生命早期肠道菌群的建立及其影响因素

肠道微生物结构和功能已成为目前生命科学和医学领域的研究热点。研究表明,新生儿的肠道菌群主要来源于母体和新生儿之间的菌群交换,孕期生活方式、生产方式、喂养方式以及抗生素的使用等因素均可影响婴儿肠道菌群的平衡。而婴幼儿早期肠道菌群紊乱与儿童肥胖、过敏性疾病及儿童自闭症等疾病的发生发展密切相关。如果母亲在孕期能提早进行肠道菌群的健康检测,及时干预调节,那么婴儿出生后就能建立平衡的肠道微生态,也能最大程度的减少婴幼儿罹患各种疾病的风险。     

人乳源外泌体对新生儿坏死性小肠结肠炎治疗潜力的研究进展

新生儿坏死性小肠结肠炎(neonatal necrotizing enterocolitis, NEC)是新生儿死亡的重要原因之一, 目前尚缺乏有效的治疗药物, 而母乳喂养是NEC安全有效的预防措施。人乳源外泌体是母乳中的膜性囊泡, 有抑制炎症反应、抗氧化应激、调节免疫应答、促进肠上皮增殖与迁移、维持肠道上皮紧密连接等功能, 在维持肠道屏障完整性和促进肠道上皮损伤修复方面发挥重要作用。     

16SrRNA荧光定量PCR技术检测轮状病毒肠炎患儿肠道菌群变化的临床意义

目的以轮状病毒(RV)肠炎患儿和健康婴幼儿为研究对象,探讨荧光定量PCR技术在检测肠道菌群变化的实用性和可行性。 方法应用荧光定量PCR技术测定细菌的16SrRNA，对RV肠炎患儿和健康婴幼儿粪便中双歧杆菌、乳酸杆菌和大肠杆菌进行定量检测和分析,并和其他专家用传统方法所获得的结果进行比较。 结果RV肠炎患儿的肠道菌群与健康儿童比较发现肠道中双歧杆菌和乳酸杆菌的数量变化差异有显著性(P<0.05)，而大肠杆菌的数量差异无显著性(P>0.05)。其结果与其他文献报道的用细菌培养的方法所得结果一致。 结论RV肠炎患儿肠道中益生菌的数量较正常对照组明显减少。荧光定量PCR技术比传统方法特异性高、敏感性强，更省时和省力，临床上可用此方法对患儿肠道细菌变化进行定量分析。     

消化系统疾病

益生元与婴儿肠道健康，婴幼儿进食行为异常的临床评估和干预，醒脾养儿冲剂治疗小儿厌食症54例，功能性消化不良及厌食患儿的胃电节律变化，健儿消食口服液加赖氨酸维生素B12合剂治疗小儿厌食症疗效观察     

在人乳中的甲状旁腺素的可能生理学意义

最近作者报导了在人乳中存在甲状旁腺素(PTH)的免疫反应。从发现的PTH的浓度看来,可能对乳汁有生理功能。不是作用于乳腺就是作用于新生儿肠道对钙(Ca)、无机磷(Pi)和镁(Mg)的吸收。本研究是调查PTH在人乳中和钙、镁及无机磷、碱性磷酸酶(AP)、降钙素(CT)之间的关系。从离心后去掉脂肪的初乳中直接测定PTH、Ca、Mg、AP和CT。PTH(羧基端)和CT用放射免疫方法测定;Ca、Mg、Pi和AP是用标准的临床化学方法测定的。用聚丙稀酰胺胶板(pH3.5～9.5)CooMassie蓝染色,作PTH分析的等焦距。     

阴道微生物与子宫颈HPV感染及子宫颈病变的关系

子宫颈癌是威胁全球女性健康的第四大癌症,年轻女性的子宫颈癌发病率及死亡率呈上升趋势,人乳头瘤病毒(HPV)特别是高危型HPV(HR-HPV)持续感染是导致子宫颈癌前病变及子宫颈癌的主要原因。阴道微生物在女性生殖道健康中发挥重要作用,研究表明阴道微生物失调如乳杆菌数量减少、厌氧菌数量上升、微生物多样性增加等与女性子宫颈HPV感染、子宫颈癌前病变及子宫颈癌之间存在相关性,本文综述了常见阴道微生物与子宫颈HPV感染及子宫颈病变之间的关系并总结其相关机制,为防治子宫颈疾病提供新的切入点。     

低出生体重儿应用人乳蛋白制剂的临床与实验研究

目的 评价添加以人乳为原料的母乳强化剂(HMF)对低出生体重儿的影响.方法 新生儿重症监护病房的87例低出生体重儿随机分为2个实验组及对照组:人乳+HMF9307组(添加蛋白6 g/L)及人乳组;配方奶+HMF9308组(添加SIgA 500 mg/L)及配方奶组.结果 人乳+HMF9307组平均每日体重增长13.8 g,人乳组增长9.4 g(P＜0.01),前者粪氮排泄亦明显增多.粪SIgA排泄量人乳+HMF 9307组(1.37 mg/g)及配方奶+9308组(1.38 mg/g)较两组对照组(0.62 mg/g及0.68 mg/g)明显增多(P＜0.05).结论 单纯人乳喂养的低出生体重儿体重增长较缓慢,添加人乳蛋白制剂可促进其生长,增加免疫保护.     

