發(fā)布時間：2018-12-06 15:20

【摘要】：目的 探討在早產(chǎn)極低出生體重兒喂養(yǎng)開始時預防性口服益生菌，對系統(tǒng)水平促炎性細胞因子及抗炎性細胞因子水平的調(diào)節(jié)及其臨床意義。 方法 根據(jù)納入標準，將2011年1月1日至10月31日期間，在我院產(chǎn)科分娩的早產(chǎn)極低出生體重兒隨機分成兩組，益生菌組及對照組，益生菌組在開始接受腸內(nèi)喂養(yǎng)時給予預防性口服益生菌制劑（培菲康，0.5g，bid，含活菌量約為1.0×10^7cfu/g，連續(xù)服用28天），對照組不添加益生菌喂養(yǎng)，實驗時長為28天。記錄兩組病例圍產(chǎn)期相關(guān)情況及出生一般情況，記錄實驗期間的喂養(yǎng)情況、體重增長、住院期間并發(fā)癥發(fā)生情況，于出生第1天及生后第28天抽取動脈血應用酶聯(lián)免疫吸附檢測法分別檢測血清中的細胞因子IL-10、TNF-及TGF-的變化，并進行統(tǒng)計分析。 結(jié)果 1.兩組病例在圍產(chǎn)期相關(guān)因素及出生史上存在的差異無統(tǒng)計學意義(p0.05)。 2.益生菌組病例出現(xiàn)肺炎比例明顯低于對照組(6.7%vs26.7%)，差異有統(tǒng)計學意義(p=0.038)，益生菌組病例敗血癥發(fā)病比例及使用廣譜抗生素的比例低于對照組，但差異無統(tǒng)計學意義(p0.05)。 3.益生菌組病例在實驗期間出現(xiàn)喂養(yǎng)不耐受比例低于對照組(10.0%vs33.3%)，差異有統(tǒng)計學意義(p=0.028)；益生菌組病例在生后第28天時達到全腸內(nèi)喂養(yǎng)比例明顯多于對照組(93.3%vs73.3%)，差異有統(tǒng)計學意義(p=0.038)。 4.兩組病例在出生平均體重上的差異無統(tǒng)計學意義(p=0.421)；在生后第21天時，益生菌組病例體重平均增長較對照組高，但差異無統(tǒng)計學意義(p=0.118)；在生后第28天時，益生菌組病例體重增長水平明顯高于對照組，差異有統(tǒng)計學意義(p=0.043)。 5.益生菌組與對照病例在出生時測得IL-10水平分別為(27.59±2.29)(pg/ml)及(27.93±2.70)(pg/ml)， TGF-水平分別為(12.61±1.46)(ng/ml)及(12.08±1.51)(ng/ml)，TNF-水平分別為(54.45±3.81)(pg/ml)及(53.55±3.19)(pg/ml)，三者差異無統(tǒng)計學意義(IL-10為p=0.707、TNF-為p=0.487、TGF-為p=0.333)；在生后第28天時，益生菌組病例IL-10水平為(38.39±2.74)(pg/ml)，對照組則為(36.92±1.50)(pg/ml)，益生菌組病例測得TGF-的平均水平為(19.85±2.68)(ng/ml)，對照組則為(17.23±3.02)(ng/ml)，IL-10及TGF-的平均水平均為益生菌組明顯高于對照組，且差異有統(tǒng)計學意義(p=0.043及p=0.006)；而益生菌TNF-的水平為(85.63±9.41)(pg/ml)，顯著低于對照組(96.60±10.09)(pg/ml)，且差異有統(tǒng)計學意義(p=0.001)。 結(jié)論 1.預防性口服益生菌可明顯上調(diào)循環(huán)中IL-10、TGF-的水平，下調(diào)TNF-水平，從而保持早產(chǎn)兒系統(tǒng)水平促炎性和抗炎性細胞因子間的平衡。 2.口服益生菌并無增加敗血癥、肺炎、壞死性小腸結(jié)腸炎感染的比例。 3.預防性口服益生菌可改善早產(chǎn)極低出生體重兒喂養(yǎng)耐受性，縮短達到全腸內(nèi)喂養(yǎng)的時間，加快體重增長的進度。
[Abstract]:Objective to investigate the regulation of probiotic probiotics on systemic proinflammatory cytokines and anti-inflammatory cytokines at the beginning of preterm very low birth weight infant feeding and its clinical significance. Methods from January 1 to October 31, 2011, premature infants with very low birth weight were randomly divided into two groups: probiotics group and control group. Probiotics group was given prophylactic oral probiotics (Peifeikang, 0.5gbid, containing about 1.0 脳 10 ^ 7cfu-g-1 / g for 28 days), while the control group did not add probiotic feeding for 28 days. The perinatal correlation and general situation of birth, feeding status, weight gain and complications during hospitalization were recorded in the two groups. The changes of serum cytokines IL-10,TNF- and TGF- were detected by enzyme-linked immunosorbent assay (Elisa) on the first day of birth and 28 days after birth. Result 1. There was no significant difference in perinatal factors and birth history between the two groups (p 0.05). 