CN103082167B - Composite enteral nutrition applicable to AIDS patients - Google Patents
Composite enteral nutrition applicable to AIDS patients Download PDFInfo
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- CN103082167B CN103082167B CN201310019973.5A CN201310019973A CN103082167B CN 103082167 B CN103082167 B CN 103082167B CN 201310019973 A CN201310019973 A CN 201310019973A CN 103082167 B CN103082167 B CN 103082167B
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Abstract
The invention discloses a composite enteral nutrition applicable to AIDS patients. The composite enteral nutrition comprises nutrients such as proteins, fat, carbohydrates, vitamins, minerals and dietary fibers required by human bodies. The nutrition has a good clinical nutritional supporting effect on the AIDS patients, is beneficial to absorption of the AIDS patients and improvement of poor nutrient conditions of the patients compared with a common whole protein type nutrition, and can obviously improve the living quality of the patients; compared with a common nutrient group, the nutrition has the advantages of remarkably improving the nutrient conditions of the patients and lightening the decline of various physical measurement indexes such as weight caused by AIDS; various biochemical indexes of blood of the patients can be remarkably improved, the blood sugar and the blood fat of the patients are adjusted, and the insulin resistance and the lipid metabolism disorder of the patients are lightened; and the intestinal floras of the patients are adjusted, the intestinal barrier function of the patients is protected, diarrhea caused by the flora disorder of the patients is reduced, the immunity of the patients is enhanced, and the opportunistic infections caused by intestinal flora translocation are reduced.
Description
Technical field
The present invention relates to the compound enteral nutrition preparation that a kind of AIDS patient of being applicable to uses.
Background technology
AIDS (Acquired Immunodeficiency Syndrome, AIDS) be by human immunodeficiency virus (Human Immunode ficiency Virus, HIV) the chronic consumption communicable disease causing, patient immune function is badly damaged, and often merges opportunistic infections and causes MOF and death; AIDS is from 1981 first since the U.S. finds, epidemic situation develops rapidly, and its clinical symptoms complexity, complication is many, case fatality rate is high, current one of the most disruptive in history epidemic infectious diseases that become.China's first report in 1985 is found AIDS patient, by the end of the year 2011, accumulative total is reported HIV the infected and AIDS patient 43.4 ten thousand people, and wherein dead 8.8 ten thousand people estimate the existing HIV the infected alive of China and AIDS patient approximately 780,000 people (AIDS patient approximately 15.4 ten thousand people).China AIDS popular is still lasting ascendant trend in recent years; Preventing and treating in process of AIDS, the effect of nutrition is more and more subject to international community and payes attention to.2006 Nian59Jie World Health Assembly are thought: food and reasonably nutrition are HIV the infected or the direct and the most crucial demand of AIDS patient, and urge the integral part of its member state using nutrition as reply HIV/AIDS strategy, require WHO Secretary General to strengthen the technological guidance to member state's nutrition policy and nutrition project aspect.But at present still without special AIDS nutritional preparation.
Nutrition and HIV/AIDS's is in close relations, the two reciprocal causation.Malnutrition had both easily facilitated HIV to infect, and was again the result that HIV infects.Enteron aisle is the center organ that stores bacterium, is also the initiating organ of infection and multiple organ dysfunction; It is impaired that malnutrition can cause gut barrier function, and gut flora and Endotoxin Translocation, cause general infection, due to AIDS patient's immunologic hypofunction, infects and occur to be difficult to control, and finally causes MOF and death; It is reported approximately have 98%AIDS patient to have malnutrition, and be to cause HIV the infected and AIDS patient to occur the key factor of poor prognosis.
Merge underfed HIV the infected and be more prone to opportunistic infections and other complication, and infect and be not easy to control, cause MOF and death; Meanwhile, malnutrition can be accelerated the course of disease that HIV infects, and impels AIDS more early to occur, and affects antiviral therapy effect.HIV infects and can cause damage to metabolism and nutrition condition, especially progressive stage, and can cause catabolism hyperfunction by a variety of causes, and then occur serious albumen-caloric malnutrition, cause consumption state, the Body weight loss of general; This Body weight loss is different from the Body weight loss that simple hunger causes, the latter is mainly that adipose tissue declines 80%, and musculature only declines 20%; And after HIV infects or while suffering from AIDS, fat and musculature all decline simultaneously, Body weight loss exceedes 5% patient in the recent period, and its mortality risk significantly increases; Consumption is the most serious malnutritive form of expression, also be the most outstanding nutrition problem after HIV infects, while especially proceeding to AIDS stadium, consumption itself just forms this sick characteristic performance, be AIDS wasting syndrome (AIDS wasting syndrome, AWS).Investigation shows, 1/3 Asymptomatic HIV Infection person exists Body weight loss, and when PD is during to late period (AIDS stadium), nearly all patient, by occurring serious consumption, shows as and becomes thin and cachexia; Therefore, consumption is to form one of diagnosis content of AIDS, AWS is defined as: body weight obviously decline (>10% baseline weight), (every day is rare just more than 2 times to merge chronic diarrhea, continue 30d or more than), maybe chronic weakness and the heating (meet or exceed 30d, intermittently or lasting) that can not explain by other complication (as cancer, tuberculosis, Cryptosporidiosis or other specificity enteritis) except HIV infects; Consumption is index AIDS patient's final result to predictability.AIDS nutritional status in late extremely lacks, and makes body's immunity low, easily causes opportunistic infections, aggravates disease.This highlights the importance of nutritional support, and nutritional support can obviously increase weight in patients, shortens the hospital stays, improve the quality of living, extends patient's life.