宫颈病变患者治疗前后阴道微生态变化与HPV感染的关系研究进展

宫颈上皮内瘤变(cervical intraepithelial neoplasia,CIN)与宫颈癌(cervical cancer)是威胁女性健康的疾病之一,人乳头瘤病毒(human papilloma virus,HPV)感染是其发生发展的主要因素。阴道菌群、酸碱度及清洁度等因素的改变在宫颈病变的进展过程中发挥至关重要的作用,尤其影响HPV感染、转归及清除。本文将对宫颈病变患者治疗前后阴道微生态变化与HPV感染间的关系进行阐述。     

超重及肥胖孕妇肠道菌群与子代健康的研究进展

<正>妊娠期超重或肥胖会导致早产、妊娠期糖尿病和子痫前期等妊娠期并发症及合并症发生风险增加，并与子代代谢性疾病、过敏性疾病、神经系统疾病发病相关。因此，如何改善肥胖孕妇的不良母儿结局，是临床上的一个重点问题。近年来随着微生物研究的不断深入，肠道微生物被发现与人体的健康息息相关，妊娠期超重或肥胖女性肠道菌群失调对于孕妇、胎儿甚至新生儿远期生长发育都有着重要影响。本文对超重或肥胖孕妇肠道微生物改变及与子代健康的相关性展开讨论，     

子痫前期与肠道菌群

肠道菌群是一个定植于人体肠道内的复杂且庞大的微生物群,可产生多种代谢产物,显著影响宿主生理、能量稳态、炎症过程和机体免疫功能,对维持机体健康发挥重大作用。近年肠道菌群的结构和生理功能、妊娠期肠道菌群变化、肠道菌群与妊娠期疾病的相关性已成为研究的热点。虽然子痫前期的病因和发病机制仍不明确,但大部分研究认为其可能与血管因素、免疫平衡失调、全身炎症反应因素有关。肠道菌群可能通过在血管因素、免疫反应、炎症反应等方面发挥作用,参与子痫前期的发生、发展。调整饮食结构及补充微生态调节剂能够调节肠道菌群紊乱,从而达到预防或改善子痫前期的作用,这为探索子痫前期的防治提供了新靶点和新思路。     

Shaping infant development from the inside out: Bioactive factors in human milk

Human breast milk is the optimal nutrition for all infants and is comprised of many bioactive and immunomodulatory components. The components in human milk, such as probiotics, human milk oligosaccharides (HMOs), extracellular vesicles, peptides, immunoglobulins, growth factors, cytokines, and vitamins, play a critical role in guiding neonatal development beyond somatic growth. In this review, we will describe the bioactive factors in human milk and discuss how these factors shape neonatal immunity, the intestinal microbiome, intestinal development, and more from the inside out.     

Nutritional and biochemical properties of human milk, Part I: General aspects, proteins, and carbohydrates.

Human milk provided by healthy and well-nourished mothers is believed to cover the infant's nutrient requirements during the first half year of life. It is composed of a mixture of nutritive components as well as other bioactive factors with relevant physiologic effects in the neonate infant. Human milk composition has a dynamic nature and varies with time postpartum, during a nursing, and with the mother's diet and certain diseases. The changes of human milk composition with time of lactation seem to match the changing needs of the growing infant over time. Human milk proteins are a source of peptides, amino acids, and nitrogen for the infant, but also in the protein fraction reside other properties of human milk that may benefit the breastfeeding infant. Specific whey proteins are involved in the development of the immune response (immunoglobulins), whereas others participate in the nonimmunologic defense (lactoferrin). In addition, human milk contains a complex mixture of oligosaccharides that are present only in minute amounts in other mammal's milk. They may act as inhibitors of bacterial adhesion to epithelial surfaces, and thus play an important role in preventing infectious diseases in the newborn infant. Oligosaccharides may also promote the development of a so-called bifidus flora. In the next years, future research will lead to improved characterization of human milk components and elucidation of their individual mechanisms of action, which will increase our knowledge about the properties of human milk and the benefits of breastfeeding for the infant.     