2. The incidence of pneumonia in probiotics group was significantly lower than that in control group (6.7 vs 26.7%), and the difference was statistically significant (p0.038). The incidence rate of septicemia and the proportion of using broad-spectrum antibiotics in probiotics group were lower than those in control group. But the difference was not statistically significant (p 0.05). 3. The rate of feeding intolerance in probiotics group was significantly lower than that in control group (10.0 vs 33.3%), and the difference was statistically significant (p0.028). The proportion of total enteral feeding in probiotics group was significantly higher than that in control group on the 28th day after birth (93. 3% vs 73. 3%), and the difference was statistically significant (p0. 038). 4. There was no significant difference in average birth weight between the two groups (p0. 421), but the average weight increase in probiotics group was higher than that in the control group on the 21st day after birth (p0. 118). On the 28th day after birth, the weight gain level of probiotics group was significantly higher than that of control group (p0.043). 5. The levels of IL-10 in probiotics group and control group were (27.59 鹵2.29) (pg/ml) and (27.93 鹵2.70) (pg/ml) at birth, respectively. TGF- levels were (12.61 鹵1.46) (ng/ml) and (12.08 鹵1.51) (ng/ml), TNF- levels were (54.45 鹵3.81) (pg/ml) and (53.55 鹵3.19) (pg/ml), respectively. There was no significant difference among the three groups (IL-10 was 0.707 TNF- was 0.487TGF- was p0.333); On the 28th day after birth, the levels of IL-10 in probiotics group were (38.39 鹵2.74) (pg/ml) and (36.92 鹵1.50) (pg/ml) in control group. The average level of TGF- was (19.85 鹵2.68) (ng/ml) in probiotics group and (17.23 鹵3.02) (ng/ml) in control group. The average level of IL-10 and TGF- in probiotics group was significantly higher than that in control group. The difference was statistically significant (p0. 043 and p0. 006). The level of probiotic TNF- was (85.63 鹵9.41) (pg/ml), which was significantly lower than that of the control (96.60 鹵10.09) (pg/ml), and the difference was statistically significant. Conclusion 1. Prophylactic oral probiotics can significantly up-regulate the level of IL-10,TGF- in circulation and down-regulate the level of TNF- so as to maintain the balance between systemic prophylaxis and anti-inflammatory cytokines in premature infants. 2. Oral probiotics did not increase the rates of septicemia, pneumonia, and necrotizing enterocolitis. 3. Prophylactic oral probiotics can improve the tolerance of premature very low birth weight infants, shorten the time to complete enteral feeding, and accelerate the progress of weight gain.
【學位授予單位】：廣州醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R722.6

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