AIM: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 d...AIM: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.CONCLUSION: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.展开更多
目的系统评价早期肠内营养(EEN)联合微生态制剂治疗重症急性胰腺炎(SAP)的疗效与价值。方法计算机检索中国学术期刊全文数据库、中国生物医学文献数据库、万方医学网、维普中文期刊服务平台、Cochrane Library、PubMed、Embase、Web of ...目的系统评价早期肠内营养(EEN)联合微生态制剂治疗重症急性胰腺炎(SAP)的疗效与价值。方法计算机检索中国学术期刊全文数据库、中国生物医学文献数据库、万方医学网、维普中文期刊服务平台、Cochrane Library、PubMed、Embase、Web of Science,检索时间为建库起至2019年11月1日,采用荟萃分析方法比较在SAP患者中EEN联合微生态制剂(试验组)与仅采用EEN治疗(对照组)的临床疗效,包括血清C-反应蛋白水平、多器官功能障碍综合征发生率、胰腺感染坏死发生率、其他并发症的发生率、死亡率、住院时间等主要结局指标以及血浆白细胞介素(IL)-8、肿瘤坏死因子(TNF)-α水平、胃肠道评分、外科干预的发生率等次要结局指标。由2名评价员严格按照纳入排除标准筛选文献、提取数据后采用Cochrane系统评价员手册5.1.0偏倚风险评估工具对纳入文献进行质量评价,采用Stata16.0软件进行荟萃分析。结果共纳入9项临床随机对照试验研究,762例SAP患者。荟萃分析结果显示,主要结局指标中试验组与对照组患者C反应蛋白水平[均数差(MD)=-7.58,95%可信区间(CI):-23.71~8.55]、多器官功能衰竭的发生率[对数风险比(LogRR)=-0.30,95%CI:-0.71~0.10]、胰腺感染坏死发生率(LogRR=-0.21,95%CI:-0.57~0.16)及死亡率(LogRR=0.13,95%CI:-0.36~0.62)差异均无统计学意义(P>0.05)。试验组并发症的发生率低于对照组(LogRR=-0.29,95%CI:-0.51~0.07),试验组患者住院时间(MD=-4.45,95%CI:-7.47~-1.43)较对照组时间短,差异具有统计学意义(P<0.05)。次要结局指标中试验组患者的血浆IL-8水平(MD=-7.43,95%CI:-14.28~-0.57),TNF-α水平(MD=-38.96,95%CI:-72.96~-4.95)及胃肠道评分(MD=-0.15,95%CI:-0.17~-0.13)低于对照组,差异均具有统计学意义(P<0.05),而与对照组相比外科干预的发生率(Log RR=-1.63,95%CI:-8.96~0.57)差异无统计学意义(P>0.05)。结论EEN联合微生态制剂可缩短SAP患者住院时间,降�展开更多
基金Supported by Grants from the Key Project of the Eleventh Five-Year Plan of People's Liberation Army,No.06G041
文摘AIM: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.CONCLUSION: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.
文摘目的系统评价早期肠内营养(EEN)联合微生态制剂治疗重症急性胰腺炎(SAP)的疗效与价值。方法计算机检索中国学术期刊全文数据库、中国生物医学文献数据库、万方医学网、维普中文期刊服务平台、Cochrane Library、PubMed、Embase、Web of Science,检索时间为建库起至2019年11月1日,采用荟萃分析方法比较在SAP患者中EEN联合微生态制剂(试验组)与仅采用EEN治疗(对照组)的临床疗效,包括血清C-反应蛋白水平、多器官功能障碍综合征发生率、胰腺感染坏死发生率、其他并发症的发生率、死亡率、住院时间等主要结局指标以及血浆白细胞介素(IL)-8、肿瘤坏死因子(TNF)-α水平、胃肠道评分、外科干预的发生率等次要结局指标。由2名评价员严格按照纳入排除标准筛选文献、提取数据后采用Cochrane系统评价员手册5.1.0偏倚风险评估工具对纳入文献进行质量评价,采用Stata16.0软件进行荟萃分析。结果共纳入9项临床随机对照试验研究,762例SAP患者。荟萃分析结果显示,主要结局指标中试验组与对照组患者C反应蛋白水平[均数差(MD)=-7.58,95%可信区间(CI):-23.71~8.55]、多器官功能衰竭的发生率[对数风险比(LogRR)=-0.30,95%CI:-0.71~0.10]、胰腺感染坏死发生率(LogRR=-0.21,95%CI:-0.57~0.16)及死亡率(LogRR=0.13,95%CI:-0.36~0.62)差异均无统计学意义(P>0.05)。试验组并发症的发生率低于对照组(LogRR=-0.29,95%CI:-0.51~0.07),试验组患者住院时间(MD=-4.45,95%CI:-7.47~-1.43)较对照组时间短,差异具有统计学意义(P<0.05)。次要结局指标中试验组患者的血浆IL-8水平(MD=-7.43,95%CI:-14.28~-0.57),TNF-α水平(MD=-38.96,95%CI:-72.96~-4.95)及胃肠道评分(MD=-0.15,95%CI:-0.17~-0.13)低于对照组,差异均具有统计学意义(P<0.05),而与对照组相比外科干预的发生率(Log RR=-1.63,95%CI:-8.96~0.57)差异无统计学意义(P>0.05)。结论EEN联合微生态制剂可缩短SAP患者住院时间,降�
