益生菌对牛奶蛋白过敏婴幼儿肠道菌群的影响

Effect of probiotics on gut microbiota in infants with cow's milk protein allergy

目的探讨益生菌对牛奶蛋白过敏(CMPA)婴幼儿肠道菌群丰度的影响及其干预效果。方法选取2022年3月至2023年10月在郑州市妇幼保健院就诊的CMPA患儿60例作为试验组,并选取同期于本院体检的健康婴幼儿30例作为对照组,以随机数字表法将试验组分为试验1组和试验2组,每组30例。试验1组采用回避膳食干预,试验2组在回避膳食干预的基础上联合益生菌干预。对比干预前试验组和对照组患儿的肠道菌群丰度,并比较干预前后试验1组和试验2组肠道菌群丰度、临床疗效、临床症状(全身症状、皮肤症状、消化道症状和呼吸道症状评分)及血液嗜酸性粒细胞数量(EOS)、免疫球蛋白E(IgE)和皮肤指数(SI)水平。结果与对照组比较,干预前试验组患儿肠道双歧杆菌和乳杆菌丰度显著降低,而大肠埃希菌和肠球菌丰度显著升高(t=5.671、12.201、13.097、25.584,均P<0.05)。试验2组患儿治疗的总有效率为80.00%,显著高于试验1组的53.33%(χ^(2)=4.800,P<0.05)。与干预前比较,干预后两试验组患儿肠道双歧杆菌、乳杆菌丰度均显著升高,而大肠埃希菌、肠球菌丰度和患儿全身症状、皮肤症状、消化道症状、呼吸道症状评分及EOS、IgE、SI水平均显著降低(试验1组:t=2.163、3.036、6.591、11.350、6.970、7.044、7.484、7.153、2.258、4.071、3.195,试验2组:t=4.790、5.454、9.187、14.206、8.841、8.820、8.753、8.690、4.141、7.554、5.537,均P<0.05),且试验2组中上述指标变化幅度大于试验1组(t=2.197、2.512、4.440、2.788、3.509、2.200、3.270、3.607、2.168、3.576、3.003,均P<0.05)。结论CMPA婴幼儿肠道菌群以双歧杆菌、乳杆菌丰度降低和大肠埃希菌、肠球菌丰度升高为主要特征,使用益生菌干预可有效改善患儿的肠道菌群,提高治疗效果。

Objective To explore the effect of probiotics on the gut microbiota in infants with cow's milk protein allergy(CMPA)and its intervention effect.Methods A total of 60 CMPA infants who visited our hospital from March 2022 to October 2023 were selected as the observation group,and 30 healthy infants and young children who underwent physical examination in our hospital during the same period were selected as the control group.The observation group was divided into Experiment 1 group and Experiment 2 group randomly,with 30 cases in each group.The Experiment 1 group was given avoidance dietary intervention,while Experiment 2 group was given combined probiotic intervention on the basis of avoidance dietary intervention.The abundance of gut microbiota before intervention was compared between the observation group and control group,and the abundance of gut microbiota,clinical efficacy,clinical symptoms(scores of systemic symptoms,skin symptoms,gastrointestinal symptoms and respiratory symptoms),the levels of eosinophil count(EOS),specific milk protein(IgE)and skin index(SI)before and after intervention were compared between the Experiment 1 group and Experiment 2 group.Results Compared with the control group,the abundances of Bifidobacterium and Lactobacillus in observation group significantly decreased before intervention,while those of Escherichia coli and Enterococcus significantly increased(t=5.671,12.201,13.097,25.584;all P<0.05).The total efficiency rate in Experiment 2 group was 80.00%,significantly higher than that in Experiment 1 group(53.33%)(χ^(2)=4.800,P<0.05).Compared with before intervention,the abundances of Bifidobacterium and Lactobacillus significantly increased,while those of Escherichia coli and Enterococcus,the scores of systemic symptoms,skin symptoms,digestive symptoms,respiratory symptoms,EOS,IgE and SI levels significantly decreased in the two groups after intervention(Experiment 1 group:t=2.163,3.036,6.591,11.350,6.970,7.044,7.484,7.153,2.258,4.071,3.195;Experiment 2 group:t=4.790,5.454,9.187,14.206,8.841,8.820,8.753,8.690,4.141,7.554,5.537;all P<0.05).The changes of the above indexes in Experiment 2 group were greater than those in Experiment 1 group(t=2.197,2.512,4.440,2.788,3.509,2.200,3.270,3.607,2.168,3.576,3.003;all P<0.05).Conclusion The intestinal flora of infants with CMPA is mainly characterized by a decrease in the abundances of Bifidobacterium and Lactobacillus and increase in those of Escherichia coli and Enterococcus.Use of probiotics can effectively improve the intestinal flora and the therapeutic effect.