AIDS patient's feature:
1. basis consumes increases: (the fat-free mass of the thin soma of HIV the infected, FFM) average rest energy expenditure (resting energy expenditure, REE) be increased significantly than normal healthy controls person at HIV positive, its rising amplitude is about 9%, and there have its REE of symptom the infected to increase degree to be more obvious than symptomless infection person, merge opportunistic infections or tumour, cause energy and protein requirement to increase, also cause nutrient loss simultaneously and utilize obstacle;
2. the impaired and flora imbalance of gut barrier function, make patient's digestion and absorption function obstacle, long-term existence Hypoproteinemia: HIV the infected and AIDS patient's gastrointestinal tract exist mucosal inflammation, with patient's cell cycle, lipid metabolism, the gene that intestinal mucosal barrier is relevant with digestive function is lowered, cell migration and power of regeneration decline, the pathological changes such as flora imbalance, make AIDS patient occur poor appetite, abdominal distension, diarrhoea, lose weight, enteron aisle inflammatory edema, intestinal permeability increases, the situations such as bile acid and cobalamin malabsorption, there is significant intestinal microecology imbalance in AIDS patient, digestive functional disturbance, the nutrient relevant to intestinal microecology is as B family, K family vitamin lacks, patient's long-term chronic diarrhoea, increases gut flora transposition, causes the immune activation of whole body, accelerates the generation of AIDS and opportunistic infections,
3. blood sugar and metabolism disorder of blood lipid: HIV the infected's metabolic disorder, often with insulin resistance and disorders of lipid metabolism.When entering the AIDS phase, patient accepts HAART when treatment, side effects of pharmaceutical drugs make patient have fat metabolic disturbance syndrome, its performance aspect biochemical mechanism is more various, as insulin resistance, hypercholesterolemia (T-CHOL, low-density lipoprotein white level raise, and hdl level reduces), Hypertriglyceridemia etc.Investigation shows, accepts in the patient of HAART, and 50% exists dyslipidemia, and 35% exists the abnormal distribution of fat, and fatty derangement syndrome shows as and increases angiocardiopathy and pancreatitic risk for the impact of the long-term final result of patient;
4. feed again syndrome: feed again syndrome and refer to and after long-term hunger, provide again and feed one group of caused, relevant to metabolic disorder performance of (comprise that per os is ingested, in intestines or parenteral nutrition), comprise low-phosphorous, low magnesium, hypopotassaemia, degradation under Vitamin B1 deficiency and glucose tolerance.AIDS patient is due to the factors such as feed difficulty or replacement therapy, the easily concurrent syndrome of feeding again; Hypophosphatemia is to feed the performance that syndrome is the most outstanding again, a retrospective study discovery such as Manary, and the fatal rate of serious hypophosphatemia, up to 63%, should increase the amount of phosphorus, magnesium, potassium and vitamin B1 in right amount therefore be applicable to patient's AIDS nutrient solution;
Malnutritive become the main challenge that HIV the infected and AIDS patient face, nutritional support treatment has very important meaning to AIDS wasting syndrome, it is one of effective auxiliary treatment means, because HIV infects, each tract is all had to impact, the infected's body metabolism changes and accepts HAART and treat the toxic and side effect of bringing, a kind of special dietary preparation for the configuration of AIDS patient's feature and applicable its pathophysiological change of AIDS needs of patients carries out nutritional support, in addition Yunnan Province is High prevalence areas of AIDS, there is no at present the enteral nutrition preparation that is applicable to AIDS patient.
Summary of the invention
The invention provides the total enteral nutritious preparation that a kind of AIDS patient of being applicable to uses, this is the clinical nutritive preparations that a kind of applicable AIDS patient uses, for AIDS patient carries out nutritional support treatment; The present composition needs for AIDS patient's physiology and pathology; promote enteral nutritional prods to absorb and protecting the aspects such as gut barrier function to there is very large advantage; in improving Nutritional Status of Patients; strengthen the sensitiveness of patient to medicine; protection gut barrier function; reduce bacterium and Endotoxin Translocation; strengthen patient immune function; reduce infection rate; improve patient's prognosis; extend patient's life, improve its quality of life and reduce AIDS case fatality rate, there is very important realistic meaning and Practical significance.
The total enteral nutritious preparation of the present invention, the nutritional labeling of every 100 grams of total enteral nutritious preparations comprises protein 19.5-20.5 gram, fatty 14-15 gram, carbohydrate 55-58 gram, dietary fiber 4g, sodium 393-420mg, potassium 520-542mg, calcium 361-380mg, phosphorus 527-540mg, magnesium 158-162mg, zinc 6.8-7.2mg, selenium 17-19ug, the A1550-1650IU that supports one's family, VD1 20-140IU, vitamin e1 2-14IU, Cobastab
12.5-2.8mg, Cobastab
20.8-1.0mg, Cobastab
61.3-1.5mg, Cobastab
122.4-2.5mg, vitamin C 12-15mg, glutamine 5000-6000mg, taurine 7.4-7.6mg, VBT 14-15mg.
Protein described in the present invention is the lactalbumin of mass percent 50-60%, the collagen peptide of mass percent 35-40%, the mucinous mixture of mass percent 2-5%.
Fat described in the present invention is the mixture of the deep sea fish oil of mass percent 25-35% and the olive oil of mass percent 65-75%.
Carbohydrate described in the present invention is the mixture of the maltodextrin of mass percent 65-69% and the Chinese yam starch of mass percent 31-35%.
In compound enteral nutritional composition of the present invention, dietary fiber obtains by adding 2-3 gram of inulin-type levulan and 2-3 gram of lentinan.
For the particularity of AIDS patient's pathophysiological change and nutritional need, the present invention mainly improves the demand of AIDS patient to nutrition from the following aspects:
1. total enteral nutritious preparation absorption easy to digest, energy density is high, can promote weight in patients to increase; The dietary protein origin of high-quality, is conducive to correct negative nitrogen balance.
According to investigations, AIDS patient's energy of 80%-90%, protein intake are lower than 70% left and right of normal intake, and AIDS patient's nutritional need increases, the high 10%-15% of energy Ratios healthy population, reaches 167.2kJ/ (kg.d)-188.1kJ/ (kg.d); Protein requirement is 1.5 times-2.0 times of healthy population, reaches 1.5g/ (kg.d).
