切换至 "中华医学电子期刊资源库"

中华妇幼临床医学杂志(电子版) ›› 2020, Vol. 16 ›› Issue (06) : 739 -744. doi: 10.3877/cma.j.issn.1673-5250.2020.06.018

所属专题: 文献

综述

新生儿坏死性小肠结肠炎发病机制的研究进展
马娜1, Mohd Jaish Siddiqui1, 夏斌1,()   
  1. 1. 四川大学华西第二医院儿科、出生缺陷与相关妇儿疾病教育部重点实验室,成都 610041
  • 收稿日期:2020-07-18 修回日期:2020-11-06 出版日期:2020-12-01
  • 通信作者: 夏斌

Research progresses of pathogenesis of neonatal necrotizing enterocolitis

Na Ma1, Mohd Jaish Siddiqui1, Bin Xia1,()   

  1. 1. Department of Pediatrics, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2020-07-18 Revised:2020-11-06 Published:2020-12-01
  • Corresponding author: Bin Xia
  • Supported by:
    National Natural Science Foundation of China(81370738)
引用本文:

马娜, Mohd Jaish Siddiqui, 夏斌. 新生儿坏死性小肠结肠炎发病机制的研究进展[J/OL]. 中华妇幼临床医学杂志(电子版), 2020, 16(06): 739-744.

Na Ma, Mohd Jaish Siddiqui, Bin Xia. Research progresses of pathogenesis of neonatal necrotizing enterocolitis[J/OL]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2020, 16(06): 739-744.

新生儿坏死性小肠结肠炎(NEC),是新生儿重症监护病房常见的危重胃肠道炎症性疾病,严重危及患儿生命。目前认为导致NEC的主要危险因素包括早产、肠道菌群失调、炎症反应、输注血液制品及喂养不当等,但是该病的具体发病机制迄今尚未明确。笔者拟就目前有关NEC发病机制的最新研究进行综述。

Neonatal necrotizing enterocolitis (NEC) is the frequent and lethal gastrointestinal inflammation disease in neonatal intensive care units, and seriously endangering the life of neonates. At present, the main risk factors of NEC consist of prematurity, microbiome dysbiosis, inflammatory reaction, blood products transfusion and improper feeding, etc., but the pathogenesis of NEC is not identify yet. This article reviews the latest research on the pathogenesis of NEC in recent years.

