益生菌联合早期微量喂养对早产儿肠道菌群及免疫功能影响的相关性研究
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摘要
目的 探讨口服益生菌联合早期微量喂养对早产儿肠道菌群、喂养不耐受及免疫功能的影响。方法 本研究以120例早产儿为研究对象,并随机将其分为观察组(60例)和对照组(60例)。对照组在早产儿出生24 h内开始非营养性吸吮、早期微量喂养,使用配方奶喂养,每次0.5～1 mL/kg,2～3 h 1次),观察组在对照组基础上给予口服益生菌,0.25 g/次,1次/天;观察患儿出生后3 d、7 d、14 d血清胃泌素水平,呕吐、腹胀、胃潴留、排便情况,观察体质量、恢复出生体质量时间,达到完全肠内营养时间;分别在出生后2 d、10 d、20 d检测粪便中乳杆菌和双歧杆菌数量,并比较治疗前后两组患儿的免疫指标。结果 第14 d胃泌素水平观察组高于对照组(53.75±6.50 vs 43.75±5.78)pg/mL,呕吐、腹胀、胃潴留的发生率和排便不畅的例数观察组明显低于对照组(7.55±1.34 vs 14.22±1.78),第14 d的体质量观察组高于对照组(1 682.34±159.11 vs 1 426.10±141.58)g,恢复出生体质量时间(8.00±1.22 vs 9.80±0.83)d、达到完全肠内营养时间(9.60±1.81 vs 12.00±1.93)d均短于对照组(均P<0.05);治疗10 d、20 d粪便中双歧杆菌和乳杆菌的数量均高于对照组(均P<0.05)。肠道乳杆菌和双歧杆菌菌群载量与CD4~+T细胞百分比和CD4~+/CD8~+比例存在显著正相关(均P<0.05),与CD3~+和CD8~+T细胞百分比间不存在相关性(均P>0.05)。两组治疗前CD3~+、CD4~+、CD8~+T淋巴细胞数量、CD4~+/CD8~+比较差异无统计学意义(均P>0.05)。观察组患者治疗后CD4~+T淋巴细胞水平(39.28±4.09 vs 37.42±3.97)%、CD4~+/CD8~+(1.61±0.48 vs 1.37±0.49)高于对照组,且比较差异具有统计学意义(均P<0.05)。结论 口服益生菌联合早期微量喂养对早产儿改善其肠道菌群,提高免疫功能有一定作用。
Objective To investigate the effects of oral probiotics combined with early microfeeding on intestinal flora,feeding intolerance and immune function of premature infants. Methods One hundred and twenty preterm infants were enrolled and randomly divided into observation group(60 cases)or control group(60 cases).Both groups were given non-nutritive sucking and early microfeeding(formula feeding,0.5～1 mL/kg each time at an interval of 2～3 hours)within 24 hours after birth;the observation group was additionally given oral probiotics,0.25 g qd.The serum gastrin level,vomiting,abdominal distension,gastric retention and defecation were observed at 3,7 and 14 days after birth.The body mass,time to recovery of body mass at birth and time to achievement of exclusive enteral nutrition were observed.The lactobacilli and bifidobacteria in feces were detected at 2,10 and 20 days after birth,and the immune functions in the two groups before and after treatment were compared. Results On the 14 th day,the gastrin level in the observation group was higher than in the control group(53.75±6.50 vs 43.75±5.78 pg/mL);the incidence of vomiting,abdominal distension,gastric retention and poor bowel movement was significantly lower than in the control group(7.55±1.34 vs 14.22±1.78);the body mass was higher than in the control group(1682.34±159.11 vs 1426.10±141.58 g);the time to recovery of body mass at birth(8.00±1.22 vs 9.80±0.83 days)and time to achievement of exclusive enteral nutrition(9.60±1.81 vs 12.00±1.93 days)were shorter than those in the control group respectively(all P<0.05).The amounts of bifidobacteria and lactic acid bacteria in feces were higher than in the control group at 10 and 20 days after treatment(all P<0.05).There was a significant positive correlation between the microbial loads of B. lactis and Bifidobacterium and the percentages of CD4~+ T cell and CD4~+/CD8~+(all P<0.05),but not the percentages of CD3~+ and CD8~+ T cell(all P>0.05).There were no significant differences in the numbers of CD3~+,CD4~+,CD8~+ and CD4~+/CD8~+ T lymphocytes between the two groups before treatment(all P>0.05).The patients in the observation group had higher levels of CD4~+ T lymphocytes(39.28±4.09 vs 37.42±3.97%)and CD4~+/CD8~+(1.61±0.48 vs 1.37±0.49)than those in the control group,and the differences were statistically significant(all P<0.05). Conclusion The combination of oral probiotics and early microfeeding has a significant effect for improvement of intestinal flora and immune function of premature infants.
