支气管肺发育不良早产患儿肠道外营养差异与肠道菌群变化

Differences in parenteral nutrition and changes in gut microbiota in premature infants with bronchopulmonary dysplasia

摘要

目的 探究支气管肺发育不良(BPD)早产患儿早期肠外营养差异及肠道菌群变化。方法 选取2022年1月至2023年6月期间于临汾市妇幼保健院诊治的67例BPD早产患儿(记为BPD组)及71例无BPD早产患儿(无BPD组)为研究对象,均给予早期肠外营养支持治疗,比较两组氨基酸、葡萄糖、脂质摄入开始时间、初始摄入量及出生后7d摄入总量等,观察两组生后第1、7、14、21、28d肠道菌群变化。结果 与无BPD组比较,BPD组葡萄糖、脂质摄入开始时间明显延长,氨基酸、葡萄糖、脂质初始摄入量及出生后7d摄入总量较低,出生后7d热卡摄入总量较低、液体摄入总量较高,差异均有统计学意义(t值介于2.651~39.015之间,P<0.05).两组早产患儿大肠埃希菌、肠球菌于生后第1、7、14、21d持续升高,于第28d下降;乳酸杆菌、双歧杆菌于生后第1、7、14、21d持续下降,于第28d升高,组间比较差异有统计学意义(t值介于2.234~21.337之间,P<0.05).随BPD早产患儿病情程度加重,出生7d氨基酸摄入总量、葡萄糖摄入总量、脂质摄入总量、液体摄入总量、热卡摄入总量均逐渐下降,差异有统计学意义(F值介于11.085~21.031之间,P<0.05);轻度、中度、重度BPD早产患儿出生7d大肠埃希菌、肠球菌均逐渐升高,乳酸杆菌和双歧杆菌均逐渐下降,差异有统计学意义(F值介于7.321~18.003之间,P<0.05)。结论 BPD早产患儿肠外营养开始较晚、营养量较低、肠道菌群紊乱,早期给予早产患儿肠外营养支持和肠道菌群调理对BPD防治有重要指导意义.

Abstract

Objective To investigate the differences in parenteral nutrition and changes in gut microbiota in premature infants with bronchopulmonary dysplasia (BPD). Methods A total of 67 premature infants with BPD (BPD group) and 71 premature infants without BPD (non-BPD group) who were admitted to Linfen Maternal and Child Health Hospital from January 2022 to June 2023 were selected as the research subjects. All subjects were given early parenteral nutrition support. The initial intake time, initial intakes, and total intake of amino acids, glucose, and lipid during the first 7 days after birth were compared between the two groups. Changes in gut microbiota of the two groups were observed on postnatal days 1, 7, 14, 21 and 28. Results Compared with the non-BPD group, the initial time of glucose and lipid intake in the BPD group was significantly prolonged. The initial intakes of amino acids, glucose and lipids, and total intake during the first 7 days after birth in the BPD group were lower. The total calore intake and total fluid intake during this period were higher in the BPD group (t values ranged from 2.651 to 39.015, P<0.05). Escherichia coli and Enterococci in both groups increased consistently on day 1, day 7, day 14 and day 21 after birth, and decreased on day 28; Lactobacilli and Bifidobacteria decreased consistently on day 1, day 7, day 14 and day 21 after birth, and increased on day 28. The differences between groups were statistically significant (t values ranged from 2.234 to 21.337, P<0.05). As the severity of BPD increased in premature infants, the total intake of amino acids, glucose, lipids, fluids and calories during the first 7 days after birth gradually decreased, the differences were statistically significant (F values ranged from 11.085 to 21.031, P<0.05). During the first 7 days after birth, Escherichia coli and Enterococci in premature infants with mild, moderate and severe BPD gradually increased, while Lactobacilli and Bifidobacteria gradually decreased, the differences were statistically significant (F values ranged from 7.321 to 18.003, P<0.05). Conclusion In premature infants with BPD, parenteral nutrition is initiated later, with lower nutrient levels and disrupted gut microbiota. Early parenteral nutrition support and gut microbiota regulation are important for prevention and treatment of BPD in premature infants.