[1]
Fitzgibbons SC, Ching Y, Yu D, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories[J]. J Pediatr Surg, 2009, 44(6): 1072-1075; discussion 1075-1076. DOI: 10.1016/j.jpedsurg.2009.02.013.
[2]
Adams-Chapman I. Necrotizing enterocolitis and neurodevelopmental outcome[J]. Clin Perinatol, 2018, 45(3): 453-466. DOI: 10.1016/j.clp.2018.05.014.
[3]
Müller MJ, Paul T, Seeliger S. Necrotizing enterocolitis in premature infants and newborns[J]. J Neonatal Perinatal Med, 2016, 9(3): 233-242. DOI: 10.3233/NPM-16915130.
[4]
Battersby C, Santhalingam T, Costeloe K, et al. Incidence of neonatal necrotising enterocolitis in high-income countries: a systematic review[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(2): F182, F189. DOI: 10.1136/archdischild-2017-313880.
[5]
Battersby C, Longford N, Mandalia S, et al. Incidence and enteral feed antecedents of severe neonatal necrotising enterocolitis across neonatal networks in England, 2012-13: a whole-population surveillance study[J]. Lancet Gastroenterol Hepatol, 2017, 2(1): 43-51. DOI: 10.1016/S2468-1253(16)30117-0.
[6]
Niño DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms[J]. Nat Rev Gastroenterol Hepatol, 2016, 13(10): 590-600. DOI: 10.1038/nrgastro.2016.119.
[7]
Eaton S, Rees CM, Hall NJ. Current research on the epidemiology, pathogenesis, and management of necrotizing enterocolitis[J]. Neonatology, 2017, 111(4): 423-430. DOI: 10.1159/000458462.
[8]
Arthur CM, Nalbant D, Feldman HA, et al. Anemia induces gut inflammation and injury in an animal model of preterm infants[J]. Transfusion, 2019, 59(4): 1233-1245. DOI: 10.1111/trf.15254.
[9]
Been JV, Lievense S, Zimmermann LJ, et al. Chorioamnionitis as a risk factor for necrotizing enterocolitis: a systematic review and Meta-analysis[J]. J Pediatr, 2013, 162(2): 236-242.e2. DOI: 10.1016/j.jpeds.2012.07.012.
[10]
Lu Q, Cheng S, Zhou M, et al. Risk factors for necrotizing enterocolitis in neonates: a retrospective case-control study[J]. Pediatr Neonatol, 2017, 58(2): 165-170. DOI: 10.1016/j.pedneo.2016.04.002.
[11]
Downard CD, Grant SN, Maki AC, et al. Maternal cigarette smoking and the development of necrotizing enterocolitis[J]. Pediatrics, 2012, 130(1): 78-82. DOI: 10.1542/peds.2011-3808.
[12]
Alganabi M, Lee C, Bindi E, et al. Recent advances in understanding necrotizing enterocolitis[J]. F1000Res, 2019, 8: F1000 Faculty Rev-107. DOI: 10.12688/f1000research.17228.1.
[13]
Sampath V, Menden H, Helbling D, et al. SIGIRR genetic variants in premature infants with necrotizing enterocolitis[J]. Pediatrics, 2015, 135(6): e1530-e1534. DOI: 10.1542/peds.2014-3386.
[14]
Kimak KS, de Castro Antunes MM, Braga TD, et al. Influence of enteral nutrition on occurrences of necrotizing enterocolitis in very-low-birth-weight infants[J]. J Pediatr Gastroenterol Nutr, 2015, 61(4): 445-450. DOI: 10.1097/MPG.0000000000000835.
[15]
Stoll BJ, Hansen NI, Bell EF, et al. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012[J]. JAMA, 2015, 314(10): 1039-1051. DOI: 10.1001/jama.2015.10244.
[16]
Burge K, Bergner E, Gunasekaran A, et al. The role of glycosaminoglycans in protection from neonatal necrotizing enterocolitis: a narrative review[J]. Nutrients, 2020, 12(2): 546. DOI: 10.3390/nu12020546.
[17]
Warner BB, Deych E, Zhou Y, et al. Gut bacteria dysbiosis and necrotising enterocolitis in very low birthweight infants: a prospective case-control study[J]. Lancet, 2016, 387(10031): 1928-1936. DOI: 10.1016/S0140-6736(16)00081-7.
[18]
Vongbhavit K, Underwood MA. Prevention of necrotizing enterocolitis through manipulation of the intestinal microbiota of the premature infant[J]. Clin Ther, 2016, 38(4): 716-732. DOI: 10.1016/j.clinthera.2016.01.006.
[19]