2. select lactalbumin, collagen peptide as nitrogenous source, both considered supplementing of essential amino acid, take into account again the advantage of peptide class aspect absorption.
Lactalbumin is rich in branched-chain amino acid, immune globulin bletilla lactoferrin, and low fat, low cholesterol, very easily digest and assimilate, and biological value, up to 104, can supplement rapidly protein in body, corrects negative nitrogen balance, improves immunity of organisms, increases thin soma; Collagen peptide profile of essential amino acids is similar to American National Science Research Council (NRC) amino acid pattern, digestive function impaired patients can provide digestible exogenous nitrogen, bioavilability is high, collagen Toplink is directly absorbed by enteron aisle, improves fast amino acid pattern and corrects Hypoproteinemia.
3. reduce the ratio of carbohydrate, carry high-fat for ratio of specific heat; Select the main source of oligosaccharides as carbohydrate, increase dietary fiber, improve insulin resistance.
Maltodextrin belongs to oligosaccharides, and little to the stimulation of pancreas, glycemic load is low, and inulin-type levulan is activated water soluble dietary fiber, can increase content of cellulose, improve dietary fiber source diversity, slow down the absorption of glucose;
Fish oil is rich in essential fatty acid linoleic acid and alpha-linolenic acid, eicosapentaenoic acid (EPA) and DHA (DHA), contribute to regulating lipid metabolism disorder, reduce inflammatory mediator and cell factor, there is immunoregulation effect;
Olive oil has antioxidant effect, can eliminate interior free yl, can reduce the peroxide injury in AIDS patient body, prevents that inflammation from occurring, Promote cell's growth, and accelerating wound healing, repairs intestinal barrier function.
4. be rich in glutamine, inulin-type levulan and Chinese yam mucoprotein, contribute to reparation, the adjusting normal flora of intestinal mucosa, improve function of intestinal canal.
AIDS patient's intestinal mucosa injury and reparation postpone, and are the key factors of gastrointestinal dysfunction course of disease protracted course of disease.Glutamine (Gln) is the nutrients of special procuring of the Fast Growth cells such as protection of intestinal mucosal barrier cells, and Gln can alleviate the damage of AIDS Intestinal Mucosal Injury in Patients Undergoing, promotes the regeneration of protection of intestinal mucosal barrier cells, safeguards gut barrier, the displacement of prevention enteric bacteria and toxin.Glutamine has positive effect to the improvement of protein metabolism, promotes protein synthetic, and CKIs matter is decomposed, and strengthens the immunologic function of body;
The configuration of inulin-type levulan is that fructosyl-fructose connects with β glycosidic bond, can be not digested in UGI, can in colon, ferment.Inulin-type levulan can increase content of cellulose, improves the diversity in dietary fiber source, affects specifically some gastrointestinal function (absorption of the formation of colonic microflora, Function of intestinal mucosa, endocrine activity, mineral matter), even whole body function (particularly lipid and immunologic function) and reduce the occurrence risk of various diseases.Inulin-type levulan can be by improving Mucosa Morphology, make mucoprotein retrogradation, improve mucinous formation affects enteric epithelium, regulating intestinal canal mucous membrane function; Inulin-type levulan, by increasing the quantity of " beneficial bacterium " in enteron aisle, can strengthen the barrier function of intestinal mucosa, prevents the general infection due to alimentary infection and bacterial translocation from intestine that pathogenic entero becteria causes;
Chinese yam belongs to help food, has again astriction, and long-term chronic diarrhoea is had to therapeutic action; Chinese yam contains 1.42% glutinous albumen, prevents that fat from, in vascular wall deposition, keeping blood vessel elasticity; Alpha-amylase inhibitor in Chinese yam, can hinder hydrolysis and the digestion of carbohydrate in food, reduces pancreas islet opposing; In Chinese yam polysaccharide deferrable stomach, food is emptying, contains digestive ferment, can promote the decomposition of enteron aisle internal protein and starch, improves AIDS patient's gastrointestinal function; Chinese yam polysaccharide has obvious facilitation to cytophagous phagocytic function.
5. be rich in the interior preparation of compound intestines of the mineral matters such as phosphorus, magnesium, potassium and B family vitamin, can alleviate and feed again syndrome, improve AIDS patient's nutritional status.
Feeding syndrome is the common complication of AIDS patient again, comprises low-phosphorous, low magnesium, hypopotassaemia, Cobastab
1degradation under shortage and glucose tolerance; Phosphorus is one of indispensable element maintaining cell function, is the important component of intracellular buffering liquid, participates in the composition of phosphatide, protein and nucleic acid, plays a crucial role in as glycolysis and oxidative phosphorylation process in cellular metabolism approach, also participates in many enzymolysis process.Phosphorus is to glucose glycolysis and fat, and the biosynthesis of protein and nucleic acid etc. play important regulative; Cobastab
1lacking, is to feed syndromic common manifestation again; Cobastab
1participate in the coenzyme that the decarboxylation of catalysis pyruvate oxidation generates transketolase in acetyl-CoA carboxylase and glucose phosphate pentose pathway, in close relations with energy and glycometabolism; Once lack, said process is obstructed, and pyruvic acid can not pass through the oxidized lactic acid that produces of tricarboxylic acid cycle, and excessive lactic acid generates and can cause lactic acidosis even lethal; Hypopotassaemia, Abnormality of Glycolipid Metabolism, long-term nutrition is bad in low metabolism state; While nursing, the absorption of glucose can suppress gluconeogenesis again, easily causes hyperglycaemia, hyperosmolar nonketotic coma, DKA, osmotic diuresis and dehydration etc.Meanwhile, exogenous supplementary glucose can promote Fatty synthesis metabolism, easily causes hypertriglyceridemia, therefore be rich in the interior preparation of the compound intestines of the mineral matters such as phosphorus, magnesium, potassium and B family vitamin, can alleviate and feed syndrome again, improves AIDS patient's nutritional status.
6. contain the nutrient of special efficacy.
