份。
优选地，所述营养组合物包含的蛋白质、脂肪、碳水化合物的供能比为(20.56～20.92):(41.42～42.06):(37.38～37.66)。
优选地，所述营养组合物还包含谷氨酰胺、牛磺酸、左旋肉碱和烟酰胺。
结核病患者的营养治疗原则以高能量、高蛋白、高维生素、高矿物质的半流质或者普食为主。发热、咳嗽、腹泻等症状都要消耗能量，结核病患者大都消瘦、抵抗力差，病灶的修复需要大量的蛋白质，提供足量的优质蛋白有助于机体免疫球蛋白的生成以及纠正贫血，乳清蛋白是优质蛋白，能满足结核病患者对蛋白的需求。另外，结核病灶的钙化需要大量的钙质以及维生素，维生素B6可对抗由于使用异烟肼治疗而引起的副作用，应供给充足。足够的膳食纤维使保持大便通畅，预防便秘，防止消化不良和避免体内废物积聚的必要措施。
与现有技术相比，本发明的有益效果如下：
目前，我国的专利中尚未有供结核患者的全营养制剂。根据结核患者的代谢特点和营养需求，有针对性的开发适用于结核患者的肠内营养产品，为结核患者提供合理、适当的营养，有助于提高临床治疗效果，促进结核病灶的钙化，减少住院时间及住院费用。
具体实施方式
以下将结合实施例来详细说明本发明。需要说明的是，在不冲突的情况下，本发明中的实施例及实施例中的特征可以相互组合。
实施例1
一种肺结核患者的肠内营养组合物，所含营养素包括乳清蛋白43950份、氢化植物油18400份、麦芽糊精56050份、聚葡萄糖2000份、谷氨酰胺4620份、维生素A 0.315份RE、维生素D 0.0084份、维生素B1 0.7份、维生素B2 0.7份、维生素B6 0.63份、维生素B12 0.0021份、维生素C 70份、烟酸9.1份、叶酸0.238份DFE、泛酸1.5份、钠240份、磷161份、镁98份、钙210份、铁1.23份、牛磺酸77份。
设置对照组为：给予常规治疗，包括抗感染、抗结核、对症等临床治疗，指导其进食高热量、高蛋白食物，以提高患者的营养状态，同时避免进食油腻、辛辣等刺激性食物，患者常规饮食选择我院营养食堂提供的营养餐。
设置营养支持组：在常规饮食及治疗的基础上进行肠内营养支持治疗，服用上述营养组合物。
1.实施步骤：食堂提供营养餐每日三餐常规进行，营养支持步骤：上述肠内营养粉加适量温开水配制成600ml乳剂，分别于每日10时、15时、19时服用，每次200ml。开始1～3d让患者胃肠道有一个逐渐适应、耐受肠内营养液的过程，先采用低浓度、低剂量、低速度，随后逐渐增加浓度、剂量至目标量。进行营养支持14天后分析患者各营养指标，以及纳入患者住院时间及住院费用统计。
2.两组治疗前后营养状况比较
对照组和营养支持组治疗前血红蛋白(Hb)、血清白蛋白(ALB)、总蛋白(TP)及体质指数(BMI)水平比较，差异均无统计学意义。治疗2周后，营养支持组Hb、ALB、TP水平明显高于对照组，差异有统计学意义，营养支持组体重变化百分比明显高于对照组，差异有统计学意义。具体数据见表1。结果表明：该肠内营养制剂能有效增加结核病患者总蛋白、血清白蛋白、体质指数，改善结核患者的营养状况。
3.两组并发肺部感染治疗疗效及患者住院时间、住院费用的比较
对照组并发肺部感染者43例，观察组并发肺部感染者46例，治疗2周后，对照组并发肺部感染好转15例(34.9％)，观察组好转26例(56.5％)，两组比较差异有统计学意义(χ2＝4.12，P＝0.0041)；观察组住院时间为[M(Q1,Q3)]为34.00(28.25,38.00)天，低于对照组的37.00(29.25,45.00)天，差异有统计学意义(U＝1601.00，P＝0.033)。观察组住院费用为[M(Q1,Q3)]为2.41(2.06,2.66)万元，低于对照组的2.52(2.28,3.34)万元，差异有统计学意义(U＝1416.00，P＝0.003)。