Hackam DJ, Good M, Sodhi CP. Mechanisms of gut barrier failure in the pathogenesis of necrotizing enterocolitis: Toll-like receptors throw the switch[J]. Semin Pediatr Surg, 2013, 22(2): 76-82. DOI: 10.1053/j.sempedsurg.2013.01.003.
[20]
Mihi B, Good M. Impact of toll-like receptor 4 signaling in necrotizing enterocolitis: the state of the science[J]. Clin Perinatol, 2019, 46(1): 145-157. DOI: 10.1016/j.clp.2018.09.007.
[21]
Sodhi CP, Shi XH, Richardson WM, et al. Toll-like receptor-4 inhibits enterocyte proliferation via impaired beta-catenin signaling in necrotizing enterocolitis[J]. Gastroenterology, 2010, 138(1): 185-196. DOI: 10.1053/j.gastro.2009.09.045.
[22]
Maheshwari A, Kelly DR, Nicola T, et al. TGF-β2 suppresses macrophage cytokine production and mucosal inflammatory responses in the developing intestine[J]. Gastroenterology, 2011, 140(1): 242-253. DOI: 10.1053/j.gastro.2010.09.043.
[23]
Smythies LE, Sellers M, Clements RH, et al. Human intestinal macrophages display profound inflammatory anergy despite avid phagocytic and bacteriocidal activity[J]. J Clin Invest, 2005, 115(1): 66-75. DOI: 10.1172/JCI19229.
[24]
Mara MA, Good M, Weitkamp JH. Innate and adaptive immunity in necrotizing enterocolitis[J]. Semin Fetal Neonatal Med, 2018, 23(6): 394-399. DOI: 10.1016/j.siny.2018.08.002.
[25]
Shah PS, Shah VS, Kelly LE. Arginine supplementation for prevention of necrotising enterocolitis in preterm infants[J]. Cochrane Database Syst Rev, 2017, 4: CD004339. DOI: 10.1002/14651858.CD004339.pub4.
[26]
Robinson JL, Smith VA, Stoll B, et al. Prematurity reduces citrulline-arginine-nitric oxide production and precedes the onset of necrotizing enterocolitis in piglets[J]. Am J Physiol Gastrointest Liver Physiol, 2018, 315(4): G638, G649. DOI: 10.1152/ajpgi.00198.2018.
[27]
Egan CE, Sodhi CP, Good M, et al. Toll-like receptor 4-mediated lymphocyte influx induces neonatal necrotizing enterocolitis[J]. J Clin Invest, 2016, 126(2): 495-508. DOI: 10.1172/JCI83356.
[28]
Shulhan J, Dicken B, Hartling L, et al. Current knowledge of necrotizing enterocolitis in preterm infants and the impact of different types of enteral nutrition products[J]. Adv Nutr, 2017, 8(1): 80-91. DOI: 10.3945/an.116.013193.
[29]
Collado MC, Rautava S, Aakko J, et al. Human gut colonisation may be initiated in utero by distinct microbial communities in the placenta and amniotic fluid[J]. Sci Rep, 2016, 6: 23129. DOI: 10.1038/srep23129.
[30]
Denning NL, Prince JM. Neonatal intestinal dysbiosis in necrotizing enterocolitis[J]. Mol Med, 2018, 24(1): 4. DOI: 10.1186/s10020-018-0002-0.
[31]
La Rosa PS, Warner BB, Zhou Y, et al. Patterned progression of bacterial populations in the premature infant gut[J]. Proc Natl Acad Sci USA, 2014, 111(34): 12522-12527. DOI: 10.1073/pnas.1409497111.
[32]
Underwood MA, Sohn K. The microbiota of the extremely preterm infant[J]. Clin Perinatol, 2017, 44(2): 407-427. DOI: 10.1016/j.clp.2017.01.005.
[33]
Jacquot A, Neveu D, Aujoulat F, et al. Dynamics and clinical evolution of bacterial gut microflora in extremely premature patients[J]. J Pediatr, 2011, 158(3): 390-396. DOI: 10.1016/j.jpeds.2010.09.007.
[34]
Arboleya S, Sánchez B, Milani C, et al. Intestinal microbiota development in preterm neonates and effect of perinatal antibiotics[J]. J Pediatr, 2015, 166(3): 538-544. DOI: 10.1016/j.jpeds.2014.09.041.
[35]
Sim K, Shaw AG, Randell P, et al. Dysbiosis anticipating necrotizing enterocolitis in very premature infants[J]. Clin Infect Dis, 2015, 60(3): 389-397. DOI: 10.1093/cid/ciu822.
[36]
Mai V, Young CM, Ukhanova M, et al. Fecal microbiota in premature infants prior to necrotizing enterocolitis[J]. PLoS One, 2011, 6(6): e20647. DOI: 10.1371/journal.pone.0020647.
