Effects of enteral immunonutrition on immune function in patients with multiple trauma

BACKGROUND：Enteral immunonutrition （EIN） refers to addition of some specific nutrients in enteral nutrition （EN）, which can help to increase the immune function, and reduce the inflammatory reaction and septic complications. This study aimed to determine whether EIN can improve the immune function in multiple trauma patients. METHODS：Thirty-two patients with multiple trauma who had been admitted to the general ICU of Changzheng Hospital, Shanghai, from March 2007 to May 2008, were randomly divided into two groups： an enteral immunonutrition group （EIN group, n=16） and an enteral nutrition group （EN group, n=16）. EIN suspension （RuiNeng produced by Sino-Swed Co., Ltd） and ordinary nutrition liquid （RuiSu produced by Sino-Swed Co., Ltd） were given to patients of the EIN group and EN group respectively for at least for 14 days. Peripheral blood lymphocyte count （TLC）, immunoglobulin （IgG, IgM, IgA）, and T-lymphocyte subsets （CD3, CD4, CD8, CD4 / CD8） were detected on the 1st day after grouping, and the 7th day and 14th day after nutritional support. RESULTS： TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in the EIN group on the 7th and 14th day than that on the 1st day （P〈0.05）, and continually increased with a prolonged time of EIN. The parameters of immune function in the EN group on the 7th day didn＇t change significantly compared with those on the 1st day after grouping; on the 14 th day, TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher than those on the 1st day after grouping （P〈0.05）, but were significantly lower than those in the EIN group on the 14th day （P〈0.05）. CONCLUSION： Compared with the general formula EN, EIN is more helpful for the recovery of humoral and cellular immune function in the early post-multitraumatic phase.

Effects of postoperative immune-enhancing enteral nutrition on the immune system,inflammatory responses,and clinical outcome

Objective This study was conducted to evaluate the effects of postoperative immune enhancing enteral nutrition on the immune system,inflammatory responses,and clinical outcome of patients undergoing major abdominal surgery. Methods This study was designed as a multicenter,prospective,randomized and controlled clinical trial. One hundred twenty-four patients undergoing major abdominal surgery were randomly assigned to receive either an immune enhancing enteral diet or an isocaloric and isonitrogenous control enteral diet for seven days. Enteral feeding was initiated 24 hours after surgery. Host immunity was evaluated by measuring levels of IgG,IgM,IgA,CD4,CD8,and CD4/CD8,and the inflammatory response was determined by assessing IL-1α, IL-2, IL-6, IL-10, and TNF-α levels. Infectious complications were also recorded. Results One hundred twenty patients completed the study and four patients were excluded. On postoperative day 9,among patients receiving an immune enhancing diet,IgG,IgA,CD4 and CD4/CD8 levels were significantly higher and TNF-α and IL-6 concentrations were significantly lower compared to the control group. Moreover,among patients receiving an immune enhancing diet,when comparing preoperation to day 9 postoperation levels,increases in IgA,CD4,and CD4/CD8 levels were significantly higher than in control patients and increases in TNF-α concentrations were significantly lower. No statistically significant differences were found between the two groups with regard to infectious complications. Conclusions Postoperative administration of immune enhancing enteral nutrition in patients undergoing major abdominal surgery can positively modulate postoperative immunosuppressive and inflammatory responses.