布拉氏酵母菌联合光疗治疗新生儿高胆红素血症的疗效:前瞻性随机对照研究

Effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates:a prospective randomized controlled trial

目的探讨布拉氏酵母菌联合光疗治疗新生儿高胆红素血症的疗效。方法将2018年1~12月入院治疗的高胆红素血症新生儿随机分为观察组(n=61)和对照组(n=63)。观察组给予光疗+布拉氏酵母菌散,对照组给予光疗+安慰剂,比较两组的治疗效果。治疗72 h后收集患儿粪便样本,通过16s rRNA高通量测序方法分析比较两组新生儿肠道菌群特征。结果观察组和对照组治疗前总胆红素水平差异无统计学意义(P>0.05)。观察组治疗24、48、72 h后的总胆红素水平均显著低于对照组(P<0.05)。观察组需要再次给予光疗的新生儿比例(12例,20%)显著低于对照组(47例,75%)(P<0.05)。治疗72 h后观察组肠道内拟杆菌属丰度较对照组高(P<0.05),大肠埃希菌属和葡萄球菌属丰度较对照组低(P<0.05)。结论光疗联合布拉氏酵母菌治疗对于降低高胆红素血症新生儿胆红素水平及预防黄疸退而复现有较好的疗效。布拉氏酵母菌可能通过调节患儿肠道菌群改善治疗疗效。[中国当代儿科杂志,2020,22(11):1149-1153]

Objective To study the effectiveness of Saccharomyces boulardii combined with phototherapy in the treatment of hyperbilirubinemia in neonates.Methods The neonates with hyperbilirubinemia who were hospitalized from January to December 2018 were enrolled and randomly divided into an observation group(n=61)and a control group(n=63).The neonates in the observation group were treated with phototherapy combined with Saccharomyces boulardii,and those in the control group were treated with phototherapy combined with placebo.Treatment outcomes were compared between the two groups.Fecal samples were collected 72 hours after treatment and 16s rRNA high-throughput sequencing was used to compare the features of gut microbiota between the two groups.Results There was no significant difference in the total serum bilirubin level between the two groups before treatment(P>0.05).At 24,48,and 72 hours after treatment,the observation group had a significantly lower level of total serum bilirubin than the control group(P<0.05).Compared with the control group,the observation group had a significantly lower proportion of neonates requiring phototherapy again[20%(12/61)vs 75%(47/63),P<0.05].Compared with the control group,the observation group had a significantly higher abundance of Bacteroides(P<0.05)and a significantly lower abundance of Escherichia coli and Staphylococcus in the intestine at 72 hours after treatment(P<0.05).Conclusions In neonates with hyperbilirubinemia,phototherapy combined with Saccharomyces boulardii can effectively reduce bilirubin level and prevent the recurrence of jaundice.Saccharomyces boulardii can favour the treatment outcome by regulating the gut microbiota of neonates.[Chin J Contemp Pediatr,2020,22(11):1149-1153]