Taurine: can suppress platelet aggregation, prevent artery sclerosis; Cardiac muscle cell is had to protective effect, can anti-arrhythmia; Can promote pituitrin secretion, activation pancreas function, to organism metabolism with useful adjusting; Regulate immunologic function;
VBT: carnitine is that transhipment long-chain acyl CoA enters mitochondrial center material.Have the transportation and the oxidation that promote aliphatic acid] promotion carbohydrate and amino acid whose utilization;
Lentinan: lentinan is typical t cell activation agent, promotes the generation of interleukins, can also promote the function of mononuclear macrophage, is considered to a kind of specifc immunity reinforcing agent.Its immunization feature is that it can promote the generation of lymphocyte activating factor (LAF) (LAE) to discharge various ThFs, strengthens host's Peritoneal macrophage function, recovers or stimulate the function of helper T lymphocyte; In addition, lentinan can also generate by enhancing antibody, suppressing macrophage discharges, lentinan contains a kind of double stranded RNA, can stimulate human body desmacyte and leucocyte to discharge interferon, Britain extracts a kind of material from the shiitake mushroom hypha of cultivating, can make to restore because of the T lymphocyte of AIDS viral infection, stimulating expression of macrophage, contribute to produce Antybody therapy AIDS, and safety has no side effect, and sulphation lentinan has the activity of AIDS virus resisting (HIV), can disturb absorption and the intrusion of retroviruse and other viruses.
The usage of the total enteral nutritious preparation of the present invention and consumption:
By total enteral nutritious pulvis, add warm water (60 ℃ of left and right of water temperature) and mix well, total enteral nutritious preparation energy density is 1.0kcal/ml, oral or tube feed;
(1) substitute diet completely: every day 1500-2000ml, oral or tube feed (per os ingest deficiency or taboo, the disturbance of consciousness and spirituality apocleisis);
(2) part substitutes diet: every day 750-1000ml, oral or tube feed (per os ingest deficiency);
(3) nutrition improvement: every day 250-500ml, oral;
(4) to first tube feed patient: as gastrointestinal tolerant ability, can reduce first use amount, so that body progressively adapts to, patient with severe symptoms please abide by doctor or nutritionist's suggestion.
Composite nutrient preparation provided by the invention is offered to AIDS patient to be used, then the human body component to nutrition treatment Patients Before And After, albumen, blood sugar, blood lipid metabolism, gut flora, gut barrier injury, the medical science indexs such as intestines function detect, result shows that compound enteral nutritional composition provided by the invention has good clinical nutrition to support effect to AIDS patient, compared with common whole protein type nutrition, be more conducive to AIDS patient's absorption and improve the malnutritive situation of patient, be applied to AIDS patient's supplemental treatment, can obviously improve patient's life quality, can improve significantly patient's nutrition condition compared with common nutrition group, alleviate the reduction of every Anthropometries such as the body weight that patient causes due to AIDS, can significantly improve the every blood parameters of patient, regulate patient's blood sugar, blood fat, alleviate patient's insulin resistance and disorders of lipid metabolism, regulate Intestinal Mucosal Injury in Patients Undergoing flora and protection patient intestinal barrier function, reduce due to AIDS patient's Flora Disturbance and suffer from diarrhoea, strengthen patient's immunity, reduce the opportunistic infections due to gut flora transposition simultaneously.
The present invention is with respect to the advantage of prior art:
(1) total enteral nutritious preparation absorption easy to digest, energy density is high;
(2) lactalbumin and collagen peptide are as nitrogenous source, and bioavilability easy to digest is high;
(3) put forward the high-fat ratio of specific heat that supplies, oligosaccharides, as the main source of carbohydrate, containing soluble dietary fiber, is conducive to improve insulin resistance;
(4) glutamine, inulin-type levulan and Chinese yam mucoprotein, contribute to intestinal mucosa reparation, regulate normal flora, improve function of intestinal canal;
(5) be rich in mineral matter and the B family vitamins such as phosphorus, magnesium, potassium, can prevent to feed again syndrome;
(6) nutrient that contains special efficacy, as taurine, VBT, lentinan etc., contributes to cell repair;
(7) advantage of nutrition aspect: compound enteral nutritional composition, for aids patient pathologic, physiologic feature, can be brought into play effects such as improving nutritional status, reparation intestinal mucosa, adjustment immunologic function; This composition protein source, in lactalbumin, collagen peptide and mucoprotein, is rich in branched-chain amino acid, immune globulin bletilla lactoferrin, and collagen Toplink is directly absorbed by enteron aisle, improves fast amino acid pattern and corrects Hypoproteinemia; Fatty acid source is in fish oil and olive oil, in, the aliphatic acid combination of long-chain, be rich in essential fatty acid linoleic acid and alpha-linolenic acid, EPA, DHA contribute to regulating lipid metabolism disorder, reduce inflammatory mediator and cell factor, immunoregulation effect; Carbohydrate derives from maltodextrin and Chinese yam; Inulin-type levulan, lentinan have anti-oxidant, anti-sudden change, steadily blood sugar, effect of reduction insulin resistance; Inulin-type levulan, by increasing the quantity of " beneficial bacterium " in enteron aisle, can strengthen the biological barrier function of intestinal mucosa, prevents the general infection due to enteric infection and bacterial translocation from intestine that pathogenic entero becteria causes; Glutamine, Taurine, VBT, have the immunocompetent effect of enhancing, and glutamine can promote gastrointestinal tract mucosa hyperplasia, safeguards the integrality of intestinal mucosa 26S Proteasome Structure and Function; The vitamin of overall balance and mineral energy meet the demand of human body, and phosphorus, magnesium etc. can prevent to alleviate feeds syndrome again.
The specific embodiment
Below by embodiment, the present invention is done to progressive detailed description in detail, but protection domain of the present invention is not limited to described content, in embodiment, method all experimental technique operations routinely if no special instructions, are used reagent to be if no special instructions conventional reagent.