关键词

早产患儿 / 支气管肺发育不良 / 早期肠外营养 / 肠道菌群

Key words

premature infant / bronchopulmonary dysplasia / early parenteral nutrition / gut microbiota

参考文献

[1] Jiang J, Mao Y, Wu J, et al. Relationship between hematological parameters and bronchopulmonary dysplasia in premature infants[J]. J Int Med Res, 2023, 51(7): 30-33.

[2] 鲁元元, 方欣, 赵小林, 等. 新生儿支气管肺发育不良高危因素的研究进展[J]. 中国妇幼健康研究, 2020, 31(12): 1739-1743.

[3] Gilfillan M, Bhandari V. Pulmonary phenotypes of bronchopulmonary dysplasia in the preterm infant[J]. Semin Perinatol, 2023, 47(6): 151-153.

[4] 高敏, 张亚丽, 刘梅, 等. 胎龄32周以下的支气管肺发育不良早产儿预后不良的危险因素[J]. 安徽医学, 2023, 44(4): 445-448.

[5] Lu X, Gao Y, Liu C, et al. Effect of breast milk on the frequency of bronchopulmonary dysplasia in very low birth weight premature infants: a meta-analysis[J]. Breastfeed Med, 2023, 18(9): 636-644.

[6] Willis K A, Silverberg M, Martin I, et al. The fungal intestinal microbiota predict the development of bronchopulmonary dysplasia in very low birth weight newborns[J]. medRxiv, 2023, 38(29): 121-123.

[7] 中华医学会儿科学分会新生儿学组, 中华儿科杂志编辑委员会. 早产儿支气管肺发育不良临床管理专家共识[J]. 中华儿科杂志, 2020, 5(24): 358-365.

[8] 李睿雯, 史源. 支气管肺发育不良诊断标准的研究进展[J]. 临床儿科杂志, 2021, 39(4): 308-312.

[9] Nadeau L, Forest J C, Masson M, et al. Biochemical markers in the assessment of protein-calorie malnutrition in premature neonates[J]. Clin Chem, 2023, 32(7): 1269-1273.

[10] 徐儒政, 孙斌, 赵乃琤. 早期肠外营养与早产儿支气管肺发育不良发生的关系[J]. 中国当代儿科杂志, 2023, 25(4): 362-367.

[11] 尧惠慈, 卢红艳, 朱玥, 等. 双调蛋白对支气管肺发育不良模型小鼠肺泡分化的影响[J]. 中国病理生理杂志, 2023, 39(1): 110-116.

[12] Lin H, Bai G, Ge J, et al. Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China[J]. BMC Pediatr, 2024, 24(1): 235-238.

[13] Heras A, Chambers R, Solomon Z, et al. Nutrition-based implications and therapeutics in the development and recovery of bronchopulmonary dysplasia[J]. Semin Perinatol, 2023, 47(6): 57-59.

[14] 吴遥. 肠道菌群失调对流感病毒感染小鼠急性肺损伤的影响[J]. 现代预防医学, 2018, 45(4): 694-699.

[15] Salgao M K, Natalia P P, Thaís M T, et al. Probiotic infant cereal improves children's gut microbiota: insights using the simulator of human intestinal microbial ecosystem (SHIME)[J]. Food Res Int, 2021, 143(1): 121-123.

[16] 范佳英. 早产儿肠道菌群变化与支气管肺发育不良症的相关研究[D]. 苏州: 苏州大学, 2020.

[17] Shen X, Yang Z, Wang Q, et al. Lactobacillus plantarum L168 improves hyperoxia-induced pulmonary inflammation and hypoalveolarization in a rat model of bronchopulmonary dysplasia[J]. NPJ Biofilms Microbiomes, 2024, 10(1): 29-32.

[18] 黄佩怡, 敖当, 蔡娜莉. 早产儿生命早期肠道菌群的建立及其相关疾病研究进展[J]. 中国微生态学杂志, 2022, 34(3): 360-363.

[19] 包晟川, 闫曙光, 陈婷, 等. 肺肠合治法治疗肺系疾病的研究进展[J]. 中国实验方剂学杂志, 2022, 28(8): 116-122.