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 d...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 8 th 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 7 th 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 7 th 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.展开更多
目的观察肠内与肠外营养对重症急性胰腺炎(SAP)患者免疫功能的影响。方法将63例SAP患者随机分为肠内营养(EN)组和全肠外营养(TPN)组,EN组29例,TPN组34例。总热量按Harris-Benedict公式计算。TPN组从中心静脉补充营养液,EN组入院48～72 ...目的观察肠内与肠外营养对重症急性胰腺炎(SAP)患者免疫功能的影响。方法将63例SAP患者随机分为肠内营养(EN)组和全肠外营养(TPN)组,EN组29例,TPN组34例。总热量按Harris-Benedict公式计算。TPN组从中心静脉补充营养液,EN组入院48～72 h后经空肠给予持续性肠内营养配合常规治疗。观察EN和TPN对SAP患者外周血T淋巴细胞亚群CD3+、CD4+、CD8+与免疫球蛋白IgA、IgG、IgM的影响。结果在入组第1天,CD3+、CD4+T淋巴细胞百分比、CD4+/CD8+比值及血浆免疫球蛋白IgA、IgG、IgM水平较正常对照组明显降低,差异有统计学意义(P<0.05)。在第7、14天,EN组CD4+T细胞数明显高于TPN组(43.4±2.40 vs 32.2±1.05;45.4±5.98 vs 38.9±4.28),差异有统计学意义(P<0.05);在入组第7天,EN组CD4+/CD8+比值也明显高于TPN组(1.68±0.26 vs 1.27±0.33),差异有统计学意义(P<0.05)。虽免疫球蛋白、补体C3、C4在两组间的差异无统计学意义(P>0.05),但EN组血浆IgG和IgM水平比TPN组增加更快。结论SAP患者在病程早期存在免疫功能的下降;EN能有效改善机体免疫功能,TPN不利于机体免疫功能的恢复。展开更多
基金Supported by Grants from the Key Project of the Eleventh Five-Year Plan of People's Liberation Army,No.06G041
文摘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 8 th 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 7 th 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 7 th 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.
文摘目的观察肠内与肠外营养对重症急性胰腺炎(SAP)患者免疫功能的影响。方法将63例SAP患者随机分为肠内营养(EN)组和全肠外营养(TPN)组,EN组29例,TPN组34例。总热量按Harris-Benedict公式计算。TPN组从中心静脉补充营养液,EN组入院48～72 h后经空肠给予持续性肠内营养配合常规治疗。观察EN和TPN对SAP患者外周血T淋巴细胞亚群CD3+、CD4+、CD8+与免疫球蛋白IgA、IgG、IgM的影响。结果在入组第1天,CD3+、CD4+T淋巴细胞百分比、CD4+/CD8+比值及血浆免疫球蛋白IgA、IgG、IgM水平较正常对照组明显降低,差异有统计学意义(P<0.05)。在第7、14天,EN组CD4+T细胞数明显高于TPN组(43.4±2.40 vs 32.2±1.05;45.4±5.98 vs 38.9±4.28),差异有统计学意义(P<0.05);在入组第7天,EN组CD4+/CD8+比值也明显高于TPN组(1.68±0.26 vs 1.27±0.33),差异有统计学意义(P<0.05)。虽免疫球蛋白、补体C3、C4在两组间的差异无统计学意义(P>0.05),但EN组血浆IgG和IgM水平比TPN组增加更快。结论SAP患者在病程早期存在免疫功能的下降;EN能有效改善机体免疫功能,TPN不利于机体免疫功能的恢复。
