儿童短肠综合征肠道菌群研究进展

doi:10.12372/jcp.2026.25e0381

摘要/Abstract

摘要：

儿童短肠综合征（SBS）是指由于小肠大部分切除、旷置或先天性短肠等原因所致小肠吸收能力受限、无法满足患儿正常生长发育需求且需肠外营养支持42 d以上的一类疾病。由于小肠结构与功能显著异常，SBS 患儿存在肠道微生态失衡，表现为菌群多样性下降，代谢途径异常等。营养支持方式、预防性抗生素应用、解剖结构与生长发育情况为影响SBS患儿肠道菌群特征的主要因素。维持肠道菌群多样性和稳定性对增强SBS患儿肠道屏障、促进肠道适应和减少并发症至关重要。

关键词: 短肠综合征, 肠道菌群, 肠外营养, 儿童

Abstract:

Pediatric short bowel syndrome (SBS) is defined as a clinical condition characterized by impaired intestinal absorptive capacity resulting from extensive small bowel resection, bypass, or congenital short bowel, which fails to meet the nutritional requirements for normal growth and development, necessitating parenteral nutrition (PN) support for a duration exceeding 42 days. Owing to significant structural and functional abnormalities of the small intestine, pediatric SBS patients exhibit intestinal microecological dysbiosis, as evidenced by reduced microbial diversity and aberrant metabolic pathways. Key factors influencing the intestinal microbiota profiles in these patients include nutritional support modalities, prophylactic antibiotic administration, anatomical configuration, and growth and developmental status. Maintenance of intestinal microbiota diversity and stability is of paramount importance for enhancing intestinal barrier function, facilitating intestinal adaptation, and mitigating complications in pediatric SBS patients.

Key words: short bowel syndrome, intestinal microbiome, parenteral nutrition, child

中图分类号:

刘释忆, 王莹. 儿童短肠综合征肠道菌群研究进展[J]. 临床儿科杂志, 2026, 44(4): 348-354.

LIU Shiyi, WANG Ying. Research advances on the intestinal microbiome in pediatric short bowel syndrome[J]. Journal of Clinical Pediatrics, 2026, 44(4): 348-354.