Objective To investigate the effects of oral probiotics combined with early microfeeding on intestinal flora,feeding intolerance and immune function of premature infants. Methods One hundred and twenty preterm infants were enrolled and randomly divided into observation group(60 cases)or control group(60 cases).Both groups were given non-nutritive sucking and early microfeeding(formula feeding,0.5～1 mL/kg each time at an interval of 2～3 hours)within 24 hours after birth;the observation group was additionally given oral probiotics,0.25 g qd.The serum gastrin level,vomiting,abdominal distension,gastric retention and defecation were observed at 3,7 and 14 days after birth.The body mass,time to recovery of body mass at birth and time to achievement of exclusive enteral nutrition were observed.The lactobacilli and bifidobacteria in feces were detected at 2,10 and 20 days after birth,and the immune functions in the two groups before and after treatment were compared. Results On the 14 th day,the gastrin level in the observation group was higher than in the control group(53.75±6.50 vs 43.75±5.78 pg/mL);the incidence of vomiting,abdominal distension,gastric retention and poor bowel movement was significantly lower than in the control group(7.55±1.34 vs 14.22±1.78);the body mass was higher than in the control group(1682.34±159.11 vs 1426.10±141.58 g);the time to recovery of body mass at birth(8.00±1.22 vs 9.80±0.83 days)and time to achievement of exclusive enteral nutrition(9.60±1.81 vs 12.00±1.93 days)were shorter than those in the control group respectively(all P<0.05).The amounts of bifidobacteria and lactic acid bacteria in feces were higher than in the control group at 10 and 20 days after treatment(all P<0.05).There was a significant positive correlation between the microbial loads of B. lactis and Bifidobacterium and the percentages of CD4~+ T cell and CD4~+/CD8~+(all P<0.05),but not the percentages of CD3~+ and CD8~+ T cell(all P>0.05).There were no significant differences in the numbers of CD3~+,CD4~+,CD8~+ and CD4~+/CD8~+ T lymphocytes between the two groups before treatment(all P>0.05).The patients in the observation group had higher levels of CD4~+ T lymphocytes(39.28±4.09 vs 37.42±3.97%)and CD4~+/CD8~+(1.61±0.48 vs 1.37±0.49)than those in the control group,and the differences were statistically significant(all P<0.05). Conclusion The combination of oral probiotics and early microfeeding has a significant effect for improvement of intestinal flora and immune function of premature infants.
引文
[1] FANG Xiao,DUAN Rongshuai,WANG Fengshan.Research progress in the modulators of intestinal microbiota[J].Chinese Journal of Biochemical Pharmaceutics,2014,38(1):142-144,146.(in Chinese) 房晓,段荣帅,王凤山.肠道菌群调节制剂的研究进展[J].中国生化药物杂志,2014,38(1):142-144,146.
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[4] OUYANG Fengxiu,WANG Xu.Factors influencing gut microbiota in early life and childhood obesity[J].Journal of Shanghai Jiao Tong University(Medical Science),2016,36(9):1378-1382.(in Chinese) 欧阳凤秀,王旭.生命早期肠道菌群的影响因素与儿童肥胖[J].上海交通大学学报(医学版),2016,36(9):1378-1382.
[5] Groer MW,Luciano AA,Dishaw LJ,et al.Development of the preterm infant gut microbiome are search priority[J].Microbiome,2014,2:38.
