Effect of Enteral Nutrition Versus Parenteral Nutrition on Immune Function in Patients with Severe Acute Pancreatitis

Objective To assess the effect of enteral nutrition(EN) and total parenteral nutrition(TPN) on immune function in patients with severe acute pancreatitis(SAP).Methods Sixty-three patients with SAP were randomly assigned to EN group(29 cases) or TPN group(34 cases).Total calorie was estimated according to Harris-Benedict formula.Nutritional infusion was given through central veins in TPN-group,and enteral nutrition was offered by naso-jejunal tube placed to the distal to the ligament of Treitz.Plasma levels of IgG,IgM and IgA were measured,and percent of subsets of lymphocyte(CD3+,CD4+,CD8+) in peripheral blood were detected by flow cytometry on entry trial and repeated on day 7 and 14 thereafter.Results Plasma concentrations of IgG and IgM were markedly decreased at the first day of entry trial in SAP compared with that in control group(P0.05),and the percent of CD3+、CD4+ T lymphocytes and ratio of CD4+/ CD8+ were obviously decreased.After 7 and 14 days,the percentage of CD4+ T lymphocytes in EN group were higher than those in TPN group(43.4±2.40 vs 32.2±1.05;45.4±5.98 vs 38.9±4.28,P0.05).The ratio of CD4+/ CD8+ in EN group was higher than that in TPN group(1.68±0.26 vs 1.27±0.33,P0.05).Plasma concentrations of IgG and IgM in the two groups were not obviouly different,but immunoglobulin(IgG and IgM) in EN group increased more rapidly than that in TPN group.Conclusion The immune function of SAP are reduced in early stage.EN enhanced the improvement of immune function,and TPN inhibits the normalization of immune function in the patients with SAP.