广西医学

目的探讨危重症早产儿早期肠道菌群的定植特征及其与临床效果的相关性。方法选取33例28周≤出生胎龄<34周、出生方式为剖宫产、采用配方奶肠道喂养的危重症早产儿，根据治疗效果分为疗效不满意组（A组）18例和疗效满意组（B组）15例。在出生后48 h内采集两组患儿的粪便样本，应用Illumina高通量测序技术对粪便标本中所有细菌的16S rRNA V3~V4区进行DNA测序，分析肠道菌群的物种分类、丰富度和多样性。结果在门水平上，两组主要优势菌群均包含厚壁菌门、变形菌门、拟杆菌门、放线菌门和未分类菌门等；A组放线菌门、拟杆菌门的绝对丰度较B组下降（P<0.05）。在属水平上，两组主要优势菌群均包含肠球菌属、葡萄球菌属、克雷伯菌属、肠杆菌属和特布尔西菌属等；A组双歧杆菌属、丙酸杆菌属、罗斯氏菌属和拟杆菌属的绝对丰度较B组下降，肠球菌属的绝对丰度较B组升高（P<0.05）。A组的Shannon指数、Simpson指数低于B组（P<0.05）；β多样性指数分析显示组间差异大于组内差异（R值>0，P<0.05）。结论不同疗效的危重症早产儿肠道菌群在门、属水平上的主要优势菌群大致相同，但其肠道菌群构成、丰富度和多样性存在差异，其中疗效不满意者的放线菌门、拟杆菌门及双歧杆菌属、丙酸杆菌属、罗斯氏菌属和拟杆菌属的绝对丰度，以及肠道菌群的丰富度和多样性均降低。

To explore the colonization characteristics of early intestinal flora in critically ill premature infants and their correlations with clinical effects. Methods A total of 33 critically ill premature infants, whose gestational age was equal or greater than 28 weeks and less than 34 weeks, birth method was Cesarean section, and who received intestinal feeding with formula milk, were selected, and they were assigned to efficacy dissatisfied group (group A, 18 cases) or efficacy satisfied group (group B, 15 cases) according to therapeutic effects. Fecal samples of the two groups were collected within 48 hours after birth, and DNA sequencing was performed on 16S rRNA V3⁃V4 regions of all bacteria in fecal samples by using the Illumina high⁃throughput sequencing technique. The species classification, abundance, and diversity of intestinal flora were analyzed. Results At the phylum level, both groups mainly contained dominant flora in terms of Firmicutes, Proteobacteria, Bacteroidetes, Actinobacteria, and unclassified phylum of bacteria, etc. , moreover, group A exhibited decreased absolute abundance of Actinobacteria and Bacteroidetes as compared with group B (P<0.05). At the genus level, both groups mainly contained dominant flora with respect to Enterococcus, Staphylococcus, Klebsiella, Enterobacte, and Trabulsiella, etc. , in addition, group A yielded decreased absolute abundance of Bifidobacterium, Propionibacterium, Rothia, and Bacteroidetes, whereas an elevated absolute abundance of Enterococcus as compared with group B (P<0.05). The Shannon index and Simpson index of group A were lower than those of group B (P<0.05) ; furthermore, β diversity index analysis revealed that the difference between groups was greater than the difference within groups (R value>0, P<0.05). Conclusion The main dominant flora of intestinal flora in critically ill premature infants with different efficacy are almost the same at the phylum and genus levels, but there are differences in the composition, abundance, and diversity of intestinal flora between critically ill premature infants, therein the absolute abundance of Actinobacteria, Bacteroidetes, and Bifidobacterium, Propionibacterium, Rothia, Bacteroidetes in individuals with unsatisfactory efficacy is decreased, as well as the abundance and diversity of intestinal flora are also decreased.

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