结果表明：该肠内营养组合物能有效改善患者感染症状，明显减少了患者的住院时间及住院费用。
表1两组患者治疗前后营养状况比较
实施例2
一种肺结核合并肠结核患者的肠内营养组合物，所含营养素包括乳清蛋白19360份、麦芽糊精92760份、MCT 10450份、抗性糊精1650份、维生素A 0.017份、维生素D 0.00915份、维生素E 37.3份、维生素B1 1.73份、维生素B2 2.05份、维生素B6 2.76份、维生素B120.00648份、维生素C 167份、维生素K 0.0511份、烟酸8.65份、叶酸0.6685份、泛酸5.3份、胆碱62.7份、生物素0.0198份、钠448份、磷146份、钾826份、镁33份、钙209份、铁20份、锌23份、铬0.032份、碘0.168份、铜179份、锰0.00324份、硒0.05991份、氯96份、钼.0105份、左旋肉碱10.92份、牛磺酸130.92份、烟酰胺15份。
共纳入28例肺结核合并肠结核患者，给予常规治疗，包括抗感染、抗结核、对症等临床治疗，指导其半流质或流质饮食，同时避免进食油炸、高纤维、坚硬、辛辣等食物，患者饮食选择我院营养食堂提供的流质或半流质营养餐。同时给予肠内营养支持治疗，服用上述营养组合物。
经过14天的肠内营养治疗后，患者平均腹泻次数明显减少，患者血红蛋白和白蛋白水平有显著性升高，结果均有统计学意义(P＜0.001)。
结果表明，肠内营养支持对肺结核伴肠结核患者而言，能够有效改善患者的肠道症状，维护肠粘膜屏障功能，提高患者的营养水平。
表2患者治疗前后营养指标变化(g/L)
| 血红蛋白(Hb) | 血清总蛋白(TP) | 血清白蛋白(ALB) | |
| 治疗前 | 104.66±22.93 | 61.58±7.49 | 31.86±7.00 |
| 治疗后 | 110.90±23.24 | 62.49±8.99 | 35.87±5.20 |
| t值 | -5.105 | -0.904 | -5.410 |
| P值 | ＜0.001 | 0.368 | ＜0.001 |
实施例3
一种肺结核合并II型糖尿病患者的肠内营养组合物，所含营养素包括乳清蛋白68460份、麦芽糊精42760份、氢化植物油16180份、低聚果糖4900份、钠263份，维生素A0.750份RE、维生素D 0.00712份、维生素E 14.9份、维生素K 0.040份、维生素B1 1.47份、维生素B2 1.47份、维生素B6 1.47份、维生素B12 0.00435份、维生素C 125份、叶酸0.4975份、泛酸7.05份、烟酸7份、生物素0.0165份、磷154份、钾105份、钙294份、铁25.9份、锌23.4份、铬0.062份、碘0.150份、铜1.5份、锰3份、硒0.050.1份、烟酰胺13.3份、牛磺酸84份。
设置对照组为：给予常规治疗，包括抗感染、抗结核、对症等临床治疗，指导其糖尿病饮食，增加奶类摄入量，以提高患者的营养状态，同时避免进食油腻、辛辣等刺激性食物，患者常规饮食选择我院营养食堂提供的糖尿病营养餐。
设置营养支持组：在常规饮食及治疗的基础上进行肠内营养支持治疗，服用上述营养组合物。
实施步骤同实施例1。
治疗前两组患者空腹血糖、餐后2h血糖情况对比差异无统计学意义(P＞0.05)。治疗后两组患者空腹血糖、餐后2h血糖控制情况与治疗前对比，结果差异有统计学意义(P＜0.05)。营养支持组患者治疗后空腹血糖、餐后2h血糖控制情况与对照组相比，明显优于对照组，两组结果对比有统计学意义(P＜0.05)。
