Effects of enteral immunonutrition on immune function in patients with multiple trauma

doi:10.5847/wjem.j.1920-8642.2011.03.009

Abstract

Abstract:

BACKGROUND: Enteral immunonutrition (EIN) refers to addition of some specific nutrients in enteral nutrition (EN), which can help to increase the immune function, and reduce the inflammatory reaction and septic complications. This study aimed to determine whether EIN can improve the immune function in multiple trauma patients.
METHODS: Thirty-two patients with multiple trauma who had been admitted to the general ICU of Changzheng Hospital, Shanghai, from March 2007 to May 2008, were randomly divided into two groups: an enteral immunonutrition group (EIN group, n=16) and an enteral nutrition group (EN group, n=16). EIN suspension (RuiNeng produced by Sino-Swed Co., Ltd) and ordinary nutrition liquid (RuiSu produced by Sino-Swed Co., Ltd) were given to patients of the EIN group and EN group respectively for at least for 14 days. Peripheral blood lymphocyte count (TLC), immunoglobulin (IgG, IgM, IgA), and T-lymphocyte subsets (CD3, CD4, CD8, CD4 /CD8) were detected on the 1st day after grouping, and the 7th day and 14th day after nutritional support.
RESULTS: TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher in the EIN group on the 7th and 14th day than that on the 1st day (P<0.05), and continually increased with a prolonged time of EIN. The parameters of immune function in the EN group on the 7th day didn't change significantly compared with those on the 1st day after grouping; on the 14 th day, TLC, IgG, IgM, IgA, CD4 and CD4/CD8 ratio were significantly higher than those on the 1st day after grouping (P<0.05), but were significantly lower than those in the EIN group on the 14th day (P<0.05).
CONCLUSION: Compared with the general formula EN, EIN is more helpful for the recovery of humoral and cellular immune function in the early post-multitraumatic phase.

Key words: Multiple trauma, Enteral immune nutrition, Immune function

Sha-luo Li, Yong-hua Xu, Xi Wang, Xue-feng Liu, Liang Zhao. Effects of enteral immunonutrition on immune function in patients with multiple trauma[J]. World Journal of Emergency Medicine, 2011, 2(3): 206-209.

Figures/Tables 3

Table 1

Table 2

Table 3

References 13

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Ingredients	Content
Ingredients	EIN	EN
Energy (KJ)	543.4	418
Protein (g)	5.85	3.8
Fat (g)	7.2	3.4
Carbohydrate (g)	10.4	13.8
ω-3 fatty acid (g)	0.3	0.17
ω-3: ω-6	1:2.5	1:6.5
Dietary fiber (g)	1.3
Vitamin A (mg)	0.2	0.06
Vitamin C (mg)	8.0	4.5
Vitamin E (mg)	2.7	0.75
Osmotic concentration (mmol/L)	350	250

Patient information	EIN group (n=16)	EN group (n=16)
Age (yr)	53.2±10.1	54.9±8.7
Sex (M/F)	10/6	9/7
Wt (kg)	61.8±9.6	63.1±10.2
MAP (mmHg)	88.4±11.5	84.6±10.6
HR (times/min)	96.8±21.1	94.6±16.3
RR (times/min)	24.2±6.5	22.8±5.4
ISS
<20 (no.)	4	6
≥20 (no.)	12	10
Hb (g/L)	103±20	110±16
Alb (g/L)	29.6±4.8	28.7±4.2

Immune indices	EIN group (n=16)			EN group (n=16)
Immune indices	1st day	7th day	14th day	1st day	7th day	14th day
TLC (×10⁹/L)	1.21±0.25	1.46±0.20	1.62±0.19^#	1.24±0.22	1.31±0.26	1.42±0.30
IgG (g/L)	10.12±2.06	12.20±1.83	13.08±1.94^#	9.81±2.11	10.03±2.08	11.18±2.14
IgM (g/L)	1.26±2.34	1.92±3.06	2.14±3.26^#	1.30±2.18	1.58±1.99	1.87±2.60
IgA (g/L)	2.20±1.91	2.58±2.15	2.66±1.80^#	2.25±1.12	2.23±2.09	2.41±1.76
CD3 (%)	49.70±3.25	50.48±4.17	49.66±6.25	48.96±4.22	48.05±3.45	49.02±5.72
CD4 (%)	32.14±3.60	37.22±5.35	42.63±3.86^#	33.85±4.01	32.64±4.58	36.06±3.21
CD8 (%)	21.30±2.40	20.04±2.60	19.98±2.33	21.06±1.99	22.14±2.83	21.86±2.90
CD4/CD8	1.70±0.31	1.90±0.40	2.20±0.63^#	1.68±0.42	1.70± 0.44	1.94±0.52

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