Prendergast Andrew J, Kelly Paul
aBlizard Institute, Queen Mary University of London, London, UK bZvitambo Institute for Maternal and Child Health Research, Harare, Zimbabwe cDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA dUniversity Teaching Hospital, Lusaka, Zambia.
Curr Opin Infect Dis. 2016 Jun;29(3):229-36. doi: 10.1097/QCO.0000000000000261.
This review focuses on recent data highlighting the interactions between intestinal pathogens, enteropathy and malnutrition in developing countries, which drive morbidity and mortality and hinder the long-term developmental potential of children.
Diarrhoea remains the second commonest cause of death in children below 5 years, and malnutrition underlies 45% of all child deaths. Even in the absence of diarrhoea, subclinical pathogen carriage and enteropathy are almost universal in developing countries. Here, we review recent studies addressing the causes and consequences of diarrhoea; emerging data on environmental influences that govern postnatal development of the gut and microbiota; current concepts of environmental enteric dysfunction; and recent intervention trials in the field. We highlight the interactions between these processes, whereby intestinal pathogens drive a cycle of gut damage, malabsorption, chronic inflammation and failed mucosal regeneration, leading to malnutrition and susceptibility to further enteric infections.
Efforts to improve child survival and long-term developmental potential need to address the overlapping and interacting effects of diarrhoea, enteropathy and malnutrition. Recent insights from human and animal studies suggest potential targets for intervention.
本综述聚焦于近期数据，这些数据凸显了发展中国家肠道病原体、肠病和营养不良之间的相互作用，这些相互作用导致了发病率和死亡率，并阻碍了儿童的长期发展潜力。
腹泻仍然是5岁以下儿童第二大常见死因，营养不良是所有儿童死亡的45%的根本原因。即使在没有腹泻的情况下，亚临床病原体携带和肠病在发展中国家几乎普遍存在。在此，我们综述了近期关于腹泻的原因和后果的研究；关于影响肠道和微生物群产后发育的环境因素的新数据；环境性肠功能障碍的当前概念；以及该领域最近的干预试验。我们强调了这些过程之间的相互作用，即肠道病原体驱动肠道损伤、吸收不良、慢性炎症和黏膜再生失败的循环，导致营养不良和易患进一步的肠道感染。
为提高儿童生存率和长期发展潜力所做的努力需要解决腹泻、肠病和营养不良的重叠和相互作用的影响。来自人类和动物研究的最新见解提示了潜在的干预靶点。
