Role of Bacterial Colonization in Neonatal Necrotizing Enterocolitis and Its Prevention

細菌菌落在新生兒壞死性小腸結腸炎中的作用及其預防

戴定威(Ding-Wei Dai) ； W. Allan Walker

《Acta Paediatrica Sinica》 39卷6期 (1998/12) Pp. 357-365

https://doi.org/10.7097/APS.199812.0357

摘要

新生兒壞死性小腸結腸炎（NEC）是早産兒最常見的危重症。NEC病理生理中的一個重要因子是細菌和不成熟腸道的相互作用。正常腸菌群在生物體抗細菌感染中扮演重要作用。飮食和環境因素影響這一生態系。母乳餵養嬰兒腸菌中以比菲得氏桿菌爲主，而配方奶餵養兒腸菌中主要是腸桿菌、腸球菌和類桿菌。早産新生兒腸細菌菌落明顯不同於健康足月兒，這些需要重症監護的嬰兒腸細菌菌落形成慢，腸菌群建立受阻。腸菌群建立延遲和有限數量菌株菌落對生物體不利。有限量菌株菌落可導致某細菌過度生長。腸細菌的過度生長是促進細菌移位的主要因素之一。因此，早産兒腸細菌菌落異常可能是NEC病因之一。母乳餵養有益於預防NEC。母乳中的低聚糖和糖結合物可作爲細菌受體的類似物而防止腸病原菌的粘附和菌落形在。Probiotics是含活細菌的食品添加劑，可改善腸菌群。Prebiotics是不可消化的食品成分，可促進腸有益菌的生長和／或增強其活性。Probiotics和Prebiotics通過阻止有害菌的菌落形成和／或促進有益菌的生長而保護腸道。控制和調整新生兒腸細菌菌落將成爲一預防和治療各種腸細菌感染性疾病的新方法。

關鍵字

細菌菌落 ； 壞死性小腸結腸炎 ； 母乳 ； 低聚糖 ； Probiotics ； Prebiotics

並列摘要

Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency in premature infants. A major component of the pathophysiology of NEC is the nature of the interaction of bacteria with the premature gut. Intestine microflora are important to the host in resistance to bacterial infections. Diet and environmental conditions can influence this ecosystem. A breast-fed full-term infant has a preferred intestine microbiota in which bifidobacteria predominate over the potentially harmful bacteria, whereas in formula-fed infants coliforms, enterococci and bacteroides predominate. The pattern of bacterial colonization in the premature neonate gut is quite different fram that in the gut of the healthy full-term infant. Those infants requiring intensive care acquire intestinal organisms slowly, and the establishment of bifidobacterial flora is retarded. A delayed bacterial colonization of the gut with a limited number of bacterial species tends to be virulent. Bacterial overgrowth is one of major factors promoting bacterial translocation. The aberrant colonization of the premature infant may contribute to the development of NEC. Breast feeding protects infants against NEC. Oligosaccharides and glycoconjugates, natural components in human milk, may prevent intestinal attachment of enteropathogens by acting as receptor homologues. Probiotics and prebiotics modulate the composition of human intestine microflora to the benefit of the host. The beneficial effects may result in the suppression of colonization of harmful microoganisms and/or the stimulation of bifidobacterial growth. In the future, control and manipulation of bacterial colonization in the neonate gut may be a new approach to the prevention and treatment of bacterial intestinal disease of various etiologies.

並列關鍵字

bacterial colonization ； necrotizing enterocolitis ； breast milk ； oligosaccharide ； probiotics ； prebiotics