Enteral Nutrition Improves The Mucosal Immunity And Host Defense

Enteral Nutrition Improves the Mucosal Immunity and Host Defense Objective:To evaluate the role of enteral nutrition in the improvement of mucosal immunity and host defense in patients with nutrition therapy, comperisons were performed among patients with enteral nutrition (EN), parental nutrition (PN). The parameters used in this study including nutrition status, mucosal activation, immunoglobulins, cytokine, monocyte function, T lymphocyte subsets and inflammamatory index. Methods:A prospective, successive and controlled trial was conducted. 39 patients with intestinal fistula and convalescent severe acute pancreatitis were divided into two groups: Enteral nutrition group (EN) (n=18); Parenteral nutrition group (PN) (n=21). 10 patients admitted with the diagnoses of cholecystic polypus or inguinal hernias were served as control group (control). The blood samples were taking before and after 7 days' nutrition support in EN and PN groups and 2 days after admission in control group. The blood level about nutrition status (albumin, pre-albumin, fibronectin, transferring), mucosal immunity (IgA, secretary component (SC), D-lactic acid), host defense (CD4, CD8, IgA, IgG, IgA IgG IgM IgE, IL-10), monocytefunction (HLA-DR) and inflammatory index (C reaction protein) were measured and compared in all groups. Results:The surum level of albumin, pre-albumin, fibronectin and transferring in EN group were as same as PN group when compared each other before and after one week nutrition support (P>0.05). The surum level of protein in EN and PN group were significantly higher than that before one week nutrition support (P0.01). Whenever before and after one week of nutrition support the levels of albumin, pre-albumin, fibronectin and transferring in EN or PN group was still lower than control group(P<0.05).Mucosal immunity: The level of IgA in EN, PN groups were lower (especially in PN) than c ontrol group (P0.05). But the 1 evel o f IgAin EN was much higher t han PN's (P0.01). The SC level of EN was as same as control's (P>0.05) , while the level in PNwas significantly lower than other two groups (P<0.01). The D-lactic acid level in PN was significantly higher than EN (P0.01) and control groups (P<0.05).The HLA-DR levels of PN group was significant decreased (P0.01) and was lower than EN and Control groups (P<0.01). No significant difference was found between EN and control group (P>0.05).Cellular immunity: The CD4 level in EN, PN were significantly different when compared with control (P0.05), while the level in EN was lower than control (P0.05), higher than PN (PO.05). CD8 level were also different significantly in all EN PN and Control groups (PO.05).The IL-10 level, compared with control group, in PN and EN were higher statisticly in turns (P0.01). No difference was found when comparing EN with PN group (P>0.05). The IgG level in EN group was higher than PN (PO.05), and no differences were found when compared with Control group (P>0.05). The CRP level increased in turns from control to EN and PN. The differences in these three groups were very significant (PO.01). Conclusion:By observing and comparing nutrition status, intestine mucosal immunity and host difense in three groups, it was confirmed that intestinal nutrition could not only promote body nutrition status, but also promote, observing through the surum IgA and secrete component, intestinal immunity and mucosal barrier function. With further studying of cellular immunity and humoral immunity it was found that the patients who received intestine nutrition whatever its cellular immunity or humoral immunity were much better than others and IL-10, as an accurate track, could accurately reflect the severity of patients. It is first time demonstrated that intestinal nutrition could enhance mucosal imunity and host defense. Enteral nutrition is not only an effective route to improve nutrition, but also provides a pathway to rebuild mucosal barrier function and enhance host difence.