[6] Berrington JE,Stewart CJ,Embleton ND,et al.Gut microbiota in preterm infants:assessment and relevance to health and disease[J].Arch Dis Child Fetal Neonatal Ed,2013,98(4):F286-290.
[7] Salvetti E,O′Toole PW.The genomic basis of Lactobacilli as health-promoting organisms[J].Microbiol Spectr,2017,5(3).
[8] XU Dongbao,WANG Haowen,ZHU Xuanjiao,et al.Clinical investigation of prebiotics on feeding intolerance and early growth in preterm infants with low birth weight[J].J of Wannan Medical College,2011,30(1):48-51.(in Chinese) 许东宝,汪浩文,祝选娇,等.益生菌对低体重早产儿喂养不耐受和生长发育的影响[J].皖南医学院学报,2011,30(1):48-51.
[9] Chrzanowska-Liszewska D,Seliga-Siwecka J,Kornacka MK.The effect of Lactobacillus rhamnosus GG supplemented enteral feeding on the microbiotic flora of preterm infants-double blinded randomized control trial[J].Early Hum Dev,2012,88(1):57-60.
[10] GAN Xin,LI Juan.Research progress of the application of probiotics in premature infants[J].Chin J Contemp Pediatr,2016,18(9):909-914.(in Chinese) 甘馨,李娟.益生菌在早产儿的应用进展[J].中国当代儿科杂志,2016,18(9):909-914.
[2] Isolauri E.Development of healthy gut microbiota early in life[J].J Paediatr Child Health,2012,48(Suppl 3):1-6.
[3] ZHAO Jiali,ZHANG Huimin.Effect of live combined bacillus subtilis and enterococcus faecium enteric-coated capsules on ulcerative colitis[J].Journal of Xinxiang Medical University,2016,33(11):983-986.(in Chinese) 赵嘉莉,张慧敏.枯草杆菌二联活菌肠溶胶囊治疗溃疡性结肠炎疗效观察[J].新乡医学院学报,2016,33(11):983-986.
[4] OUYANG Fengxiu,WANG Xu.Factors influencing gut microbiota in early life and childhood obesity[J].Journal of Shanghai Jiao Tong University(Medical Science),2016,36(9):1378-1382.(in Chinese) 欧阳凤秀,王旭.生命早期肠道菌群的影响因素与儿童肥胖[J].上海交通大学学报(医学版),2016,36(9):1378-1382.
[5] Groer MW,Luciano AA,Dishaw LJ,et al.Development of the preterm infant gut microbiome are search priority[J].Microbiome,2014,2:38.
[6] Berrington JE,Stewart CJ,Embleton ND,et al.Gut microbiota in preterm infants:assessment and relevance to health and disease[J].Arch Dis Child Fetal Neonatal Ed,2013,98(4):F286-290.
[7] Salvetti E,O′Toole PW.The genomic basis of Lactobacilli as health-promoting organisms[J].Microbiol Spectr,2017,5(3).
[8] XU Dongbao,WANG Haowen,ZHU Xuanjiao,et al.Clinical investigation of prebiotics on feeding intolerance and early growth in preterm infants with low birth weight[J].J of Wannan Medical College,2011,30(1):48-51.(in Chinese) 许东宝,汪浩文,祝选娇,等.益生菌对低体重早产儿喂养不耐受和生长发育的影响[J].皖南医学院学报,2011,30(1):48-51.
[9] Chrzanowska-Liszewska D,Seliga-Siwecka J,Kornacka MK.The effect of Lactobacillus rhamnosus GG supplemented enteral feeding on the microbiotic flora of preterm infants-double blinded randomized control trial[J].Early Hum Dev,2012,88(1):57-60.
[10] GAN Xin,LI Juan.Research progress of the application of probiotics in premature infants[J].Chin J Contemp Pediatr,2016,18(9):909-914.(in Chinese) 甘馨,李娟.益生菌在早产儿的应用进展[J].中国当代儿科杂志,2016,18(9):909-914.