参考文献 53

[1]	李幼生, 蔡威, 藜介寿, 等. 中国短肠综合征诊疗共识(2016年版)[J]. 中华医学杂志, 2017, 97 (8): 569-576.
	Li Y, Cai W, Li J, et al. Chinese consensus on diagnosis and treatment of short bowel syndrome (2016 edition) [J]. Zhonghua Yixue Zazhi, 2017, 97(8): 569-576.
[2]	Adak A, Khan MR. An insight into gut microbiota and its functionalities[J]. Cell Mol Life Sci, 2019, 76 (3): 473-493.
[3]	Zhang D, Jian YP, Zhang YN, et al. Short-chain fatty acids in diseases[J]. Cell Commun Signal, 2023, 21 (1): 212.
[4]	Braszczyńska-Sochacka J, Sochacki J, Mik M. The gut's secret code: bowel microbiota as a biomarker for adaptation[J]. Nutrients, 2025, 17(13): 2117.
[5]	Cerdó T, García-Santos JA, Rodríguez-Pöhnlein A, et al. Impact of total parenteral nutrition on gut microbiota in pediatric population suffering intestinal disorders[J]. Nutrients, 2022, 14(21): 4691.
[6]	Neelis EG, De Koning BAE, Hulst JM, et al. Gut microbiota and its diet‐related activity in children with intestinal failure receiving long‐term parenteral nutrition[J]. JPEN J Parenter Enteral Nutr, 2022, 46 (3): 693-708.
[7]	Thänert R, Thänert A, Ou J, et al. Antibiotic-driven intestinal dysbiosis in pediatric short bowel syndrome is associated with persistently altered microbiome functions and gut-derived bloodstream infections[J]. Gut Microbes, 2021, 13 (1): 1940792.
[8]	Wang P, Wang Y, Lu L, et al. Alterations in intestinal microbiota relate to intestinal failure-associated liver disease and central line infections[J]. J Pediatr Surg, 2017, 52 (8): 1318-1326.
[9]	Zhang T, Wang Y, Yan W, et al. Microbial alteration of small bowel stoma effluents and colonic feces in infants with short bowel syndrome[J]. J Pediatr Surg, 2020, 55 (7): 1366-1372.
[10]	Dowhaniuk JK, Szamosi J, Chorlton S, et al. Starving the gut: a deficit of butyrate in the intestinal ecosystem of children with intestinal failure[J]. JPEN J Parenter Enteral Nutr, 2020, 44 (6): 1112-1123.
[11]	Piper HG, Fan D, Coughlin LA, et al. Severe gut microbiota dysbiosis is associated with poor growth in patients with short bowel syndrome[J]. JPEN J Parenter Enteral Nutr, 2017, 41 (7): 1202-1212.
[12]	Chichlowski M, Hale LP. Bacterial-mucosal interactions in inflammatory bowel disease: an alliance gone bad[J]. Am J Physiol Gastrointest Liver Physiol, 2008, 295 (6): G1139-1149.
[13]	Korpela K, Mutanen A, Salonen A, et al. Intestinal microbiota signatures associated with histological liver steatosis in pediatric-onset intestinal failure[J]. JPEN J Parenter Enteral Nutr, 2017, 41 (2): 238-248.
[14]	Talathi S, Wilkinson L, Meloni K, et al. Factors affecting the gut microbiome in pediatric intestinal failure[J]. J Pediatr Gastroenterol Nutr, 2023, 77 (3): 426-432.
[15]	Zeichner SL, Mongodin EF, Hittle L, et al. The bacterial communities of the small intestine and stool in children with short bowel syndrome[J]. PLoS One, 2019, 14 (5): e0215351.
[16]	Sinclair JL, Alexander M. Role of resistance to starvation in bacterial survival in sewage and lake water[J]. Appl Environ Microbiol, 1984, 48 (2): 410-415.
[17]	Buchman AL, Moukarzel AA, Bhuta S, et al. Parenteral nutrition is associated with intestinal morphologic and functional changes in humans[J]. J PEN Parenter Enteral Nutr, 1995, 19 (6): 453-460.
[18]	Talathi S, Wilkinson L, Meloni K, et al. Scheduled empiric antibiotics may slter the gut microbiome and nutrition outcomes in pediatric intestinal failure[J]. Nutr Clin Pract, 2021, 36 (6): 1230-1239.
[19]	Everard A, Belzer C, Geurts L, et al. Cross-talk between Akkermansia muciniphila and intestinal epithelium controls diet-induced obesity[J]. Proc Natl Acad Sci USA, 2013, 110 (22): 9066-9071.
[20]	Engelstad HJ, Barron L, Moen J, et al. Remnant small bowel length in pediatric short bowel syndrome and the correlation with intestinal dysbiosis and linear growth[J]. J Am Coll Surg, 2018, 227 (4): 439-449.
[21]	Goulet O, Baglin-Gobet S, Talbotec C, et al. Outcome and long-term growth after extensive small bowel resection in the neonatal period: a survey of 87 children[J]. Eur J Pediatr Surg, 2005, 15 (2): 95-101.
[22]	Mignini I, Piccirilli G, Di Vincenzo F, et al. Intestinal-failure-associated liver disease: beyond parenteral nutrition[J]. Biomolecules, 2025, 15(3): 388.
[23]	Ruiz L, Margolles A, Sánchez B. Bile resistance mechanisms in Lactobacillus and Bifidobacterium[J]. Front Microbiol, 2013, 4: 396.
[24]	Bering J, DiBaise JK. Short bowel syndrome: complications and management[J]. Nutr Clin Pract, 2023, 38 Suppl 1: S46-S58.
[25]	Kurkchubasche AG, Smith SD, Rowe MI. Catheter sepsis in short-bowel syndrome[J]. Arch Surg, 1992, 127 (1): 21-24.
[26]	Terra RM, Plopper C, Waitzberg DL, et al. Remaining small bowel length: association with catheter sepsis in patients receiving home total parenteral nutrition: evidence of bacterial translocation[J]. World J Surg, 2000, 24 (12): 1537-1541.
[27]	Zafar H, Jimenez B, Schneider A. Small intestinal bacterial overgrowth: current update[J]. Curr Opin Gastroenterol, 2023, 39 (6): 522-528.
[28]	Belza C, Betts Z, de Silva N, et al. Factors related to the development of small-bowel bacterial overgrowth in pediatric intestinal failure: a retrospective cohort study[J]. JPEN J Parenter Enteral Nutr, 2020, 44 (7): 1280-1284.
