Studies On Effects Of Early Enteral Nutrition On Acute Pancreatitis In Obesity

Backgrounds and Aims:Effects of obesity on prognosis of acute pancreatitis(AP)had attached great importance.Early enteral nutrition(EEN)has been considered to be able to protect mucosa of AP patients and alleviate inflammatory reactions.But up to now,there were in lack of studies on effects of EEN on prognosis of AP with obesity in China and abroad,one kind of special and general pancreatitis.What's more,because of lack of animal models of SAP with obesity,rudimentay studises on AP with obesity had not been well done.Our studies were to explore effects of EEN on AP in obesity.Our studies were divided into two parts:Part one Effects of early enteral nutrition on progression and prognosis of acute pancreatitis in patients with visceral fat obesityMethods1.A prospective randomized control trial including patients with moderately severe acute pancreatitis(MSAP)or severe acute pancreatitis(SAP)was conducted from September 15th,2014 to October 31st,2016.Enrolled patients were divided into 3 groups:group A:non-visceral fat obesity(non-VFO)patients received delayed enteral nutrition(DEN)(n=108);group B:VFO patients received DEN(n=88),and group C:VFO patients received EEN(n=91).2.The percentage of SAP among MSAP and SAP patients was compared between group B and group A,group C and group B,respectively.The local complications,organ dysfunctions and case fatality were also compared between group B and group A,group C and group B,respectively.The level of serum tumor necrosis factor alpha(TNF-?),interleukin-8(IL-8),interleukin-10(IL-10),intestinal fatty acid binding protein(I-FABP)and citrulline were examined on the 1st day,the 3rd day and the 7th day after admission,respectively,and compared between group C and group B,group B and group A,respectively.Results:1.The percentage of SAP patients among MSAP and SAP patients in group B was significantly higher than that in group A(P<0.05).The rate of the patients of developing local complications(acute peripancreatic fluid collection,acute pancreatic necrotic collection,walled-off necrosis and pancreatic necrotic infection)and rate of acute respiratory failure in group B were all significantly higher than thoses in group A(P<0.05).The rate of pancreatic necrotic infection in group C was greatly lower than that in group B(P<0.05).There is no significant difference regarding acute peripancreatic fluid collection,acute pancreatic necrotic collection,pancreatic pseudocyst,walled-off necrosis,acute respiratory failure,acute renal failure,cardiac failure and shock between group B and group C(P>0.05).But there was no significant difference regarding mortality between group B and group A,group C and group B.(P>0.05).2.The serum levels of TNF-a(on the 3rd and the 7th day after admission),IL-8(on the 1st,the 3rd and the 7th day after admission)?IL-10(on the 1st,the 3rd and the 7th day after admission)and I-FABP(on the 3rd and the 7th day after admission)in group B were significantly higher than those in group A(P<0.05),respectively.The serum levels of citrulline in group B on the 3rd and the 7th day were significantly lower than those in group A,respectively(P<0.05).Compared with group B,by EEN in group C,the serum levels of TNF-a(on the 3rd and the 7th day after admission),IL-8(on the 3rd day after admission)and I-FABP(on the 3rd and 7th day after admission)decreased significantly,respectively(P<0.05).Compared with group B,by EEN in group C,the serum levels of IL-10(on the 7th day after admission)and citrulline(on the 3rd and 7th day after admission)increased significantly respectively(P<0.05).ConclusionsVFO was a risk factor for aggravating of AP.EEN prevented the VFO patients from developing pancreatic necrotic infection,the mechanism of which might be related with inhibiting excessive inflammatory reactions and adjusting the imbalance of inflammatory response,and alleviating ischemia of intestine mucosa.Part 2 Effects of early enteral nutrition on obese rats with severe acute pancreatitisMethods:1.Sprague-Dawley(SD)rats were allocated into 3 groups:group A(normal weight rats plus DEN)(n=24),group B(obese rats plus DEN)(n=24),group C(obese rats plus EEN)(n=24).2.At 36,48 and 72h after modeling,every 8 rats in each group were sacrificed for blood and tissue samples.The obtained blood content was usded for examination of endotoxin(ET),interleukin-6(IL-6)and amylase(AMY).The tissues samples including lung,pancreas and small intestine were harvested for detection of microscopic pathological changes and microscopic histologic scoreing.Immuno-histochemistry(IH)and Western-blot(WB)methods were used to examine the distribution and expression of ICAM-1(intercellular cell adhesion molecule-1)and nuclear factor-k-gene binding(NF-?B)in mucosa of small intestine.Results:1.The levels of serum AMY(at 72h after modeling),plasma ET(48 and 72h after modeling)and serum IL-6(at 36,48 and 72h after modeling)in the group B were significantly higher than those in group A,respectively(P<0.05).Compared with group B,by EEN in group C,the serum levels of AMY(at 48 and 72h after modeling),and plasma ET(at 48 and 72h after modeling)and IL-6(at 48 and 72h after modeling)decreased significantly,respectively(P<0.05).2.The pathological scores of injured pancreas(at 36,48 and 72h after modeling),injured lung(at 48 and 72h after modeling)and injured mucosa of small intestine(at 48 and 72h after modeling)in the group B were significantly higher than those in group A,respectively(P<0.05).Compared with group B,by EEN in group C,the pathological scores of injured pancreas(at 72h after modeling),injured lung(at 48 and 72h after modeling)and injured mucosa of small intestine(at 48 and 72h after modeling)in group C increased significantly respectively(P<0.05).3.Compared with group B,by EEN in group C,expression of ICAM-1 andNF-?B in mucosa of small intestine of group C significantly decreased,respectively(P<0.05).ConclusionsObesity promoted inflammation reactions in SAP rats and aggravated the pathological damage of pancreas,lung and small intestine mucosa.In SAP obese rats,by EEN,pathological damages of injured pancreas,lung and mucosa of small intestine were alleviated,the mechanisms of which might be related with inhibiting inflammatory reactions,protecting intestine mucosa barrier and decreasing secretion of inflammatory cytokines by inhibiting expression of ICAM-1 and NF-?B and inhibiting intestinal ET.