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陈沐熙, 商正云, 程懿, 等. 自制肠内营养液增稠剂的热稳定性及吞咽安全性探索[J]. koko体育app 学报（医学版）, 2024, 55(3): 769-776. DOI:
引用本文: 陈沐熙, 商正云, 程懿, 等. 自制肠内营养液增稠剂的热稳定性及吞咽安全性探索[J]. koko体育app 学报（医学版）, 2024, 55(3): 769-776. DOI:
CHEN Muxi, SHANG Zhengyun, CHENG Yi, et al. Examination of the Thermal Stability and Swallowing Safety of a Self-Developed Enteral Nutrition Thickening Agent[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(3): 769-776. DOI:
Citation: 🎶 CHEN Muxi, SHANG Zhengyu🌺n, CHENG Yi, et al. Examination of the Thermal Stability and Swallowing Safety of a Self-Developed Enteral Nutrition Thickening Agent[J]. Journal of Sichuan University (Medical Sciences), 2024, 55(3): 769-776. DOI:

自制肠内营养液增稠剂的热稳定性及吞咽安全性探索

Examination of the Thermal Stability and Swallowing Safety of a Self-Developed Enteral Nutrition Thickening Agent

  • 摘要:
    目的  通过实验验证一种自制热稳定性增稠剂对于标准浓度的肠内营养液质构特性的影响，以及其在改善吞咽障碍方面的应用效果。
    方法 ①取不同剂量梯度自制增稠剂（1.0 g、1.5 g、2.0 g、2.5 g、3.0 g）及常见的3种市售增稠剂，所有增稠剂中均加入23.391 g某款全营养配方粉溶于85 mL纯水，各配成100 mL标准浓度营养液。使用质构仪测量在不同温度梯度下（20 ℃、40 ℃、60 ℃、80 ℃）4种增稠后营养液的质构参数（内聚性、黏性、稠度、硬度），比较其热稳定性。②通过会厌切除术制造吞咽障碍大鼠模型，探究该增稠剂对吞咽障碍大鼠肺部组织损伤评分和炎性因子水平。取吞咽障碍大鼠模型分为待测干预组、阳性对照组、阴性对照组，并设立空白对照组（不进行手术，禁食1 d后正常饲养），每组15只。大鼠术后均禁食1 d后，待测干预组喂食自制增稠剂增稠的标准浓度营养液，阳性对照组喂食市售品3增稠的标准浓度营养液，阴性对照组正常饲养。4组均持续喂养2周，食物均加入食品级果绿色素。观察大鼠一般情况并记录体质量与食量。两周后，称重计算肺组织脏器系数，以常规HE染色评估脏器情况，根据Mikawa表评分计算肺组织损伤病理评分；收集血液上清检测血清总蛋白、白蛋白检测大鼠营养状况；实时定量聚合酶链反应（RT-qPCR）法检测肺组织中的白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）基因表达；ELISA法检测肺组织、肺组织混悬液和血清中的IL-6、TNF-α蛋白表达；计算误吸发生率。
    结果 ①在1.0～3.0 g的剂量范围内，20～80 ℃下，自制增稠剂增稠后的待测样品内聚性的热稳定性优于3种市售品，差异有统计学意义（P<0.01），黏性、硬度的热稳定性与3种市售品的差异无统计学意义。市售品1稠度热稳定性最优，待测样品和市售品2次之，市售品3最差，差异有统计学意义（P<0.01）。②动物实验结果示，阳性对照组和待测干预组体质量增加量低于空白对照组和阴性对照组（P<0.01）。待测干预组的脾脏系数低于阳性对照组和空白对照组（P<0.01），心脏、肝脏、肾脏系数低于空白对照组（P<0.01），肺脏系数与其他3组差异无统计学意义。待测干预组、阳性对照组和阴性对照组血清总蛋白、白蛋白水平均低于空白对照组（P<0.01）。ELISA检测结果示空白对照组和待测干预组血清中IL-6水平均低于阴性对照组和阳性对照组（P<0.05），其余指标4组间差异无统计学意义（P>0.05）。4组间肺组织损伤病理评分，肺组织中的IL-6、TNF-α基因表达水平的差异均无统计学意义。4组误吸发生率均为0。
    结论 自制肠内营养液增稠剂热稳定性优良，且符合吞咽安全性，可进一步探索其用于吞咽障碍患者的可行性。
     
