外源性益生菌预防新生儿坏死性小肠结肠炎的研究进展

Research Progress of Exogenous Probiotics in Preventing Neonatal Necrotizing Enterocolitis

摘要: 目的：总结外源性益生菌预防新生儿坏死性小肠结肠炎(NEC)的循证证据、作用机制与临床策略，为实践与后续研究提供参考。方法：系统检索国内外数据库关于外源性益生菌预防新生儿NEC的随机对照试验、Meta分析及机制研究文献，进行归纳分析。结果：Meta分析证实特定益生菌菌株或复合制剂可降低早产儿NEC发生率、病死率，机制涉及增强肠屏障、调节免疫、抑制病原定植及产生短链脂肪酸，但安全性方面，益生菌相关败血症、耐药基因转移及产品监管缺失仍是临床常规化的主要障碍。结论：益生菌预防NEC对特定菌株效果确切，但因菌株异质性、安全性隐忧及监管不足，常规应用仍受限，未来应聚焦个体化精准策略与药品级标准建设。

Abstract: Objective: To summarize the evidence, mechanisms, and clinical strategies of exogenous probiotics for preventing neonatal necrotizing enterocolitis (NEC), and to provide reference for clinical practice and future research. Methods: A systematic search of domestic and international databases was conducted for randomized controlled trials, meta-analyses, and mechanistic studies on exogenous probiotics for preventing neonatal NEC, followed by inductive analysis. Results: Meta-analyses have confirmed that specific probiotic strains or compound formulations can reduce the incidence and mortality of NEC in preterm infants. The underlying mechanisms include reinforcing intestinal barrier function, regulating immunity, inhibiting pathogenic colonization, and generating short-chain fatty acids. Nevertheless, from a safety perspective, probiotics-associated sepsis, horizontal transfer of antimicrobial resistance genes, and insufficient supervision of probiotic products remain major barriers to its routine clinical implementation. Conclusions: Specific probiotic strains have demonstrated definite efficacy in preventing NEC. However, their routine administration remains limited due to strain heterogeneity, potential safety concerns and inadequate regulatory oversight. Future research should focus on individualized precision strategies and the establishment of pharmaceutical-grade quality standards.