Warner Barbara B, Tarr Phillip I
Fetal Care Center, Division of Newborn Medicine, Washington University School of Medicine, St Louis, MO, USA.
Division of Gastroenterology, Hepatology, and Nutrition, Pathobiology Research Unit, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
Semin Fetal Neonatal Med. 2016 Dec;21(6):394-399. doi: 10.1016/j.siny.2016.06.001. Epub 2016 Jun 22.
Necrotizing enterocolitis remains an intractable consequence of preterm birth. Gut microbial communities, especially bacterial communities, have long been suspected to play a role in the development of necrotizing enterocolitis. Direct-from-stool nucleic acid sequencing technology now offers insights into the make-up of these communities. Data are now converging on the roles of Gram-negative bacteria as causative agents, despite the dynamic nature of bacterial populations, the varying technologies and sampling strategies, and the overall small sample sizes in these case-control studies. Bacteria that confer protection from necrotizing enterocolitis have not been identified across studies. The beneficial effect of probiotics is not apparent in infants with birth weights <1000 g (these infants are at greatest risk of, and have the highest case fatality rate from, necrotizing enterocolitis). Further work should be directed to the modulating gut microbes, or the products they produce, to prevent this devastating complication of preterm birth.
坏死性小肠结肠炎仍然是早产难以解决的后果。长期以来，肠道微生物群落，尤其是细菌群落，一直被怀疑在坏死性小肠结肠炎的发展中起作用。直接从粪便中提取核酸的测序技术现在使人们能够深入了解这些群落的组成。尽管细菌种群具有动态性、技术和采样策略各不相同，且这些病例对照研究的样本量总体较小，但目前的数据都指向革兰氏阴性菌作为病原体的作用。在各项研究中尚未发现能预防坏死性小肠结肠炎的细菌。益生菌对出生体重<1000g的婴儿没有明显益处（这些婴儿患坏死性小肠结肠炎的风险最高，病死率也最高）。未来的工作应致力于调节肠道微生物或它们产生的产物，以预防早产带来的这种毁灭性并发症。
