Effect of enteral nutrition on cytokine production and plasma endotoxin in patients with severe acute pancreatitis

AIM:To assess the influence of enteral nutrition(EN) on interleukin(IL)-6,IL-10,and tumor necrosis factor-α(TNF-α) production and plasma endotoxin level in patients with severe acute pancreatitis(SAP).METHODS:Seventy-two patients with SAP were randomly divided into two groups to receive either EN or parenteral nutrition(PN) on the basis of routine comprehensive treatment.Conventional indicators,TNF-α,IL-6,IL-10 and plasma concentration of endotoxin were evaluated on 0,1,4,7,and 14 d after treatment.The infection rates,mortality,hospitalization days and hospitalization costs were compared for the two groups.RESULTS:After 14 d of treatment,C-reactive protein(CRP) and white blood cell count(WBC) in the EN group were significantly lower than those in the PN group(P < 0.05).After 4 d of treatment,plasma concentration of endotoxin in the EN group was significantly lower than that in the PN group.On day 7,plasma concentrations of TNF-a and IL-6 in the EN group significantly declined compared with the PN group(P < 0.05).Plasma concentration of IL-10 in the EN group was significantly higher than that in the PN group after 4 d of treatment(P< 0.05).CONCLUSION:In patients with SAP,early implementation of EN can regulate inflammation,and delay the development of complications such as systemic inflammatory response syndrome(SIRS) and multiple organ dysfunction syndrome(MODS).EN can protect the intestinal mucosal barrier,decrease plasma endotoxin level,and reduce systemic infection.