Brief Article
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World J Gastroenterol. Feb 14, 2013; 19(6): 917-922
Published online Feb 14, 2013. doi: 10.3748/wjg.v19.i6.917
Effects of early enteral nutrition on immune function of severe acute pancreatitis patients
Jia-Kui Sun, Xin-Wei Mu, Wei-Qin Li, Zhi-Hui Tong, Jing Li, Shu-Yun Zheng
Jia-Kui Sun, Xin-Wei Mu, Jing Li, Shu-Yun Zheng, Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
Jia-Kui Sun, Wei-Qin Li, Zhi-Hui Tong, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, Jiangsu Province, China
Author contributions: Sun JK, Li WQ and Tong ZH designed the research; Sun JK, Mu XW, Li J and Zheng SY performed the research; Sun JK and Li WQ analyzed the data; and Sun JK wrote the paper.
Supported by Grants from the Key Project of the Eleventh Five-Year Plan of People’s Liberation Army, No. 06G041
Correspondence to: Wei-Qin Li, Professor, Department of General Surgery, Jinling Hospital, Nanjing University School of Medicine, No. 305, Zhongshan East Road, Nanjing 210002, Jiangsu Province, China. sjk0935119@163.com
Telephone: +86-25-80860066 Fax: +86-25-84803956
Received: September 28, 2012
Revised: November 22, 2012
Accepted: December 15, 2012
Published online: February 14, 2013
Processing time: 142 Days and 15.7 Hours
Abstract

AIM: To investigate the effects of early enteral nutrition (EEN) on the immune function and clinical outcome of patients with severe acute pancreatitis (SAP).

METHODS: Patients were randomly allocated to receive EEN or delayed enteral nutrition (DEN). Enteral nutrition was started within 48 h after admission in EEN group, whereas from the 8th day in DEN group. All the immunologic parameters and C-reactive protein (CRP) levels were collected on days 1, 3, 7 and 14 after admission. The clinical outcome variables were also recorded.

RESULTS: Sixty SAP patients were enrolled to this study. The CD4+ T-lymphocyte percentage, CD4+/CD8+ ratio, and the CRP levels in EEN group became significantly lower than in DEN group from the 7th day after admission. In contrast, the immunoglobulin G (IgG) levels and human leukocyte antigen-DR expression in EEN group became significantly higher than in DEN group from the 7th day after admission. No difference of CD8+ T-lymphocyte percentage, IgM and IgA levels was found between the two groups. The incidences of multiple organ dysfunction syndrome, systemic inflammatory response syndrome, and pancreatic infection as well as the duration of intensive care unit stay were significantly lower in EEN group than in DEN group. However, there was no difference of hospital mortality between the two groups.

CONCLUSION: EEN moderates the excessive immune response during the early stage of SAP without leading to subsequent immunosuppression. EEN can improve the clinical outcome, but not decrease the hospital mortality of SAP patients.

Keywords: Early enteral nutrition; Immune; Severe acute pancreatitis