Hunter Catherine J, Upperman Jeffrey S, Ford Henri R, Camerini Victoria
Department of Surgery, University of Southern California, Keck School of Medicine, Children's Hospital Los Angeles, Los Angeles, California 90027, USA.
Pediatr Res. 2008 Feb;63(2):117-23. doi: 10.1203/PDR.0b013e31815ed64c.
Necrotizing enterocolitis (NEC) is the most common life-threatening gastrointestinal emergency encountered in the neonatal intensive care unit. Despite advances in neonatal care, NEC remains a leading cause of morbidity and mortality among premature infants. Epidemiologic studies have identified multiple factors that increase an infant's risk for the development of NEC, although premature birth, bacterial colonization, and enteral feeding are thought to play central roles in disease pathogenesis. Appreciating factors that underlie the susceptibility of prematurely born infants to NEC is important for the development of new strategies aimed at the prevention and treatment of disease. In this review, we discuss defense mechanisms in the intestine and discuss how these systems may be insufficient in the prematurely born infant and thereby further contribute to initiation of NEC. In addition, based on a review of the literature, we suggest that, although numerous bacterial and viral pathogens have been associated with NEC, no individual organism is known to be responsible for disease. Finally, we comment on the possible role for probiotics in promoting maturation of intestinal defense mechanisms thereby attenuating or preventing the sequence of events that lead to NEC.
坏死性小肠结肠炎（NEC）是新生儿重症监护病房中最常见的危及生命的胃肠道急症。尽管新生儿护理取得了进展，但NEC仍然是早产儿发病和死亡的主要原因。流行病学研究已经确定了多种增加婴儿患NEC风险的因素，尽管早产、细菌定植和肠内喂养被认为在疾病发病机制中起核心作用。了解早产婴儿易患NEC的潜在因素对于制定预防和治疗该疾病的新策略很重要。在这篇综述中，我们讨论肠道中的防御机制，并探讨这些系统在早产婴儿中可能如何不足，从而进一步促使NEC的发生。此外，基于对文献的回顾，我们认为，尽管许多细菌和病毒病原体与NEC有关，但尚无已知的单一病原体可导致该疾病。最后，我们评论了益生菌在促进肠道防御机制成熟从而减轻或预防导致NEC的一系列事件方面可能发挥的作用。