结果表明：该肠内营养组合物能有控制结核合并II型糖尿病患者的血糖水平。
表3两组患者治疗前后空腹血糖及餐后2h血糖变化情况(mmol/L)
上述实施例阐明的内容应当理解为这些实施例仅用于更清楚地说明本发明，而不用于限制本发明的范围，在阅读了本发明之后，本领域技术人员对本发明的各种等价形式的修改均落入本申请所附权利要求所限定的范围。
Claims (10)
1.一种结核病患者的肠内营养组合物，其特征在于，所述营养组合物包含蛋白质、脂肪、碳水化合物、膳食纤维、谷氨酰胺、水溶性维生素、脂溶性维生素、矿物质和水。
2.根据权利要求1所述的肠内营养组合物，其特征在于，按重量份数计，所含营养组合物包含：蛋白质19000~69000份、脂肪10000~20000份、碳水化合物40000~93000份、膳食纤维1000~5000份、水溶性维生素10~700份、脂溶性维生素0.2~400份、矿物质40~7000份。
3.根据权利要求1所述的肠内营养组合物，其特征在于，所述蛋白质为乳清蛋白，所述脂肪来源于氢化植物油、MCT中的一种或两种，所述碳水化合物来源于麦芽糊精，所述膳食纤维为聚葡萄糖、抗性糊精、低聚果糖、低聚木糖中的一种或几种，所述水溶性维生素为维生素B1、维生素B2、维生素B6、维生素B12、维生素C、泛酸、烟酸、叶酸、胆碱、生物素中的一种或几种，所述脂溶性维生素包含维生素A、维生素D、维生素E、维生素K中的一种或几种，所述矿物质包含磷、钠、氯、镁、钾、钙、铁、锌、铜、锰、碘、铬、钼、硒中的一种或几种。
4.根据权利要求1所述的肠内营养组合物，其特征在于，按重量份数计，所述脂肪来源于MCT 10000~20000份、氢化植物油10000~20000份。
5.根据权利要求1所述的肠内营养组合物，其特征在于，按重量份数计，所述膳食纤维包含聚葡萄糖1000~5000份、抗性糊精1000~5000份、低聚果糖1000~5000份、低聚木糖1000~5000份。
6.根据权利要求1所述的肠内营养组合物，其特征在于，按重量份数计，所述水溶性维生素包含维生素B1 0.1~3.0份、维生素B2 0.7~4.0份、维生素B6 0.4~5份、维生素B120.001~0.015份、维生素C 50~170份、泛酸1.8~8.0份、烟酸4~50份、叶酸0.4~0.9份、胆碱60~450份、生物素0.006~0.020份。
7.根据权利要求1所述的肠内营养组合物，其特征在于，按重量份数计，所述脂溶性维生素包含维生素A 0.01~0.8份、维生素D 0.007~0.015份、维生素E 14~40份、维生素K0.035~0.060份。
8.根据权利要求1所述的肠内营养组合物，其特征在于，按重量份数计，所述矿物质包含磷140~170份、镁30~100份、钾100~900份、钙200~300份、铁1~30份、锌20~30份、铜1~190份、锰0.003~0.004份、铬0.020~0.065份、钼0.010~0.020份、硒0.050-0.060份、钠200~500份、氯90~100份。
9.根据权利要求1所述的肠内营养组合物，其特征在于，所述营养组合物包含的蛋白质、脂肪、碳水化合物的供能比为（20.56~20.92）: （41.42~42.06）: （37.38~37.66）。
10.根据权利要求1所述的肠内营养组合物，其特征在于，所述营养组合物还包含谷氨酰胺、牛磺酸、左旋肉碱和烟酰胺。
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