Human milk microbes: Strategies to improve delivery to the infant

Mother's own milk provides personalized nutrition and immune protection to the developing infant. The presence of healthy microbes plays an important role in the infant's gut by programming the microbiota and excluding potential pathogens. This review describes the important components in mother's own milk that contribute to its superiority for infant nutrition and suggest potential strategies to replicate these factors in alternative feedings when sufficient milk is unavailable. Current strategies to supplement, substitute and replicate mother's own milk including microbial restoration, use of unpasteurized donor human milk, probiotics and fortification are discussed. Critical work remains to be done in understanding the human milk microbiome and metabolome and in improving lactation support for mothers of preterm infants. Increasing delivery of mother's own milk and milk components to infants would likely positively impact infant mortality and health worldwide.     

Immunologic components in human milk and allergic diseases with focus on food allergy

Human milk contains a wide range of immunomodulatory factors, including immunoglobulins, human milk oligosaccharides, cytokines, microbiome, innate factors and food antigens. Maternal diet can influence the content of human milk as it is well-established that dietary antigens can be secreted in human milk after maternal consumption, but whether these dietary antigens promote tolerance or sensitization in the infant is a subject of debate. This review summarizes the current literature on these immunologically active factors in human milk, including the microbiome, innate factors, and maternal diet-derived dietary antigens in the context of development of allergic diseases, with the focus on food allergy.     

Human milk pumping rates of mothers of singletons and mothers of multiples.

Rates of breastfeeding are increasing, but the methods by which human milk is fed to infants is not well described. Using a retrospective survey design, the authors collected information about infant feeding from mothers of term, preterm, singleton, and multiple-gestation infants (n=346). Human milk feeding methods were characterized as solely at the breast, pumped only, or a combination. Sixty-eight percent of mothers in the study fed their infants at least some human milk; 77% of these mothers reported pumping milk. There was no difference in the percentage of pumping based on multiple gestation or length of pregnancy. Feeding human milk solely at the breast at early postpartum time points was associated with longer durations of human milk feeding overall. More research is needed to better understand why mothers choose pumping over direct human milk feedings and to evaluate the health outcomes associated with this practice.     

Breastfeeding the low birth weight preterm infant

The recent increase in the use of human milk in feeding low birth weight (LBW) preterm infants has stimulated new research questions in infant nutrition, especially in regards to the nutritional adequacy and nutrient composition of milk from mothers of mature and preterm infants. The current state of knowledge on the effect of feeding human milk with or without nutritional supplements on growth of the low birth weight infant is summarized. Recommendations and guidelines for feeding human milk and/or supplementing human milk in LBW infants are discussed and appropriate handling of human milk and feeding schedules are outlined.     

Factors influencing the microbial composition of human milk

Aside from nutritional components, human milk is rich in microorganisms. Through breastfeeding these microorganisms are introduced to the infant gut where they may transiently or persistently colonize it. Therefore, the human milk microbiota may be an important factor which shapes the infant gut microbiota further influencing infant health and disease. In the current review we aim to give a brief updated insight into the putative origin of the human milk microbiota, its constituents and the possible factors that shape it. Understanding the factors that determine the human milk microbiota composition and function will aid developing optimal postnatal feeding and intervention strategies to reduce the risk of communicable and noncommunicable diseases.     

HIV and infant feeding: issues in developed and developing countries

Women in developed countries who are human immunodeficiency virus (HIV)-positive generally feed their infants formula to avoid virus transmission via breastfeeding. However, for most of the world's women who are HIV positive, the choice of infant feeding method is not so clear. Poor socioeconomic and living conditions place infants on breast milk substitutes at higher risk of non-HIV infectious diseases as compared with breastfed infants. Mothers in these settings who are HIV positive must weigh the risks and benefits of breastfeeding to choose the best infant feeding option.     

Key nutrients and growth factors for the neonatal gastrointestinal tract

The nutritional support of gastrointestinal growth and function is an important consideration in the clinical care of neonatal infants. In most health infants, the provision of either breast milk or formula seems to support normal intestinal mucosal growth, but the most significant advantages of breast milk may be for host defense or gut barrier-related functions that are involved in reducing infection. The specific effects of various milk-borne growth factors on key mucosal immune and barrier functions are likely to provide valuable new clues to the advantages of human milk. A substantial number of preterm, low-birth weight babies or those suffering from compromised intestinal function, however, often cannot tolerate oral feedings and instead receive TPN. The consequences of TPN on gastrointestinal function and how this contributes to morbidity of these infants warrants further study, with respect to both clinical and basic research questions. Although enteral nutrition seems to be a critical stimulus for intestinal function, the minimal amounts and composition of nutrients necessary to maintain specific intestinal functions remain to be established. The experimental tools exist to start defining the specific nutrient requirements for the infant gut and some of these nutrients are known (e.g., glutamate, glutamine, and threonine). Peptide growth factors and gut hormones clearly play a role in gut growth and in several ways mediate the trophic actions of enteral nutrition. Although a number of these growth factors are good candidates for therapeutic use, their clinical application in the management of gastrointestinal insufficiency and disease has been slow. The emergence of GLP-2 as a trophic peptide that seems to target the gut is a promising candidate on the horizon.