基于析因设计探讨抗菌药物和年龄对婴幼儿肠道菌群的影响

Exploration of effects of antimicrobial drugs and age on intestinal flora of infants based on factorial design

目的 探讨年龄和不同抗菌药物治疗方案对婴幼儿肠道微生态的影响。方法 选取医院2019年1月至12月收治的72例需要抗菌药物治疗的婴幼儿和24例健康婴幼儿,按照年龄(1~6月、7~12月、13~24月)和抗菌药物使用(无抗菌药物、β内酰胺类、非β内酰胺类、β内酰胺类+非β内酰胺类)2个因素,采用3×4析因设计,每组8例。观察菌种分类及所占比例,按照菌群失调分度标准划分为Ⅰ、Ⅱ、Ⅲ3个等级;采用16S r RNA实时荧光定量PCR(q PCR)检测粪便中双歧杆菌和乳酸杆菌的相对含量。结果 抗菌药物治疗组Ⅰ、Ⅱ、Ⅲ度肠道菌群失调发生比例高,与对照组相比,差异有统计学意义(P <0.05)。与β内酰胺类相比,非β内酰胺类、β-内酰胺类+非β-内酰胺类组Ⅰ、Ⅱ、Ⅲ度肠道菌群失调发生比例高,差异有统计学意义(P <0.05)。抗菌药物治疗显著降低了婴幼儿肠道乳酸杆菌和双歧杆菌的数量,且联合抗菌药物组较单一抗菌药物组效果更显著。在双歧杆菌的年龄与抗菌药物的交互作用统计分析结果中,提示年龄、抗菌药物之间的交互作用存在统计学意义(P <0.05)。结论 抗菌药物导致婴幼儿肠道菌群失调,联合抗菌药物方案的影响高于单一抗菌药物方案,年龄因素参与抗菌药物对部分菌群的调控。

AIM To investigate the effects of age and different antimicrobial treatment schemes on intestinal microecology of infants.METHODS A total of 72 infants requiring antimicrobial treatment and 24 healthy infants admitted to the hospital from January to December 2019 were selected according to their age(1–6 months,7–12 months,13–24 months) and the use of antimicrobial drugs(no antimicrobial drugs,β-lactams,non-β-lactams,β-lactams + non-β-lactams) 2 factors.A 3 × 4 factorial design was used,with 8 patients in each group.The classification and proportion of strains were observed,and were divided into grades Ⅰ,Ⅱ and Ⅲ according to the division standard of flora imbalance.The relative contents of bifidobacterium and lactobacillus in feces were detected by 16S rRNA real-time fluorescence quantitative PCR(qPCR).RESULTS The incidence of Ⅰ,Ⅱ and Ⅲ intestinal flora in the antimicrobial imbalance treatment group was higher,and the difference was significant compared with the control group(P < 0.05).Compared with β-lactams group,the proportion of non-β-lactams,β-lactams + non-β-lactams had higher incidence of degreeⅠ,Ⅱ,Ⅲintestinal flora disorders,and the difference was statistically significant(P < 0.05).Antimicrobial treatment significantly reduced the number of intestinal lactobacillus and bifidobacteria in infants,and the combined antimicrobial treatment group was more effective than the single antimicrobial treatment group.The statistical analysis of the interaction between the age of bifidobacterium and antimicrobial drugs suggested that there was statistical significance in the interaction between age and antimicrobial drugs(P < 0.05).CONCLUSION Antimicrobial drugs lead to imbalance of intestinal flora in infants.The effect of combined antimicrobial treatment regimens is higher than that of single antimicrobial treatment regimens,and age factor is involved in the regulation of some bacteria by antibacterial drugs.