Embodiment 1: be originally applicable to the total enteral nutritious preparation that AIDS patient uses, the nutritional labeling of the total enteral nutritious preparation of every 100g comprises 20.5g protein, 14g fat, 55g carbohydrate, 4g dietary fiber, 393mg sodium, 542mg potassium, 361mg calcium, 527mg phosphorus, 158mg magnesium, 7.2mg zinc, 17ug selenium, 1650IU vitamin A, 140IU vitamin D, 14IU vitamin E, 2.5mg Cobastab
1, 0.8mg Cobastab
2, 1.3mg Cobastab
6, 2.4mg Cobastab
12, 12mg vitamin C, 5000mg glutamine, 7.5mg taurine, VBT 15mg; Wherein protein is 12g lactalbumin, 8g collagen peptide and the mucinous mixture of 0.5g, and fat is the mixture of 4g deep sea fish oil and 10g olive oil, and carbohydrate is the mixture of 38g maltodextrin and 17g Chinese yam starch.
The present embodiment composition of raw materials is as follows:
| Material composition | Use level (every 100 grams) | Unit |
| PURE WHEY | 12 | g |
| Collagen peptide | 8 | g |
| Mucoprotein | 0.5 | g |
| Glutamine | 5 | g |
| Taurine | 7.5 | mg |
| VBT | 15 | mg |
| Deep sea fish oil | 4 | g |
| Olive oil | 10 | g |
| Maltodextrin | 38 | g |
| Chinese yam starch | 17 | g |
| Inulin-type levulan | 2 | g |
| Lentinan | 2 | g |
| Vitamin A | 1650 | IU |
| Vitamin D | 140 | IU |
| Vitamin C | 12 | mg |
| Cobastab 1 | 2.5 | mg |
| Cobastab 6 | 1.3 | mg |
| Cobastab 12 | 2.4 | ug |
| Dipotassium hydrogen phosphate | 0.8 | mg |
| Magnesium chloride | 2 | mg |
| Selenium | 10 | ug |
| Zinc lactate | 25 | mg |
| Calcium carbonate | 0.8 | g |
| Sodium chloride | 1 | g |
The usage of the total enteral nutritious preparation of the present invention and consumption:
Total enteral nutritious pulvis, in 4.5 times of ratios, is added to warm water (60 ℃ of left and right of water temperature) and mixes well, be mixed with the suspension that energy density is 1.0kcal/ml; All patient's energy are pressed 25kcal/kg/d and are supplied with, and 300-500ml/ time, 3-4 time/d is oral.
Total enteral nutritious the present embodiment preparation is offered to AIDS patient and use, specific experiment thes contents are as follows:
1. experiment grouping and heat are supplied with situation
The present embodiment AIDS patient choice criteria: the age between 20-50 year, AIDS patient in mid-term, CD4+T cell 200-350/mm
3, constitutional index <18.5kg/m
2, RNA virus load <10
4/ mL, estimates existence >2, and mesotrophy is bad, is not in the mood for, liver, renal function and hemopoietic system grievous injury person, gets rid of pregnant woman, children or mental patient.
(1) 60 routine AIDS patients are divided into three groups at random: whole protein type nutritional support group, composite nutrient support group and full diet control group, every group of each 20 examples; Whole protein type nutritional support group, male 13 examples, female's 7 examples, 28～49 years old age (33.7 ± 6.60 years old mean age); Composite nutrient support group, male 11 examples, female's 9 examples, 26～49 years old age (35.1 ± 5.91 years old mean age); Full diet control group, male 10 examples, female's 10 examples, 26～49 years old age (35.8 ± 7.20 years old mean age);
(2) all patient's energy are all supplied with by 25kcal/kg/d, use whole protein type enteral nutrition preparation, compound enteral nutrition preparation and full diet that energy 1000-1500kcal is provided, energy shortage part is supplemented by common food under dietician's guidance, and diet is pressed the principle pantry of balanced diet;
(3) nutritional support group enteral nutrition preparation energy density is 1.0kcal/ml, and Energy distribution is: 20.5g protein, 14g fat, 55g carbohydrate;
(4) full diet control group, according to the principle of balanced diet, instructs patient to select feed by dietician;
(5) case all derives from the clinical and Laboratory Diagnosed case of Kunming the 3rd the People's Hospital's Infection Dept. 1, through X
2check, P>0.05, sex, age have comparativity.
2. measuring body composition analysis experiment
After nutrition treatment surrounding, use lnBody220 type human body composition analyzer, experimental subjects is carried out to physical property nutrition mensuration, the variation of protein, inorganic salts, body fat, skeletal muscle, body weight before and after test experience; And the variation of determination experiment object triceps skinfold thickness (TSF), upper-arm circumference (AC), arm muscle circumference (AMC), result is with mean ± standard deviation
represent, adopt variance analysis to carry out data statistics, the results are shown in Table 1 and 2;
Table 1: nutrition treatment is anthropological measuring result comparison between group after 4 weeks
Note: a: compared with before experiment, P<0.01; B: compared with before experiment, P<0.05; C: compared with full diet control group, P<0.01; D: compared with full diet control group, P<0.05; E: with the comparison of whole protein type nutritional support group, P<0.05;
Table 2: human body component measurement result comparison between each group before and after nutritional support
In table, result shows: nutrition treatment is after 4 weeks, whole protein type nutritional support group increases to some extent compared with the body weight of full diet control group and constitutional index, and that composite nutrient support group increases is more obvious, difference has statistical significance (P<0.05); Before and after the treatment of composite nutrient support group, there were significant differences for body weight and constitutional index increase, and difference has statistical significance (P<0.01).
