目的:比较窒息新生儿与非窒息新生儿粪便肠道菌群对不同碳水化合物产气的差异,探讨其临床意义。方法:选取窒息新生儿20例,同时选取20例非窒息新生儿作为对照,收集入组患儿出生后第1、第7天粪便样本,用以乳糖(LAT)、低聚果糖(FOS)、母乳低聚糖(FL-2)和低聚半乳糖(GOS)为主要碳源的培养基进行体外发酵,采用肠道体外气体分析仪测定发酵后产气总量及主要成分二氧化碳(CO₂)、氢气(H₂)、甲烷(CH₄)、硫化氢(H₂S)的含量,比较各组差异。结果:窒息组患儿生后第1、第7天粪便菌群发酵GOS产气总量均显著高于对照组,粪便发酵 FOS、GOS、LAT后产CO₂量均显著高于对照组(P＜0.05),生后第 1 天粪便发酵4种底物后产CH₄量均显著高于对照组(P＜0.05)。结论:窒息新生儿肠道产气量显著高于对照组婴儿,其中CO₂含量明显高于对照组。受不同碳源影响,增加母乳低聚糖喂养或许能减少气体产生。肠道CH₄产生量明显高于对照组,提示早期CH₄菌定植可能,参与新生儿早期胃肠功能紊乱的发生发展。

[1] 王俊怡,虞人杰,刘淑芳,等.新生儿窒息多器官损害发生率、高危因素和转归的多中心研究[J].中华围产医学杂志,2016,19(1):23-28.
[2] LAWN J E,COUSENS S,ZUPAN J.4 million neonatal deaths:when? where?why?[J].Lancet,2005,365(9462):891-900.
[3] FUNKHOUSER L J,BORDENSTEIN S R.Mom knows best:the universality of maternal microbial transmission[J].PLoS Biol,2013,11(8):e1001631.
[4] AAGAARD K,MA J,ANTONY K M,et al.The placenta harbors a unique microbiome[J].Sci Transl Med,2014,6(237):237ra65.
[5] BORRE Y E,O'KEEFFE G W,CLARKE G,et al.Microbiota and neurodevelopmental windows:implications for brain disorders[J].Trends Mol Med,2014,20(9):509-518.
[6] 阎贝贝,李晓莺.新生儿肠道菌群及其相关疾病研究进展[J].中国实用儿科杂志,2018,33(7):556-560.
[7] PIMENTEL M,MATHUR R,CHANG C.Gas and the microbiome[J].Curr Gastroenterol Rep,2013,15(12):356.
[8] SOMMER F,BÄCKHED F.The gut microbiota—masters of host development and physiology[J].Nat Rev Microbiol,2013,11(4):227-238.
[9] 中华医学会围产医学分会新生儿复苏学组.新生儿窒息诊断的专家共识[J].中华围产医学杂志,2016,19(1):3-6.
[10] RICHARDS P J,FLAUJAC-LAFONTAINE G M,CONNERTON P L,et al.Galacto-oligosaccharides modulate the juvenile gut microbiome and innate immunity to improve broiler chicken performance[J].mSystems,2020,5(1):e00827.
[11] LI S,ZHU X,XING M.A new β-galactosidase from the antarctic bacterium alteromonas sp.ant48 and its potential in formation of prebiotic galacto-oligosaccharides[J].Mar Drugs,2019,17(11):599.
[12] BERTINO E,PEILA C,GIULIANI F,et al.Metabolism and biological functions of human milk oligosaccharides[J].J Biol Regul Homeost Agents,2012,26(3 Suppl):35-38.
[13] PELED Y G T,LIBERMAN E.The development of methane production in childhood and adolescence[J].J Pediatr Gastroenterol Nutr,1985,4:575-579.
[14] RUTILI A,CANZI E,BRUSA T,et al.Intestinal methanogenic bacteria in children of different ages[J].New Microbiol,1996,19(3):227-243.
[15] LEVITT M D,FURNE J K,KUSKOWSKI M,et al.Stability of human methanogenic flora over 35 years and a review of insights obtained from breath methane measurements[J].Clin Gastroenterol Hepatol,2006,4(2):123-129.
[16] ROCCARINA D,LAURITANO E C,GABRIELLI M,et al.The role of methane in intestinal diseases[J].Am J Gastroenterol,2010,105(6):1250- 1256.
[17] PIMENTEL M,LIN H C,ENAYATI P,et al.Methane,a gas produced by enteric bacteria,slows intestinal transit and augments small intestinal contractile activity[J].Am J Physiol Gastrointest Liver Physiol,2006,290(6):G1089-G1095.
[18] CHRISTL S U,GIBSON G R,CUMMINGS J H.Role of dietary sulphate in the regulation of methanogenesis in the human large intestine[J].Gut,1992,33(9):1234-1238.
[19] GIBSON G R,CUMMINGS J H,MACFARLANE G T.Competition for hydrogen between sulphate-reducing bacteria and methanogenic bacteria from the human large intestine[J].J Appl Bacteriol,1988,65(3):241-247.
[20] NEWMAN A.Breath-analysis tests in gastroenterology[J].Gut,1974,15(4):308-323.
[21] MACFARLANE G T,STEED H,MACFARLANE S.Bacterial metabolism and health-related effects of galacto-oligosaccharides and other prebiotics[J].J Appl Microbiol,2008,104(2):305-344.
[22] 闫兴军,卢根林,邓勇.硫化氢在肠缺血-再灌注损伤大鼠肠黏膜屏障功能障碍中的作用[J].中华实验外科杂志,2010(1):71-74.
[23] TEAGUE B,ASIEDU S,MOORE P K.The smooth muscle relaxant effect of hydrogen sulphide in vitro:evidence for a physiological role to control intestinal contractility[J].Br J Pharmacol,2002,137(2):139-145.
[24] WALLACE J L,VONG L,MCKNIGHT W,et al.Endogenous and exogenous hydrogen sulfide promotes resolution of colitis in rats[J].Gastroenterology,2009,137(2):569-578.