The Effects Of Early Enteral Nutrition On Immunity Of Patients With Severe Acute Pancreatitis

Objective: To observe the chronologic changes of lymphocyte in patients with severeacute pancreatitis (SAP), and investigate the effects of early enteral nutrition (EEN)on immune function in patients with SAP.Methods: Thirty-three patients with SAP who admitted to Pancreas surgerydepartment of Union Hospital affiliated to Huazhong University of Science andTechnology during Apr.2011to Feb.2012, within24hours from the onset of illness,were randomly assigned into early enteral nutrition (EEN) group and delayed enteralnutrition (DEN) group, and started enteral nutrition within72hours or after6daysfrom the onset of illness, respectively. On each patient, both serum C reaction protein(CRP) and serum amylase were determined on days1,3,9and15, meanwhile AcutePhysiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) was performed. Thepercentage of CD4+T lymphocytes/CD8+T lymphocytes/B lymphocytes/nature killer(NK) cells/monocytes and CD4+/CD8+ratio in serum were evaluated by flowcytometer on days3,6,9,12and15. Incidence of both infectious complications andmultiple organ dysfunction syndrome (MODS) as well as mortality were observed inboth groups.Results: Patients’ characteristics, severity of illness and immune status were similaron admission between the two groups. Serum amylase, serum CRP along withAPACHEⅡscore decreased steadily in both groups, whereas the latter two decreasedmarkedly faster in the EEN group than in the DEN group. The levels of variousimmunologic parameters in the EEN group were quite different from the DEN group,with much more the percentage of CD4+T lymphocytes, B lymphocytes as well asNK cells on days9,12and15, and much less percentage of CD8+T lymphocytes ondays9and15. Moreover, the CD4+/CD8+ratio were significantly higher in the EEN group as opposed to DEN group since day6after the onset of illness. Compared withthe DEN group, notably lower incidence of infectious complications was observed inthe EEN group, nonetheless, incidence of MODS and mortality were similar in bothgroups.Conclusion: Immunologic impairment occurs from the early stage of SAP. Earlystart (within72h from the onset of illness) of nasojejunal enteral nutrition is safe andeffective. Furthermore, it can modulate body immune function in order to reduceimmunosuppression and build up body resistance, which may therefore reduce therisk of subsequent infectious complications.