3. the every inspection item in laboratory
After nutrition treatment 4 weeks, human body total protein (TP), albumin (ALB), prealbumin (PA), T-CHOL (CHOL), triglyceride (TG), HDL-C (HDL), LDL-C (LDL), blood sugar (GLU), urea nitrogen (BUN), creatinine (CREA), hemoglobin (Hb), lymphocyte quantity according to a conventional method, result is with mean ± standard deviation
represent, adopt variance analysis to carry out data statistics;
The index of the reaction patient body internal proteins such as whole protein type nutritional support group TP, ALB, PA increases to some extent compared with full diet control group, and that composite nutrient group increases is more obvious, and difference has statistical significance (P<0.01); The index composite nutrient group of the reaction blood sugar such as CHOL, TG, LDL, GLU and blood lipid metabolism reduces compared with full diet control group and whole protein type nutrition group, and difference has statistical significance (P<0.05), in table 3;
Table 3: nutrition treatment is laboratory examination results comparison between group after 4 weeks
Note: a: compared with full diet control group, P<0.01; B: compared with full diet control group, P<0.05; C: with the comparison of whole protein type nutrition group, P<0.01; D: with the comparison of whole protein type nutrition group, P<0.05.
4. human body intestinal canal flora test experience
After nutrition treatment after 4 weeks, leave and take patient's stool sample, after pretreatment, extract the method for operating in kit description by bacterial genomes DNA, extract fecal bacteria DNA, measure the quantity of every group of five kinds of bacteriums by SYBR Green I real-time fluorescence quantitative PCR method, group intercropping comparative analysis, result is with mean ± standard deviation
represent, adopt variance analysis to carry out data statistics;
Whole protein type nutritional support group increases compared with full diet control group Bifidobacterium and Lactobacillus, and composite nutrient support group increases more obvious compared with full diet control group, and difference has statistical significance (P<0.05); Composite nutrient support group significantly reduces (P<0.01) compared with the Escherichia coli of whole protein type nutritional support group, enterococcus faecalis and VREF quantity, in table 4;
Table 4: nutrition treatment is stool sample bacteria quantified result comparison between group after 4 weeks
Note: a: compared with full diet control group.P < 0.01; B: compared with full diet control group, P < 0.05; C: with the comparison of whole protein type nutrition group, P<0.05; D: with relatively P<0.01 of whole protein type nutrition group.
5. gut barrier injury test experience
After nutrition treatment 4 weeks, detect the variation of nutrition treatment Patients Before And After FABP-2, D-ALPHA-Hydroxypropionic acid, diamine oxidase;
Intestinal fatty acid-binding (intestinal fatty acid-binding protein, iFABP) be mainly present in the ripe enterocyte cytosol of small intestine, in stomach and large intestine, content is little, there is good tissue specificity, under normal circumstances, the content of iFABP in serum is very little, and when intestines ischemic, permeability of cell membrane increases, and iFABP molecule can be released into blood by cell membrane; D-ALPHA-Hydroxypropionic acid (D-lactate, D-LC) is the metabolite of autochthonous flora in alimentary canal, and enteron aisle various bacteria all can produce; In mammalian body, there is no the enzyme system that its tachymetabolism can be decomposed, thereby under normal circumstances in blood the level of D lactic acid very low, in the time that intestinal mucosal barrier is destroyed, just can enter blood circulation by impaired intestinal mucosa by bacteriogenic a large amount of D lactic acid, in blood, D lactic acid can be used as the impaired index of monitoring intestinal mucosal barrier; Diamine oxidase (diamine oxidase, DAO) is present on mammiferous mucous membrane upper strata or fine hair in confluent monolayer cells, and major part is present in small intestinal mucosa, the highest with backlash intestines activity.In human normal plasma, DAO content is very low, when intestinal mucosa is because a variety of causes is when impaired, this enzyme is released into blood, or the protection of intestinal mucosal barrier cells coming off with necrosis enters enteric cavity, enters enterocyte gap lymphatic vessel and capillary, make in blood plasma DAO raise, therefore measure integrality and permeability that DAO activity in blood can indirectly reflect intestinal mucosa.Therefore, plasma D AO, D-LC and iFABP are the common methods of assessment intestinal barrier function, both simple and quick practicalities.In experiment, we select above 3 indexs to detect AIDS patient's intestinal barrier function.
Composite nutrient group reduces compared with full diet control group and whole protein type nutrition group intestines barrier injury index iFABP, D-LC, has significant difference (P<0.01); DAO difference has statistical significance (P<0.05), in table 5;
Table 5: nutrition treatment is the impaired result comparison of intestinal mucosal barrier between group after 4 weeks
Note: a: compared with full diet control group, P<0.01; B: compared with full diet control group, P<0.05; C: with relatively P<0.01 of whole protein type nutrition group.
6. patient's stomach and intestine function monitoring
To 60 routine AIDS patients, at experimental session, gastrointestinal tolerant situation is monitored as abdominal distension, stomachache, diarrhoea and constipation etc.,
After nutrition treatment after 4 weeks, stomach and intestine do not tolerate situation: 5 examples (25%) are organized in full diet control group 13 examples (65%), whole protein type nutritional support group 9 examples (45%), composite nutrient support, and composite nutrient support group can significantly be improved AIDS patient's gastrointestinal tolerant situation (P<0.05) compared with full diet control group.
This composition protein mainly comes from lactalbumin and collagen peptide, be rich in branched-chain amino acid, immune globulin bletilla lactoferrin, can directly be absorbed by enteron aisle compared with preparation in these compound intestines of preparation in whole protein type intestines, correct fast Hypoproteinemia for enteron aisle directly provides nutrition substrate.Inulin-type levulan, by increasing the quantity of " beneficial bacterium " in enteron aisle, can strengthen the barrier function of intestinal mucosa.Glutamine, Taurine, VBT, have the immunocompetent effect of enhancing, and glutamine can promote gastrointestinal tract mucosa hyperplasia, safeguards the integrality of intestinal mucosa 26S Proteasome Structure and Function.So, can significantly improve AIDS patient's intestinal barrier function, alleviate the states such as abdominal distension, stomachache, diarrhoea and constipation.
