Effect Of Early Enteral Nutrition Supplemented With Glutamine For Patients With Severe Acute Pancreatitis On Systemic Inflammatory Response And Immune Function

Objective To evaluate the effect of early enteral nutrition(EEN)supplemented with glutamine(Gln)for patients with severe acute pancreatitis(SAP)on systemic inflammatory response and immune function.Methods Forty-nine SAP patients admitted to the general surgery of anqing hospital affiliated to anhui medical university from October 2015 to May 2017 were randomly divided into experimental group(24 cases)and control group(25 cases),The experimental group was treated with EEN combined with Gln,while the control group were treated with EEN only,blood samples from the patients of two groups were collected for analysis of inflammatory markers(C-Reactive protein(CRP),procalcitonin(PCT),Interleukin-6(IL-6),Interleukin-8(IL-8),tumor necrosis factor-?(TNF-?))and immune indices(CD3~+,CD4~+,CD4~+/CD8~+)on the day l,6 and11 after admission,compare the differences between the two groups.The statistical significance of the differences between mean values was defined as p<0.05.Results(1)Compared with the control group,there was no significant difference of systemic inflammation markers(including CRP,PCT,IL-6,IL-8,TNF-?)and immune parameters(CD3~+,CD4~+,CD4~+/CD8~+)in the experimental group on the first day after admission.(2)On day 6,the difference between the two groups was significant,as CRP(56.31±18.04 vs 98.12±11.54,P=0.037),IL-6(45.87±10.99 vs54.72±4.77,P=0.026),IL-8(45.15±9.27 vs 59.03±4.87,P=0.013),TNF-?(24.35±7.15 vs 32.41±4.22,P=0.010),PCT(1.11±0.49 vs 1.50±0.30,P=0.024)in experimental group were both lower than the control group.Else,immune indices including CD3~+(63.42±2.86 vs 54.67±1.76,P=0.035),CD4~+(43.69±1.83 vs40.08±1.08,P=0.014),CD4~+/CD8~+(2.25±0.39 vs 1.87±0.22,P=0.006)were higher in the experimental group.(3)On day 11,the inflammatory markers as CRP(16.81±7.56 vs 43.01±2.74,P=0.009),IL-6(29.39±7.92 vs 38.29±5.33,P=0.020),IL-8(30.73±9.26 vs 39.69±5.26,P=0.018),TNF-?(13.87±5.67 vs 20.35±3.82,P=0.019),PCT(0.34±0.11 vs 0.95±0.29,P=0.035)were also lower in the experimental group than the control group,and immune indices as CD3+(69.68±1.87vs 61.14±1.21,P=0.017),CD4+(54.27±3.23 vs 45.30±1.59,P=0.007)CD4~+/CD8~+(2.98±0.51 vs 2.01±0.28,P=0.012)were also higher in the experimental group than the other group.Conclusion For patients with severe acute pancreatitis,EEN combined with Gln is superior to EEN alone in reducing systemic inflammatory response and improving immune function.