Effect Of Enteral Ecoimmunonutrition On Immune Function Of Severe Acute Pancreatitis Model In Pigs

[Background]Severe acute pancreatitis is associated with substantial alterations of the immunologic host response which has been claimed to promote multiple organ dysfunction,septic complications,and mortality. Immune function inhibition in severe acute pancreatitis(SAP)in closely correlated with the development and prognosis of disease.It has been reported that enteral nutrition(EN)especially ecoimmunonutrition(EIN) is superior to parenteral nutrition(PN)in the treatment of SAP due to a proposed beneficial effect on the immune function.[Aims]To investigate the effect of enteral ecoimmunonutrition on the disease course and immune function of SAP model in pigs.[Method]The operations including the jejunostomy,the cystostomy and the pancreatic duct catheterization were performed in eighteen healthy pigs which weight between 20kg and 25kg.All the pigs which were selected to establish a model of SAP were induced by retrograde injection of 5%sodium taurocholate and trypsin into the pancreatic duct in the second day after the operations.Eighteen pigs were randomly divided into three groups,parenteral nutrition(PN)group(n=6), elemental enteral nutrition(EEN)group(n=6),and ecoimmunonutrition (EIN)group(n=6)after induction of SAP models.Each group was treated with the different nutritional supports for eight days,respectively.The changes of immunoglobulin(IgA,IgG,IgM),serum amylase and pancreatic amylase at various time points were observed.Secretory immunoglobulin A(sIgA)in small intestinal mucus was examined by radioimmunoassay.T-lymphocyte subsets(CD3~+,CD4~+,CD8~+)of peripheral blood were assayed by Flow Cytometer before,24h after SAP model and 4,8d after nutrition supports.The pancreas and kidney were analyzed by histopathologic grading and scoring of the severity.[Results]There were no statistical differences among three groups in the data of serum amylase and pathologic scores of pancreas.Pancreatic amylase level in the EEN group was significantly lower than those in PN group and EEN group.CD3~+,CD4~+ lymphocytes and the CD4~+/CD8~+ in peripheral blood in EIN group were significantly increased as compared with those in EEN group and TPN groups.Furthermore,compared with TPN and EEN,the EIN group had an increased level of IgA,IgG concentration in peripheral blood and a higher sIgA concentration in small intestinal mucus.Renal injury was the most severe in PN group and mildest in EIN group.[Conclusion]Our results showed that early enteral EIN was obviously superior to PN and EEN in modulating the immune function of body. Ecoimmunonutrition supports could enhance cellular immunity and humoral immunity of SAP models in pigs;moreover it may improve immunofunction and efficiency of therapy.