More than experiment shows, can improve significantly patient's nutrition condition according to the compound EA of AIDS patient's pathology physilogical characteristics preparations compared with common nutrition group, alleviates the reduction of every Anthropometries such as body weight that patient causes due to AIDS; Can significantly improve the every blood parameters of patient, regulate patient's blood sugar, blood fat, alleviate patient's insulin resistance and disorders of lipid metabolism; Regulate Intestinal Mucosal Injury in Patients Undergoing flora and protection patient intestinal barrier function, reduce due to AIDS patient's Flora Disturbance and suffer from diarrhoea, strengthen patient's immunity, reduce the opportunistic infections due to gut flora transposition simultaneously.
This experiment also illustrates that this compound enteral nutritional composition has good clinical nutrition to support effect to AIDS patient, compared with common whole protein type nutrition, be more conducive to AIDS patient's absorption and improve the malnutritive situation of patient, applied and AIDS patient's supplemental treatment, can obviously be improved patient's life quality.
Embodiment 2: be originally applicable to the total enteral nutritious preparation that AIDS patient uses, the nutritional labeling of the total enteral nutritious preparation of every 100g comprises 19.5g protein, 15g fat, 55g carbohydrate, 4g dietary fiber, 400mg sodium, 520mg potassium, 370mg calcium, 540mg phosphorus, 160mg magnesium, 6.8mg zinc, 18ug selenium, 1550IU vitamin A, 130IU vitamin D, 13IU vitamin E, 2.8mg Cobastab
1, 0.9mg Cobastab
2, 1.5mg Cobastab
6, 2.5mg Cobastab
12, vitamin C 15mg, 6000mg glutamine, 7.4mg taurine, 14mg VBT; Wherein protein is 11.7g lactalbumin, 6.8g collagen peptide and the mucinous mixture of 1g, and fat is the mixture of 3.8g deep sea fish oil and 11.2g olive oil, and carbohydrate is the mixture of 35.8g maltodextrin and 19.2g Chinese yam starch.
The present embodiment composition of raw materials is as follows:
| Material composition | Use level (every 100 grams) | Unit |
| Lactalbumin | 11.7 | g |
| Collagen peptide | 6.8 | g |
| Mucoprotein | 1 | g |
| Glutamine | 6 | g |
| Taurine | 7.4 | mg |
| VBT | 14 | mg |
| Deep sea fish oil | 3.8 | g |
| Olive oil | 11.2 | g |
| Maltodextrin | 35.8 | g |
| Chinese yam starch | 19.2 | g |
| Inulin-type levulan | 2 | g |
| Lentinan | 2 | g |
| Vitamin A | 1550 | IU |
| Vitamin D | 130 | IU |
| Vitamin C | 15 | mg |
| Cobastab 1 | 2.8 | mg |
| Cobastab 6 | 1.5 | mg |
| Cobastab 12 | 2.5 | ug |
| Dipotassium hydrogen phosphate | 0.8 | mg |
| Magnesium chloride | 2 | mg |
| Selenium | 10 | ug |
| Zinc lactate | 25 | mg |
| Calcium carbonate | 0.9 | g |
| Sodium chloride | 1.0 | g |
The composite nutrient composition of preparing in the present embodiment adopts the nutritive validity of verifying this composition with embodiment 1 same procedure, result shows that the compound composition of the present embodiment is also applicable to AIDS patient and uses, and compared with common whole protein type nutrition, be more conducive to AIDS patient's absorption and improve the malnutritive situation of patient, applied and AIDS patient's supplemental treatment, can obviously be improved patient's life quality; Can improve significantly patient's nutrition condition compared with common nutrition group, alleviate the reduction of every Anthropometries such as the body weight that patient causes due to AIDS; Can significantly improve the every blood parameters of patient, regulate patient's blood sugar, blood fat, alleviate patient's insulin resistance and disorders of lipid metabolism; Regulate Intestinal Mucosal Injury in Patients Undergoing flora and protection patient intestinal barrier function, reduce due to AIDS patient's Flora Disturbance and suffer from diarrhoea, strengthen patient's immunity, reduce the opportunistic infections due to gut flora transposition simultaneously.
Embodiment 3: be originally applicable to the total enteral nutritious preparation that AIDS patient uses, the nutritional labeling of the total enteral nutritious preparation of every 100g comprises 20g protein, 14g fat, 56g carbohydrate, 4g dietary fiber, 420mg sodium, 530mg potassium, 380mg calcium, 535mg phosphorus, 162mg magnesium, 7.0mg zinc, 19ug selenium, 1600IU vitamin A, 120IU vitamin D, 12IU vitamin E, 2.7mg Cobastab
1, 1.0mg Cobastab
2, 1.4mg Cobastab
6, 2.5mg Cobastab
12, vitamin C 13mg, 5000mg glutamine, 7.6mg taurine, 14.5mg VBT; Wherein protein is 11.6g lactalbumin, 8g collagen peptide and the mucinous mixture of 0.4g, and fat is the mixture of 4.9g deep sea fish oil and 9.1g olive oil, and carbohydrate is the mixture of 38.1g maltodextrin and 17.9g Chinese yam starch.
