摘要
目的分析早产儿生后早期联合应用多种抗菌药物对肠道梭菌、拟杆菌、乳酸杆菌和双歧杆菌含量的影响。方法选取2017年1月至2018年12月在永康市妇幼保健院就诊的120例早产儿,根据是否7天内应用抗菌药将其分为用药组(87例)和未用药组(33例),对两组早产儿均分别于生后2周和4周时各采集1次粪便样本,通过高通量测序方法检测患儿粪便菌群含量,并进行统计分析。结果用药组与未用药组早产儿生后2周、4周时肠道菌群ACE丰度指数和shannon多样性指数比较差异均无统计学意义(均P>0.05)。在门水平上,用药组早产儿生后2周时的拟杆菌、放线菌和厚壁菌含量均较未用药组升高(Z值分别为2.56、3.01、7.67,均P<0.05),变形杆菌含量较未用药组明显下降(Z=6.47,P<0.05);用药组早产儿生后4周时的拟杆菌、放线菌和厚壁菌含量均较未用药组升高(Z值分别为2.67、2.84、2.01,均P<0.05),变形杆菌含量较未用药组明显下降(Z=4.16,P<0.05)。在属水平上,用药组早产儿生后2周时的乳酸杆菌、肠球菌和链球菌含量均较高,梭菌、埃希菌、拟杆菌、双歧杆菌、克雷伯菌含量均较低;其中,用药组梭菌、克雷伯菌、埃希菌含量均较未用药组明显下降(Z值分别为2.18、4.65、23.05,均P<0.05),用药组早产儿生后4周时的梭菌和克雷伯菌含量均较未用药组明显下降(Z值分别为2.08、5.17,均P<0.05)。联合用药组早产儿生后2周、4周时的肠道菌群ACE丰度指数和shannon多样性指数与单用青霉素组比较差异均无统计学意义(均P>0.05)。在门水平上,联合用药组与单用青霉素组早产儿生后2周时的拟杆菌、放线菌、厚壁菌和变形杆菌含量比较差异均无统计学意义(均P>0.05);联合用药组与单用青霉素组早产儿生后4周时的拟杆菌、放线菌、厚壁菌和变形杆菌含量比较差异均无统计学意义(均P>0.05)。在属水平上,联合用药组与单用青霉素组早产儿生后2周时的乳酸杆菌、双歧杆菌、肠球菌和链球菌含量比较差异均无统计学意义(均P>0.05);联合用药组与单用青霉素组早产儿生后4周时的乳酸杆菌、梭菌和克雷伯菌含量比较差异均无统计学意义(均P>0.05),但联合用药组的双歧杆菌含量较单用青霉素组明显下降(Z=2.57,P<0.05)。结论早产儿生后早期联合应用多种抗菌药物者对肠道菌群的影响较单用青霉素者更加明显,抗菌药物的应用可导致早产儿肠道梭菌、拟杆菌、乳酸杆菌和双歧杆菌等含量减少。
Objective To analyze effect of early combined use of various antibiotics on contents of Clostridium intestinalis,Bacteroides,Lactobacillus and Bifidobacterium in intestinal tract of preterm infants.Methods 120 preterm infants who visited in Yongkang Municipal Maternity and Child Health Hospital from January 2017 to December 2018 were selected and divided into medication group(87 cases) and non-medication group(33 cases) according to whether they were given antibiotics within 7 days after birth.The stool sample of the preterm infants at 2 weeks and 4 weeks after birth in the two groups was collected respectively.The fecal flora content was analyzed in high-throughput sequencing method.The data were analyzed statistically.Results There were no significant differences in ACE abundance index and Shannon diversity index of intestinal flora between the two groups at 2 and 4 weeks after birth(all P>0.05).At phylum level,the contents of bacteroides,actinomycetes and Chlamydia at 2 weeks after birth of the preterm infants in the medication group were higher than those of the preterm infants in the non-medication group(Z=2.56,3.01 and 7.67 respectively,all P<0.05) while the content of Proteus was significantly lower than that in the non-medication group(Z=6.47,P<0.05).At 4 weeks after birth,the contents of bacteroides,actinomycetes and Chlamydia of the preterm infants in the medication group were higher than those of the preterm infants in the non-medication group(Z=2.67,2.84 and 2.01 respectively,all P<0.05) while the content of Proteus was significantly lower than that in the non-medication group(Z=4.16,P<0.05).At genus level,at 2 weeks after birth,the contents of lactobacillus,Enterococcus and Streptococcus of the preterm infants in the medication group were higher than those of the preterm infants in the non-medication group,while the contents of clostridium,Escherichia coli,bacteroides,bifidobacteria and Klebsiella were lower than those of the preterm infants in the non-medication group,of which,the contents of Clostridium,Klebsiella and Escherichia coli of the preterm infants in the medication group were significantly lower than those of the preterm infants in the non-medication group(Z=2.18,4.65 and 23.05 respectively,all P<0.05);the contents of Clostridium and Klebsiella in the medication group was significantly lower than that in the non-medication group at 4 weeks after birth(Z=2.08 and 5.17 respectively,both P<0.05).There were no significant differences in ACE abundance index and intestinal flora Shannon diversity index between the combined antibiotics group and the penicillin alone group at 2 and 4 weeks after birth(all P>0.05).At the phylum level,there were no significant differences in the contents of bacteroides,actinomycetes,chlamydia and Proteus between the combined antibiotics group and the penicillin alone group at 2 weeks after birth(all P>0.05) and so did in the contents of bacteroides,actinomycetes,chlamydia and Proteus between the combined antibiotics group and the penicillin alone group at 4 weeks after birth(all P>0.05).At the genus level,there were no significant differences in the contents of lactobacillus,bifidobacteria,Enterococcus and Streptococcus between the combined antibiotics group and the penicillin alone group at 2 weeks after birth(Z=0.22,0.29,0.09 and 1.20 respectively,all P>0.05),and also there were no significant difference in the contents of lactobacillus,Clostridium and Klebsiella between the combined antibiotics group and the penicillin group at 4 weeks after birth(all P>0.05),while the content of Bifidobacterium was significantly lower than that of the penicillin alone group(Z=2.57,P<0.05).Conclusion The effect of combined use of multiple antimicrobial agents on intestinal flora of preterm infants in early stage after birth is more obvious than penicillin alone.The use of antimicrobial agents can reduce the contents of Clostridium,Bacteroides,Lactobacillus and Bifidobacterium in the intestinal tract of the preterm infants.
作者
钱颖颖
陈卫园
许莉
QIAN Yingying;CHEN Weiyuan;XU Li(Department of Pharmacy,Yongkang Municipal Maternity and Child Health Hospital,Zhejiang Yongkang 321300,China;Department of Neonatology,Yongkang Municipal Maternity and Child Health Hospital,Zhejiang Yongkang 321300,China)
出处
《中国妇幼健康研究》
2020年第5期620-625,共6页
Chinese Journal of Woman and Child Health Research
关键词
早产儿
抗菌药
粪便标本
肠道菌群
preterm infant
antibiotics
fecal specimen
intestinal flora
