Effects Of Early Enteral Nutrition Supplemented On Gut Barrier And Inflammatory Cytokine In Pediatric With Severe Acute Pancreatitis

BackgroundPediatric acute pancreatitis（AP）is a kind of disease characterized by pancreatic enzyme activation and pancreatic infection or systemic inflammatory reaction caused by multiple etiologies,about 30% of pediatric AP can evolve into severe acute pancreatitis（SAP）.Early fasting treatment can result in caloric supply insufficiently,meantime systemic inflammatory reaction and multi-organ dysfunction aggravated in negative nitrogen balance,and increased metabolic decomposition,following secondary severe malnutrition,immunity suppression and opportunistic pathogens infection.Therefore,early enteral nutrition is very important for pediatric SAP.ObjectiveTo investigate the effect of early enteral nutrition therapy on intestinal mucosal permeability and cytokines secretion in pediatric SAP,it provides theoretical basis for early application of enteral nutrition therapy in pediatric SAP.MethodsRetrospective analysis of 54 pediatric SAP treated in our gastroenterology department from May 2015 to may 2021 were divided into early enteral nutrition treatment group with29 cases and intravenous nutrition control group with 25 cases.Compared the differences of relevant indexes between no treatment and two weeks treatment later:（1）disease severity: acute physiology and chronic health score II（APACHE II）,computed tomography severity index score（MCTSI）,central venous pressure（CVP）,acute pancreatitis severity bedside index score（BISAP）;（2）Nutritional status: body mass index（BMI）,serum albumin,prealbumin;（3）Serological indexes: blood lipase,blood amylase,c-reactive protein（CRP）,interleukin-6（IL-6）,tumor necrosis factor-α（TNF-α）,vascular endothelial growth factor（VEGF）;（4）Related indexes of mucosal barrier function:D-lactic acid,diamine oxidase（DAO）,endotoxin;（5）Infection complications: urinary tract infection,abdominal infection,respiratory infection,systemic inflammatory response syndrome（SIRS）;（6）Length of stay and total length of stay in intensive care unit（ICU）.Collect the clinical characteristic data,input the test results of each group into the database,compare the data change trend of each group with the clinical data for correlation statistical analysis.Collect the clinical characteristic data,input the test results of each group into the database,compare the data change trend of each group with the clinical data for correlation statistical analysis.Results1.There were no statistically differences in age,sex,etiology,disease severity before treatment（APACHE II score,CRP,mctsi score,CVP）and body mass index（BMI,hemoglobin,serum albumin,prealbumin,blood glucose）between experimental group and the negative control group（P >0.05）,conform to inclusion criteria.2.There were no significant differences of the nutritional indexes BMI,serum albumin,prealbumin and EN between experimental group and the negative control group after 14 days treatment（P<0.05）.And there were no significant differences in hemoglobin and blood glucose of these two groups on day 1 and day 14（P >0.05）.The levels of DAO,D-lactic acid and endotoxin in the treatment group were significantly lower than those in the control group after 14 days treatment,and the differences had statistically meaning（P<0.05）.The blood lipase and amylase in the treatment group were significantly lower than those in the control group,and IL-6,TNF-α and serum VEGF also decreased dramatically after 14 days treatment,all the differences had statistically meaning（P < 0.05）.The APACHE II score and bisap score of disease severity in the treatment group were significantly lower than those in the control group after 14 days treatment.And the total days of hospitalization and treamnet in ICU were significantly decreased（P<0.05）.There was no significant difference in the incidence of infection related complications including urinary tract infection,abdominal cavity infection,respiratory tract infection and SIRS between the treatment group and the control group（P >0.05）.3.Spearman correlation data analysis showed that the concentration of serum D-lactic acid was positively correlated with APACHE II,and the correlation coefficient was 0.872;The level of serum IL-6 was also positively correlated with APACHE II score,and the correlation coefficient was 0.908;There was a significant positive correlation between serum D-lactate concentration and IL-6 level,and the correlation coefficient was0.833;The content of serum VEGF was also highly positively correlated with APACHE II score,and the correlation coefficient was 0.830.ConclusionEarly enteral nutrition therapy significantly reduces intestinal mucosal inflammationthe and level of intestinal permeability,and plasma inflammatory cytokine,and repairing intestinal mucosal barrier function,promote energy to quickly reach the target value,improve nutritional status,protect organ barrier function,reduce disease activity index,improve clinical prognosis and shorten hospital stay.