    Abstract:
    Objective To experimentally validate the effects of a self-developed heat-stable thickening agent on the textual characteristics of enteral nutrition solutions of standard concentration and its applicability in improving dysphagia.
    Methods A gradient of different doses of the self-developed thickening agent (1.0 g, 1.5 g, 2.0 g, 2.5 g, and3.0 g) and three commonly used commercial thickeners were mixed with 23.391 g of a complete nutrition formula powder dissolved in 85 mL of purified water to prepare 100 mL standard concentration nutrition solutions. The textual parameters (cohesiveness, viscosity, thickness, and hardness) of these nutrition solutions were measured using a texture analyzer at various temperature gradients (20 ℃, 40 ℃, 60 ℃, and 80 ℃) to compare their thermal stability. A dysphagia rat model was created via epiglottectomy to explore the effects of the thickener on lung tissue damage scores and levels of inflammatory markers. The rats were divided into a test intervention group, a positive control group, a negative control group, and a blank control group (no surgery and normal feeding after fasting for one day), with 15 rats in each group. After fasting for one day post-surgery, the test intervention group was fed with the standard concentration nutrition solution thickened with the self-developed thickener, while the positive control group was given a standard concentration nutrition solution thickened with product 3, and the negative control group was fed a normal diet. All groups were fed for two weeks with food dyed with food-grade green dye. General conditions, body mass, and food intake were observed and recorded. After two weeks, abdominal aorta blood was collected, and heart, liver, spleen, lung, and kidney tissues were harvested and weighed to calculate the lung tissue organ coefficient. The organ conditions were evaluated using routine H&E staining, and lung damage was semi-quantitatively analyzed based on the Mikawa scoring criteria. Blood supernatants were collected to measure the total serum protein and albumin levels to determine the nutritional status of the rats. The expression of IL-6 and TNF-α genes in lung tissues was measured by RT-qPCR. IL-6 and TNF-α protein expression levels in lung tissues, lung tissue homogenate, and serum were measured by ELISA. The aspiration incidence rate was calculated.
    Results Within the dosage range of 1.0 g to 3.0 g, the self-developed thickener in the test samples exhibited superior thermal stability in cohesiveness compared to the three commercially available thickeners, with a statistically significant difference (P<0.01). The differences in the thermal stability of viscosity and hardness between the self-developed thickener and the three commercially available thickeners were not statistically significant. The viscosity stability was optimal for the self-developed thickener, followed by the commercially available thickeners 1 and 3, with thickeners 2 being the least stable, though the differences were not statistically significant (P>0.05). Product 1 showed the best thermal stability in thickness, followed by the self-developed thickener and product 2, while the product 3 exhibited the worst performance, with the difference being statistically significant (P<0.01). The self-developed thickener had the best thermal stability in hardness at temperatures ranging from 20℃ to 80 ℃, followed by products 1 and 2, with product 3 being the least stable. However, the differences were not statistically significant (P>0.05). Animal experiment results indicated that the body weight gain in the positive control group and the test intervention group was lower than that in the blank and negative control groups (P<0.01). The spleen coefficient of the intervention group was lower than that of the positive control group and the blank control group (P<0.01), while the heart, liver, and kidney coefficients were lower than those of the blank control group (P<0.01). The differences in the lung coefficient of the intervention group and those of the other three groups were no statistically significant. Levels of TP and ALB in the test intervention group, the positive control group, and the negative control group were all lower than those in the blank control group, with statistically significant differences (P<0.01). ELISA results showed that serum IL-6 levels in the blank and test intervention groups were lower than those in the negative and positive control groups (P<0.05), while the difference in the other indicators across the four groups were not statistically significant (P>0.05). There were no statistically significant differences among the four groups in terms of lung tissue damage pathology scores, or in the levels of IL-6 and TNF-α gene expression in lung tissues. The aspiration incidence rate was 0% in all groups.
    Conclusion  The self-developed enteral nutrition thickening agent demonstrated excellent thermal stability and swallowing safety. Further research to explore its application in patients with dysphagia is warranted.
     
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