[37]
Morrow AL, Lagomarcino AJ, Schibler KR, et al. Early microbial and metabolomic signatures predict later onset of necrotizing enterocolitis in preterm infants[J]. Microbiome, 2013, 1(1): 13. DOI: 10.1186/2049-2618-1-13.
[38]
Gopalakrishna KP, Macadangdang BR, Rogers MB, et al. Maternal IgA protects against the development of necrotizing enterocolitis in preterm infants[J]. Nat Med, 2019, 25(7): 1110-1115. DOI: 10.1038/s41591-019-0480-9.
[39]
Heida FH, van Zoonen A, Hulscher J, et al. A necrotizing enterocolitis-associated gut microbiota is present in the meconium: results of a prospective study[J]. Clin Infect Dis, 2016, 62(7): 863-870. DOI: 10.1093/cid/ciw016.
[40]
Brower-Sinning R, Zhong D, Good M, et al. Mucosa-associated bacterial diversity in necrotizing enterocolitis[J]. PLoS One, 2014, 9(9): e105046. DOI: 10.1371/journal.pone.0105046.
[41]
Tanner SM, Berryhill TF, Ellenburg JL, et al. Pathogenesis of necrotizing enterocolitis: modeling the innate immune response[J]. Am J Pathol, 2015, 185(1): 4-16. DOI: 10.1016/j.ajpath.2014.08.028.
[42]
Hodzic Z, Bolock AM, Good M. The role of mucosal immunity in the pathogenesis of necrotizing enterocolitis[J]. Front Pediatr, 2017, 5: 40. DOI: 10.3389/fped.2017.00040.
[43]
Zhou W, Li W, Zheng XH, et al. Glutamine downregulates TLR-2 and TLR-4 expression and protects intestinal tract in preterm neonatal rats with necrotizing enterocolitis[J]. J Pediatr Surg, 2014, 49(7): 1057-1063. DOI: 10.1016/j.jpedsurg.2014.02.078.
[44]
Cario E. Barrier-protective function of intestinal epithelial Toll-like receptor 2[J]. Mucosal Immunol, 2008, 1(Suppl 1): S62-S66. DOI: 10.1038/mi.2008.47.
[45]
Ford H, Watkins S, Reblock K, et al. The role of inflammatory cytokines and nitric oxide in the pathogenesis of necrotizing enterocolitis[J]. J Pediatr Surg, 1997, 32(2): 275-282. DOI: 10.1016/s0022-3468(97)90194-9.
[46]
Aceti A, Beghetti I, Martini S, et al. Oxidative stress and necrotizing enterocolitis: pathogenetic mechanisms, opportunities for intervention, and role of human milk[J]. Oxid Med Cell Longev, 2018, 2018: 7397659. DOI: 10.1155/2018/7397659.
[47]
Maheshwari A, Patel RM, Christensen RD. Anemia, red blood cell transfusions, and necrotizing enterocolitis[J]. Semin Pediatr Surg, 2018, 27(1): 47-51. DOI: 10.1053/j.sempedsurg.2017.11.009.
[48]
Teišerskas J, Bartašienė R, Tamelienė R. Associations between red blood cell transfusions and necrotizing enterocolitis in very low birth weight infants: ten-year data of a tertiary neonatal unit[J]. Medicina (Kaunas), 2019, 55(1): 16. DOI: 10.3390/medicina55010016.
[49]
Managlia E, Liu S, Yan X, et al. Blocking NF-κB activation in Ly6c monocytes attenuates necrotizing enterocolitis[J]. Am J Pathol, 2019, 189(3): 604-618. DOI: 10.1016/j.ajpath.2018.11.015.
[50]
MohanKumar K, Namachivayam K, Song T, et al. A murine neonatal model of necrotizing enterocolitis caused by anemia and red blood cell transfusions[J]. Nat Commun, 2019, 10(1): 3494. DOI: 10.1038/s41467-019-11199-5.
[51]
Good M, Sodhi CP, Egan CE, et al. Breast milk protects against the development of necrotizing enterocolitis through inhibition of Toll-like receptor 4 in the intestinal epithelium via activation of the epidermal growth factor receptor[J]. Mucosal Immunol, 2015, 8(5): 1166-1179. DOI: 10.1038/mi.2015.30.
[52]
Patel AL, Kim JH. Human milk and necrotizing enterocolitis[J]. Semin Pediatr Surg, 2018, 27(1): 34-38. DOI: 10.1053/j.sempedsurg.2017.11.007.
[53]
Sullivan S, Schanler RJ, Kim JH, et al. An exclusively human milk-based diet is associated with a lower rate of necrotizing enterocolitis than a diet of human milk and bovine milk-based products[J]. J Pediatr, 2010, 156(4): 562-567.e1. DOI: 10.1016/j.jpeds.2009.10.040.