[29]	Lee CH, Lo HC, Chou MC, et al. Oral antibiotics attenuate bowel segment reversal-induced systemic inflammatory response and body weight loss in massively bowel-resected rats[J]. JPEN J Parenter Enteral Nutr, 2007, 31 (5): 397-405.
[30]	Lee CH, Chen JY, Li ML, et al. Oral antibiotics attenuate bowel segment reversal-induced alterations in subpopulation and function of peripheral blood leukocytes, thymocytes, and splenocytes in massive bowel-resected rats[J]. JPEN J Parenter Enteral Nutr, 2009, 33 (1): 90-101.
[31]	Tian J, Hao L, Chandra P, et al. Dietary glutamine and oral antibiotics each improve indexes of gut barrier function in rat short bowel syndrome[J]. Am J Physiol Gastrointest Liver Physiol, 2009, 296 (2): G348-G355.
[32]	Maselli KM, Gee K, Isani M, et al. Broad-spectrum antibiotics alter the microbiome, increase intestinal fxr, and decrease hepatic steatosis in zebrafish short bowel syndrome[J]. Am J Physiol Gastrointest Liver Physiol, 2020, 319 (2): G212-G226.
[33]	Pauline M, Fouhse J, Hinchliffe T, et al. Probiotic treatment vs empiric oral antibiotics for managing dysbiosis in short bowel syndrome: impact on the mucosal and stool microbiota, short‐chain fatty acids, and adaptation[J]. JJPEN J Parenter Enteral Nutr, 2022, 46 (8): 1828-1838.
[34]	Al-Habsi N, Al-Khalili M, Haque SA, et al. Health benefits of prebiotics, probiotics, synbiotics, and postbiotics[J]. Nutrients, 2024, 16(22): 3955.
[35]	Reddy VS, Patole SK, Rao S. Role of probiotics in short bowel syndrome in infants and children--a systematic review[J]. Nutrients, 2013, 5 (3): 679-699.
[36]	Stoidis CN, Misiakos EP, Patapis P, et al. Potential benefits of pro- and prebiotics on intestinal mucosal immunity and intestinal barrier in short bowel syndrome[J]. Nutr Res Rev, 2011, 24 (1): 21-30.
[37]	Tolga Muftuoglu MA, Civak T, Cetin S, et al. Effects of probiotics on experimental short-bowel syndrome[J]. Am J Surg, 2011, 202 (4): 461-468.
[38]	Metin M, Altun A, Köylüoğlu G. The effect of probiotics on ıntestinal motility in an experimental short bowel model[J]. Acta Cir Bras, 2020, 35 (8): e202000804.
[39]	Uchida K, Takahashi T, Inoue M, et al. Immunonutritional effects during synbiotics therapy in pediatric patients with short bowel syndrome[J]. Pediatr Surg Int, 2007, 23 (3): 243-248.
[40]	Kanamori Y, Hashizume K, Sugiyama M, et al. Combination therapy with Bifidobacterium breve, Lacto-bacillus casei, and galactooligosaccharides dramatically improved the intestinal function in a girl with short bowel syndrome: a novel synbiotics therapy for intestinal failure[J]. Dig Dis Sci, 2001, 46 (9): 2010-2016.
[41]	Kanamori Y, Sugiyama M, Hashizume K, et al. Experience of long-term synbiotic therapy in seven short bowel patients with refractory enterocolitis[J]. J Pediatr Surg, 2004, 39 (11): 1686-1692.
[42]	Shiau SL, Su BH, Lin KJ, et al. Possible effect of probiotics and breast milk in short bowel syndrome: report of one case[J]. Acta Paediatr Taiwan, 2007, 48 (2): 89-92.
[43]	Kunz AN, Noel JM, Fairchok MP. Two cases of Lactobacillus bacteremia during probiotic treatment of short gut syndrome[J]. J Pediatr Gastroenterol Nutr, 2004, 38 (4): 457-458.
[44]	De Groote MA, Frank DN, Dowell E, et al. Lactobacillus rhamnosus GG bacteremia associated with probiotic use in a child with short gut syndrome[J]. Pediatr Infect Dis J, 2005, 24 (3): 278-280.
[45]	Munakata S, Arakawa C, Kohira R, et al. A case of D-lactic acid encephalopathy associated with use of probiotics[J]. Brain Dev, 2010, 32 (8): 691-694.
[46]	Takahashi K, Terashima H, Kohno K, et al. A stand-alone synbiotic treatment for the prevention of D-lactic acidosis in short bowel syndrome[J]. Int Surg, 2013, 98 (2): 110-113.
[47]	Yilmaz B, Schibli S, Macpherson AJ, et al. D-lactic acidosis: successful suppression of D-lactate-producing Lactobacillus by probiotics[J]. Pediatrics, 2018, 142 (3).
[48]	Dai LN, Yan JK, Zhang T, et al. Butyrate promotes the adaptation of intestinal smooth muscle cells through the yes-associated protein (YAP) pathway in a rat model of short bowel syndrome[J]. Am J Transl Res, 2019, 11 (1): 453-462.
[49]	Lin H, Huang Y, Tian T, et al. Propionate promotes vitamin D receptor expression via yes-associated protein in rats with short bowel syndrome[J]. Biochem Biophys Res Commun, 2020, 523 (3): 645-650.
[50]	Bartholome AL, Albin DM, Baker DH, et al. Supplementation of total parenteral nutrition with butyrate acutely increases structural aspects of intestinal adaptation after an 80% jejunoileal resection in neonatal piglets[J]. JPEN J Parenter Enteral Nutr, 2004, 28 (4): 210-222.
[51]	Davidovics ZH, Vance K, Etienne N, et al. Fecal transplantation successfully treats recurrent D-lactic acidosis in a child with short bowel syndrome[J]. JPEN J Parenter Enteral Nutr, 2017, 41 (5): 896-897.
[52]	Bulik-Sullivan EC, Roy S, Elliott RJ, et al. Intestinal microbial and metabolic alterations following successful fecal microbiota transplant for D-lactic acidosis[J]. J Pediatr Gastroenterol Nutr, 2018, 67 (4): 483-487.
[53]	Busing JD, Fouladi F, Bulik-Sullivan EC, et al. Gut microbial changes following fecal microbiota transplantation for D-lactic acidosis in two children[J]. JPGN Rep, 2023, 4 (3): e319.