先天性肛门直肠畸形患儿术后肠道菌群变化的前瞻性研究

Changes of intestinal microflorae in infants with congenital anorectal malformation after the surgery：a prospective study

摘要:

目的：前瞻性研究先天性肛门直肠畸形（anorectal malformation，ARM）患儿术后肠道菌群变化的情况。方法：实时荧光定量PCR法检测分析21名先天性ARM组患儿10日龄（出院前1 d）、1月龄和3月龄~4月龄时粪便中3种主要菌群数量，并与日龄匹配的21名对照组正常婴儿菌群数量进行比较。结果：（1）10日龄，先天性ARM组双歧杆菌与大肠杆菌数量的比值（bifidobacteria/escherichia coli，B/E）<1，大肠杆菌数量较双歧杆菌高和乳酸杆菌高（P=0.021和P=0.004），且乳酸杆菌数量较对照组高（P=0.001）。（2）1月龄，先天性ARM组B/E较10日龄增高（P=0.030），B/E>1，双歧杆菌数量增高（P=0.001），高于自身大肠杆菌、乳酸杆菌数量和对照组双歧杆菌数量（P=0.001、P<0.001和P=0.004），乳酸杆菌数量亦较对照组高（P<0.001）。（3）3月龄~4月龄，先天性ARM组乳酸杆菌数量较1月龄时降低（P=0.005），与对照组无统计学差异（P=0.571），双歧杆菌数量较对照组高（P=0.004）。（4）3月龄~4月龄，连续服用益生菌患儿肠道双歧杆菌数量显著高于对照组婴儿（P=0.013），未连续补充者肠道双歧杆菌数量和对照组婴儿相比无统计学差异（P=0.032）。结论：（1）10日龄，先天性ARM患儿以大肠杆菌数量占优势，乳酸杆菌数量亦高，较正常对照组婴儿肠道大肠杆菌和双歧杆菌数量均占优势的定植状况不同。（2）1月龄和正常对照组婴儿一样，双歧杆菌成为患儿肠道优势菌，而乳酸杆菌数量仍居高。（3）3月龄~4月龄，患儿肠道乳酸杆菌数量下降至正常对照组水平，菌群状态接近正常婴儿。（4）患儿1月龄后连续补充益生菌制剂至3月龄~4月龄能够使肠道保持高水平的双歧杆菌数量。

Abstract:

Objective：To observe the changing trends of intestinal microflorae in the postoperative infants with congenital anorectal malformation（ARM）. Methods：Real-time quantitative PCR was used to detect the numbers of three main intestinal microflorae in stools of 21 congenital ARM infants aged 10 d（the day before discharge），1 month and 3-4 months. The number of microflorae was compared between 21 congenital ARM infants and 21 normal infants. Results：（1）In congenital ARM 10 d group，the number of bifi－dobacteria versus the number of escherichia coli（B/E） was <1；the number of B/E was higher than that of bifidobacteria and lactobacilli in congenital ARM 10 d group（P=0.021，P=0.004）；the number of lactobacilli was higher in congenital ARM 10 d group than in normal control group（P=0.001）. （2）B/E was increased in congenital ARM 1 month group（B/E>1） than in congenital ARM 10 d group（P=0.030）. The number of bifidobacteria was increased significantly（P=0.001），higher than that of B/E or lactobacilliin congenital ARM 1 month group（P=0.001 and P<0.001）. The numbers of bifidobacteria and lactobacilli were higher in congenital ARM 1 month group than in normal control group（P=0.004 and P<0.001）. （3）The number of lactobacilli was lower in congenital ARM 3-4 months group than in congenital ARM 1 month group（P=0.005） and there was no difference in the number of lactobacilli congenital ARM 3-4 months group and normal control group（P=0.571）. The number of bifidobacteria was higher in congenital ARM 3-4 months group than in normal control group（P=0.004）. （4）The number of bifidobacteria was higher in infants taking probiotics continuously in con－genital ARM-4 months group than in infants in normal control group（P=0.013） whereas there was no significant difference in the number of bifidobacteria between infants taking probiotics discontinuously in congenital ARM 3-4 months group and infants in nor－mal control group（P=0.032）. Conclusion：（1）B/E is the predominant bacteria and the number of lactobacilli is higher in the con－genital ARM 10 d group. The structure of three main microflorae is different from that in normal control group. （2）Bifidobacteria be－comes the predominant bacteria in congenital ARM 1 month group and normal control group and the number of lactobacilli is still high. （3）The number of lactobacilli is decreased in congenital ARM 3-4 months group. The structure of three main microflorae in congeni－tal ARM 3-4 months group is similar to that in normal control group. （4）Taking probiotics continuously till 3-4 months’ age can keep the high level of bifidobacteria in the intestine.