The present embodiment composition of raw materials is as follows:
| Material composition | Use level (every 100 grams) | Unit |
| Lactalbumin | 11.6 | g |
| Collagen peptide | 8 | g |
| Glutamine | 5 | g |
| Mucoprotein | 0.4 | g |
| Taurine | 7.6 | mg |
| VBT | 14.5 | mg |
| Deep sea fish oil | 4.9 | g |
| Olive oil | 9.1 | g |
| Maltodextrin | 38.1 | g |
| Chinese yam starch | 17.9 | g |
| Inulin-type levulan | 2 | g |
| Lentinan | 2 | g |
| Vitamin A | 1600 | IU |
| Vitamin D | 120 | IU |
| Vitamin C | 13 | mg |
| Cobastab 1 | 2.7 | mg |
| Cobastab 6 | 1.4 | mg |
| Cobastab 12 | 2.5 | ug |
| Dipotassium hydrogen phosphate | 0.8 | mg |
| Magnesium chloride | 2 | mg |
| Selenium | 10 | ug |
| Zinc lactate | 25 | mg |
| Calcium carbonate | 0.9 | g |
| Sodium chloride | 1.0 | g |
The composite nutrient composition of preparing in the present embodiment adopts the nutritive validity of verifying this composition with embodiment 1 same procedure, result shows that the compound composition of the present embodiment is also applicable to AIDS patient and uses, and compared with common whole protein type nutrition, be more conducive to AIDS patient's absorption and improve the malnutritive situation of patient, applied and AIDS patient's supplemental treatment, can obviously be improved patient's life quality; Can improve significantly patient's nutrition condition compared with common nutrition group, alleviate the reduction of every Anthropometries such as the body weight that patient causes due to AIDS; Can significantly improve the every blood parameters of patient, regulate patient's blood sugar, blood fat, alleviate patient's insulin resistance and disorders of lipid metabolism; Regulate Intestinal Mucosal Injury in Patients Undergoing flora and protection patient intestinal barrier function, reduce due to AIDS patient's Flora Disturbance and suffer from diarrhoea, strengthen patient's immunity, reduce the opportunistic infections due to gut flora transposition simultaneously.
Embodiment 4: be originally applicable to the total enteral nutritious preparation that AIDS patient uses, the nutritional labeling of the total enteral nutritious preparation of every 100g comprises 20g protein, 14.5g fat, 58g carbohydrate, 4g dietary fiber, 420mg sodium, 530mg potassium, 380mg calcium, 535mg phosphorus, 162mg magnesium, 7.0mg zinc, 19ug selenium, 1600IU vitamin A, 120IU vitamin D, 12IU vitamin E, 2.7mg Cobastab
1, 1.0mg Cobastab
2, 1.4mg Cobastab
6, 2.5mg Cobastab
12, vitamin C 13mg, 5500mg glutamine, 7.6mg taurine, 14.5mg VBT; Wherein protein is 11.6g lactalbumin, 8g collagen peptide and the mucinous mixture of 0.4g, and fat is the mixture of 5.1g deep sea fish oil and 9.4g olive oil, and carbohydrate is the mixture of 38.3g maltodextrin and 19.7g Chinese yam starch; The method preparation of the present embodiment composition of raw materials reference example 1.
The composite nutrient composition of preparing in the present embodiment adopts the nutritive validity of verifying this composition with embodiment 1 same procedure, and result shows that the compound composition of the present embodiment is also applicable to AIDS patient and uses.
Embodiment 5: be originally applicable to the total enteral nutritious preparation that AIDS patient uses, the nutritional labeling of the total enteral nutritious preparation of every 100g comprises 20.5g protein, 14g fat, 57g carbohydrate, 4g dietary fiber, 393mg sodium, 542mg potassium, 361mg calcium, 527mg phosphorus, 158mg magnesium, 7.2mg zinc, 17ug selenium, 1650IU vitamin A, 140IU vitamin D, 14IU vitamin E, 2.5mg Cobastab
1, 0.8mg Cobastab
2, 1.3mg Cobastab
6, 2.4mg Cobastab
12, 12mg vitamin C, 5000mg glutamine, 7.5mg taurine, VBT 15mg; Wherein protein is 12g lactalbumin, 8g collagen peptide and the mucinous mixture of 0.5g, and fat is the mixture of 4g deep sea fish oil and 10g olive oil, and carbohydrate is the mixture of 38.2g maltodextrin and 18.8g Chinese yam starch; The method preparation of the present embodiment composition of raw materials reference example 1.
The composite nutrient composition of preparing in the present embodiment adopts the nutritive validity of verifying this composition with embodiment 1 same procedure, and result shows that the compound composition of the present embodiment is also applicable to AIDS patient and uses.
Claims (1)
1. be applicable to the total enteral nutritious preparation that AIDS patient uses, it is characterized in that: the nutritional labeling of every 100 grams of total enteral nutritious preparations comprises protein 19.5-20.5 gram, fatty 14-15 gram, carbohydrate 55-58 gram, dietary fiber 4g, sodium 393-420mg, potassium 520-542mg, calcium 361-380mg, phosphorus 527-540mg, magnesium 158-162mg, zinc 6.8-7.2mg, selenium 17-19ug, retinol1 550-1650IU, VD1 20-140IU, vitamin e1 2-14IU, Cobastab
12.5-2.8mg, Cobastab
20.8-1.0mg, Cobastab
61.3-1.5mg, Cobastab
122.4-2.5mg, vitamin C 12-15mg, glutamine 5000-6000mg, taurine 7.4-7.6mg, VBT 14-15mg;
Described protein is the lactalbumin of mass percent 50-60%, the collagen peptide of mass percent 35-40%, the mucinous mixture of mass percent 2-5%, and each constituent content sum is 100%;
Described fat is the mixture of the deep sea fish oil of mass percent 25-35% and the olive oil of mass percent 65-75%;
Described carbohydrate is the mixture of the maltodextrin of mass percent 65-69% and the Chinese yam starch of mass percent 31-35%;
Described dietary fiber obtains by adding 2g inulin-type levulan and 2g lentinan.
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| CN103284042B (en) * | 2013-06-03 | 2015-09-09 | 吉林大学 | A kind of enteral nutrition preparation containing egg-white protein peptide and preparation method thereof |
| CN103719875A (en) * | 2014-01-20 | 2014-04-16 | 湖北一半天制药有限公司 | Enteral nutrition preparation for diabetics |
| CN109430884A (en) * | 2018-11-26 | 2019-03-08 | 荣海生物科技有限公司 | A variety of biological nutritive agents of small-molecular peptides and preparation method thereof |
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| CN1290444C (en) * | 2003-03-18 | 2006-12-20 | 华瑞制药有限公司 | Intestinal absorbing fully nutrient emulsion for phymatostio patient |
| CN1555729A (en) * | 2004-01-06 | 2004-12-22 | 李丽丽 | Intestine nutritire preparation used for nutrition supply or/and inmune enforcement |
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