[54]
Nolan LS, Parks OB, Good M. A review of the immunomodulating components of maternal breast milk and protection against necrotizing enterocolitis[J]. Nutrients, 2019, 12(1): 14. DOI: 10.3390/nu12010014.
[55]
Garrido D, Ruiz-Moyano S, Kirmiz N, et al. A novel gene cluster allows preferential utilization of fucosylated milk oligosaccharides in Bifidobacterium longum subsp. longum SC596[J]. Sci Rep, 2016, 6: 35045. DOI: 10.1038/srep35045.
[56]
Wang C, Zhang M, Guo H, et al. Human milk oligosaccharides protect against necrotizing enterocolitis by inhibiting intestinal damage via increasing the proliferation of crypt cells[J]. Mol Nutr Food Res, 2019, 63(18): e1900262. DOI: 10.1002/mnfr.201900262.
[57]
Good M, Sodhi CP, Yamaguchi Y, et al. The human milk oligosaccharide 2′-fucosyllactose attenuates the severity of experimental necrotising enterocolitis by enhancing mesenteric perfusion in the neonatal intestine[J]. Br J Nutr, 2016, 116(7): 1175-1187. DOI: 10.1017/S0007114516002944.
[58]
Chowning R, Radmacher P, Lewis S, et al. A retrospective analysis of the effect of human milk on prevention of necrotizing enterocolitis and postnatal growth[J]. J Perinatol, 2016, 36(3): 221-224. DOI: 10.1038/jp.2015.179.
[59]
Johnson TJ, Patel AL, Bigger HR, et al. Cost savings of human milk as a strategy to reduce the incidence of necrotizing enterocolitis in very low birth weight infants[J]. Neonatology, 2015, 107(4): 271-276. DOI: 10.1159/000370058.
[60]
Berkhout D, Klaassen P, Niemarkt HJ, et al. Risk factors for necrotizing enterocolitis: a prospective multicenter case-control study[J]. Neonatology, 2018, 114(3): 277-284. DOI: 10.1159/000489677.
[61]
Siggers RH, Siggers J, Thymann T, et al. Nutritional modulation of the gut microbiota and immune system in preterm neonates susceptible to necrotizing enterocolitis[J]. J Nutr Biochem, 2011, 22(6): 511-521. DOI: 10.1016/j.jnutbio.2010.08.002.
[62]
Sodhi CP, Fulton WB, Good M, et al. Fat composition in infant formula contributes to the severity of necrotising enterocolitis[J]. Br J Nutr, 2018, 120(6): 665-680. DOI: 10.1017/S0007114518001836.
[1] 明昊, 肖迎聪, 巨艳, 宋宏萍. 乳腺癌风险预测模型的研究现状[J/OL]. 中华乳腺病杂志(电子版), 2024, 18(05): 287-291.
[2] 王振宇, 张洪美, 荆琳, 何名江, 闫奇. 膝骨关节炎相关炎症因子与血浆代谢物间的因果关系及中介效应[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 467-473.
[3] 张洁, 罗小霞, 余鸿. 系统性免疫炎症指数对急性胰腺炎患者并发器官功能损伤的预测价值[J/OL]. 中华普外科手术学杂志(电子版), 2025, 19(01): 68-71.
[4] 唐梅, 周丽, 牛岑月, 周小童, 王倩. ICG荧光导航的腹腔镜肝切除术临床意义[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 655-658.
[5] 贺斌, 马晋峰. 胃癌脾门淋巴结转移危险因素[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 694-699.
[6] 付成旺, 杨大刚, 王榕, 李福堂. 营养与炎症指标在可切除胰腺癌中的研究进展[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 704-708.
[7] 林凯, 潘勇, 赵高平, 杨春. 造口还纳术后切口疝的危险因素分析与预防策略[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 634-638.
[8] 高娟, 徐建庆, 闫芳, 丁盛华, 刘霞. Rutkow、TAPP、TEP 手术治疗单侧腹股沟疝患者的临床疗效及对血清炎症因子水平的影响[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 675-680.
[9] 杨闯, 马雪. 腹壁疝术后感染的危险因素分析[J/OL]. 中华疝和腹壁外科杂志(电子版), 2024, 18(06): 693-696.
[10] 孙璐, 蒋亚玲, 陈凌君. 布托啡诺对脑缺血再灌注损伤大鼠神经炎症和JAK2/STAT3信号通路的影响[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(06): 344-350.
[11] 张伟伟, 陈启, 翁和语, 黄亮. 随机森林模型预测T1 期结直肠癌淋巴结转移的初步研究[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(05): 389-393.
[12] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[13] 王湛, 李文坤, 杨奕, 徐芳, 周敏思, 苏珈仪, 王亚丹, 吴静. 炎症指标在早发性结直肠肿瘤中的应用[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 802-810.
[14] 李茂军, 唐彬秩, 吴青, 阳倩, 梁小明, 邹福兰, 黄蓉, 陈昌辉. 新生儿呼吸窘迫综合征的管理:多国指南/共识及RDS-NExT workshop 共识陈述简介和评价[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 607-617.
[15] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?