Effects Of Immunonutrition On The Changes Of Nutrition And Immune And Illness State In Acute Severe Stroke Patients

Objective:1.To investigate the significance of immune-enhancing enteral nutrition on the the clinical treatment in acute severe stroke patients by comparing the effects of immune-enhancing enteral nutrition on the changes of nutrition, immune and illness state with the standard enteral nutrition.2.To investigate the varying pattern and correlation of serum cortisol and protein metabolism indexes in acute severe stroke patients, thereby to guide a rational clinical nutrition and energy supplement.Methods:62 acute severe stroke patients in the intensive care unit of the department of neurology, Shanxi Da Yi Hospital were enrolled from september, 2014 to october, 2015. They were divided randomly into the immune-enhancing enteral nutrition(IEN) group and the standard enteral nutrition(SEN) group. The indwelling nasal-stomach tube should be given within 24 hours after admission for the patients of two groups. The calories of nutritional objectives were 25 Kcal /(kg·d). The enteral nutritional emulsion TPF-T were supplied to patients in IEN group and the enteral nutritional suspension TPF to patients in SEN group. Serum cortisol concentration at 8a.m., serum prealbumin concentration, serum albumin concentration, serum transferrin concentration and nitrogen equilibrium were measured on day 1, day 4, day 7, day 10 and day 13 after admission. The immune indexes(CD4, CD8, CD4 / CD8, Ig G, Ig A, Ig M) and the inflammatory index(CRP) were also measured on day 1, day 7 and day 13 after admission.Glasgow coma scale(GCS) was used to assess the severity of the stroke patients on day 1,day 7 and day 13 after admission. Besides, acute physiology and chronic health evaluationⅡ(APACHEⅡ) was used to assess the severity of the stroke patients on day 1after admission. SPSS19.0 software was used to analyze the all data. The measurement data were expressed bysx ±,and the intra-group comparison was tested by LSD t-test whereas inter-group used variance analysis. Enumeration data were denoted by case number and rate and tested by x2-test. P<0.05 was considered to be of statistical significance.Results:1. There were no significant differences in age, gender, type of disease, protein metabolism indexes, immune indexes, and inflammatory indexes between the patients of IEN group and SEN group(P<0.05).2. Serum cortisol: The changes of serum cortisol concentration after admission were dynamic. The concentration of serum cortisol on day 7 was increased to the highest level.Intra-group comparisons revealed that the serum cortisol concentration on day 13 after admission were significantly lower than that on day 13 after admission(P<0.05). The inter-group comparisons revealed that the changes of serum cortisol concentration in IEN group on day 13 were significantly lower than that in SEN group(P<0.05).3. Protein metabolism indexes: The serum albumin concentration, prealbumin concentration, transferrin concentration and nitrogen equilibrium decreased to the lowest level on day 7 after admission in the patients of two groups. Intra-group comparisons revealed that the above protein metabolism indexes on day 13 after admission were significantly higher than that on day 7 in the both groups(P<0.05). The protein metabolism indexes on day 13 after admission in IEN group were significantly higher than that in SEN group(P<0.05).4. The correlation analysis between the protein metabolism indexes and the serum cortisol: The correlation analysis revealed that the changes of serum albumin concentration,prealbumin concentration, transferrin concentration and the nitrogen equilibrium were negatively related to the serum cortisol(r=-0.590, P<0.05; r=-0.359, P<0.05; r=-0.528,P<0.05; r=-0.434, P<0.05).5. Immune indexes: The levels of CD4, CD4/CD8, Ig G, Ig A, Ig M on day 1 after admission and the concentrations of CD8 on day 13 after admission were the lowest in the patients of two groups. Intra-group comparisons revealed that the levels of CD4, CD4/CD8,Ig G, Ig A, Ig M on day 13 after admission were significantly higher than that on day 1,whereas the level of CD8 on day 13 was significantly lower than that on day 1 after admission(P<0.05). Inter-group comparisons revealed that the levels of CD4, CD4/CD8,Ig G, Ig A, Ig M on day 13 after admission in IEN group were significantly higher than that in SEN group and the concentration of CD8 in IEN group was significantly lower than that in SEN group(P<0.05).6. Inflammatory indexes: The concentration of CRP was decreased to the lowest on day 13 after admission in both groups. Intra-group comparisons revealed that the CRP level on day 13 after admission was significantly lower than that on day 1(P<0.05). The concentration of CRP on day 13 after admission in IEN group was significantly lower than that in SEN group(P<0.05).7. Glasgow Coma Scale(GCS): The GCS on day 1 after admission were the lowest in the patients of two groups. GCS on day 13 after admission was significantly higher than that on day 1(P<0.05). There was no significant difference between IEN group and SEN group for GCS on d13 after admission(P > 0.05).8. The infection rate and mortality: The incidence of hospital infection in the IEN group was significantly lower than that in SEN group(P<0.05). There was no significant difference of mortality between the two groups(P>0.05).Conclusion:1.For the acute severe stroke patients, even if a positive nutrition and energy supplement is given, malnutrition still exists. 2. The more obvious the acute stress in patients with severe stroke, the higher the risk of protein metabolism disorder appears.3.The immune function of acute severe stroke patients would be impaired due to malnutrition, metabolism disorder, stress and other factors. 4. Immune-enhancing enteral nutrition is more helpful to modulate the immune function in patients of acute severe stroke, and to control the inflammatory response. 5. Immune-enhancing enteral nutrition is not superior to the standard enteral nutrition for better consciousness and lower mortality in patients of acute severe stroke. 6. Compared to standard enteral nutrition,immune-enhancing enteral nutrition can significantly reduce the incidence of clinical infection in patients of acute severe stroke.