南京地区早产儿坏死性小肠结肠炎病原体特点和益生菌干预效果及预后影响因素分析  

Pathogen characteristics, probiotics intervention effect and prognostic factors of necrotizing enterocolitis in premature infants in Nanjing

作　　者：李忠堂 徐南[1] 李函[1] 乔立兴[1] 钱丽娟[1] LI Zhongtang;XU Nan;LI Han;QIAO Lixing;QIAN Lijuan(Department of Paediatrics,Zhongda Hospital affiliated to Southeast University,Nanjing,Jiangsu 210009,China;不详)

机构地区：[1]东南大学附属中大医院儿科,江苏南京210009

出　　处：《中国微生态学杂志》2020年第7期789-793,共5页Chinese Journal of Microecology

基　　金：江苏省自然科学基金(BK20151420)。

摘　　要：目的探究南京地区早产儿坏死性小肠结肠炎(NEC)的病原体特点,并观察益生菌辅助治疗对患儿血清炎症因子水平的影响,分析影响NEC早产儿预后的因素。方法将2014年5月至2018年12月于东南大学附属中大医院就诊的87例NEC早产儿选为研究对象,分析其病原体特点,观察不同治疗方法对患儿血清炎症因子的影响,并通过Logistic回归分析影响NEC患儿预后的危险因素。结果革兰阴性菌是NEC早产儿的主要致病菌,主要包括肺炎克雷伯菌(25株,27.78%)和大肠埃希菌(21株,23.33%)。肺炎克雷伯菌和大肠埃希菌对美罗培南、亚胺培南/西司他丁、哌拉西林/他唑巴坦、多粘菌素和阿米卡星敏感。益生菌干预后的NEC早产儿血清IL-1β、IL-10、TNF-α水平及TLR4的表达均显著低于常规治疗患儿(均P<0.05)。发病前3 d内输血、新生儿窒息、益生菌干预、非营养性吮吸、腹膜炎、败血症、加奶速度、PDA均是影响NEC早产儿预后的相关因素(均P<0.05),其中发病前3 d内输血、新生儿窒息、加奶速度、PDA是影响NEC早产儿预后的独立危险因素(均P<0.05)。结论革兰阴性菌是NEC早产儿的主要致病菌,益生菌干预可有效降低NEC早产儿血清炎症因子水平。对于NEC早产儿的治疗可选用碳青霉烯类、氨基糖苷类等抗生素,同时需关注影响NEC早产儿预后的独立危险因素。Objective To investigate the pathogen characteristics of necrotizing enterocolitis(NEC)in premature infants in Nanjing,observe the effect of probiotic adjuvant therapy on the levels of serum inflammatory factors,and analyze the prognostic factors of NEC.Methods A total of 87 premature infants with NEC admitted to our hospital from May 2014 to December 2018 were enrolled.The pathogen characteristics of premature infants with NEC were analyzed,the influence of different treatment methods on serum inflammatory factors was observed,and the risk factors affecting the prognosis of NEC infants were analyzed using logistic regression.Results Gram-negative bacteria were the main pathogenic bacteria in premature infants with NEC,including Klebsiella pneumoniae(25 strains,27.78%)and Escherichia coli(21 strains,23.33%).Klebsiella pneumoniae and Escherichia coli were sensitive to Meropenem,Imipenem/Sistatin,Piperacillin/Tazobactam,Polymyxin and Amikacin.The levels of IL-1β,IL-10 and TNF-αand the expression of TLR4 in preterm infants with NEC after probiotic intervention were significantly lower than those in the normal infants(all P<0.05).Blood transfusion within 3 days before onset of disease,asphyxia neonatorum,probiotic intervention,non nutritional sucking,peritonitis,septicaemia,milk feeding speed and PDA were risk factors(all P<0.05),among which within blood transfusion within 3 days before disease onset,asphyxia neonatorum,milk feeding speed and PDA were independent risk factors(all P<0.05).Conclusion Gram-negative bacteria are the main pathogens of NEC in preterm infants.Probiotic intervention can effectively reduce the levels of serum inflammatory factors in NEC preterm infants.Carbapenems,Aminoglycosides and other antibiotics can be used for the treatment of NEC preterm infants.Meanwhile,independent risk factors affecting the prognosis of NEC preterm infants should be paid attention.

关 键 词：早产儿 坏死性小肠结肠炎 益生菌 

分 类 号：R722.6[医药卫生—儿科]