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

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P0.05）。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。

Effect of probiotics combined with early microfeeding on 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 14th 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 P0.05）．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．