湿疹婴儿的肠道菌群变化，及益生元对肠道菌群的影响

Intestinal microbiota in infants at high risk for allergy: Effects of prebiotics and role in eczema development

DOI: https://doi.org/10.1016/j.jaci.2017.05.054

Journal of Allergy and Clinical Immunology上发表的一项随机双盲安慰剂对照试验结果，发现喂食基于部分水解乳清蛋白的配方奶粉+益生元（短链/长链低聚果糖）的婴儿，肠道菌群组成与母乳喂养的婴儿更加相似，并鉴定出了与湿疹相关的婴儿肠道菌群变化。

论文摘要

Gut microbial development in the first years of life occurs concomitantly to the development of our cognitive, metabolic, and immune systems and forms an interactive signaling network.1 The gradual diversification toward a relatively stable adult-like composition is a dynamic process influenced by several environmental factors, such as birth mode, gestational age at birth, and early-life nutrition. Alterations in the early colonization process, such as through antibiotic use or cesarean section delivery, have been associated with development of allergic manifestations later in life, but the exact microbiome dysfunction underlying this disease remains unclear.2

Eczema is typically the first allergic manifestation to appear, and its incidence is still increasing in many countries around the world. Considering the concurrent maturation of the immune system, the succession of species into a stable adult-type community, a process naturally guided by human milk, might be critically important. Breast-feeding is thought to protect against the development of allergy through the presence of allergens and immune mediators in human milk that are absent from artificial milk,3 as well as through the presence of human milk oligosaccharides stimulating a gut microbiota that might favor tolerance induction.4

Therefore several studies have been performed with different types of infant formulas enriched with nondigestible oligosaccharides, which are known as prebiotics. Prebiotics typically reach the colon intact and selectively stimulate the growth and activity of specific beneficial members of the microbiota.5, 6 Interestingly, significant reductions in eczema risk were observed in intervention trials with infant formulas supplemented with specific prebiotics.7, 8, 9

The present study arises from a parent registered study (PATCH trial) investigating the effects of a partially hydrolyzed formula containing specific oligosaccharides (pHF-OS) on the prevention of eczema in infants at increased risk of allergy. pHF-OS was shown to induce hypoantigenic and immunomodulatory effects, including increased regulatory T-cell numbers, but did not reduce eczema incidence by 12 or 18 months when compared with that in infants receiving standard cow's milk formula.10

实验综述

① 纳入138名过敏高风险婴儿，分为3组：母乳喂养、标准牛奶配方奶粉、pHF+OS组：基于部分水解乳清蛋白的配方奶粉+益生元（短链/长链低聚果糖）；

② 相比于喂食标准牛奶配方奶粉的婴儿，pHF+OS组婴儿的粪便菌群组成、代谢产物、pH值均与母乳喂养的婴儿更加相似；

③ 健康婴儿出生第4周至26周期间，肠道菌群中副拟杆菌属及2个肠杆菌属相对丰度逐渐下降，真杆菌属等可利用乳酸产生丁酸的细菌逐渐增多；

④ 1岁半前发展出湿疹的婴儿中该规律被打破。