Division of Pediatric Surgery, Children's Hospital Los Angeles.
Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Curr Opin Pediatr. 2018 Jun;30(3):417-423. doi: 10.1097/MOP.0000000000000629.
Necrotizing enterocolitis (NEC) is a devastating disease that predominately affects premature neonates. The pathogenesis of NEC is multifactorial and poorly understood. Risk factors include low birth weight, formula-feeding, hypoxic/ischemic insults, and microbial dysbiosis. This review focuses on our current understanding of the diagnosis, management, and pathogenesis of NEC.
Recent findings identify specific mucosal cell types as potential therapeutic targets in NEC. Despite a broadly accepted view that bacterial colonization plays a key role in NEC, characteristics of bacterial populations associated with this disease remain elusive. The use of probiotics such as lactobacilli and bifidobacteria has been studied in numerous trials, but there is a lack of consensus regarding specific strains and dosing. Although growth factors found in breast milk such as epidermal growth factor and heparin-binding epidermal growth factor may be useful in disease prevention, developing new therapeutic interventions in NEC critically depends on better understanding of its pathogenesis.
NEC is a leading cause of morbidity and mortality in premature neonates. Recent data confirm that growth factors and certain bacteria may offer protection against NEC. Further studies are needed to better understand the complex pathogenesis of NEC.
坏死性小肠结肠炎（NEC）是一种严重影响早产儿的疾病。NEC 的发病机制是多因素的，目前还不完全清楚。危险因素包括低出生体重、配方奶喂养、缺氧/缺血损伤和微生物失调。本综述重点介绍了我们目前对 NEC 的诊断、治疗和发病机制的理解。
最近的发现确定了特定的黏膜细胞类型作为 NEC 的潜在治疗靶点。尽管人们普遍认为细菌定植在 NEC 中起关键作用，但与这种疾病相关的细菌种群特征仍不清楚。已经在许多试验中研究了益生菌（如乳酸杆菌和双歧杆菌）的应用，但对于特定菌株和剂量尚未达成共识。虽然母乳中发现的表皮生长因子和肝素结合表皮生长因子等生长因子可能有助于预防疾病，但要开发新的 NEC 治疗干预措施，关键是要更好地了解其发病机制。
NEC 是早产儿发病率和死亡率的主要原因。最近的数据证实，生长因子和某些细菌可能对 NEC 有保护作用。需要进一步研究以更好地了解 NEC 的复杂发病机制。
