title: Effects of early enteral nutrition on immune function of severe acute pancreatitis patients.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors: Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China.
authors: Jia-Kui
authors: JK
authors: Sun
authors: Xin-Wei
authors: XW
authors: Mu
authors: Wei-Qin
authors: WQ
authors: Li
authors: Zhi-Hui
authors: ZH
authors: Tong
authors: Jing
authors: J
authors: Li
authors: Shu-Yun
authors: SY
authors: Zheng
mesh_terms: D000208:Acute Disease; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D016516:CD4-CD8 Ratio; D016009:Chi-Square Distribution; D002681:China; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006684:HLA-DR Antigens / Q000097:blood; D017052:Hospital Mortality; D006801:Humans; D007121:Immunocompetence; D016867:Immunocompromised Host; D007070:Immunoglobulin A / Q000097:blood; D007074:Immunoglobulin G / Q000097:blood; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D006684:HLA-DR Antigens; D007070:Immunoglobulin A; D007074:Immunoglobulin G; D018836:Inflammation Mediators; D002097:C-Reactive Protein
keywords: Early enteral nutrition; Immune; Severe acute pancreatitis