
人乳脂肪酸组分与新生儿母乳性黄疸的相关性分析
杨丽菲, 李菁, 胡瑞, 须丽清, 李亚璇, 盛王涛
中国当代儿科杂志 ›› 2020, Vol. 22 ›› Issue (12) : 1256-1260.
人乳脂肪酸组分与新生儿母乳性黄疸的相关性分析
Association of fatty acid composition in human milk with breast milk jaundice in neonates
目的 探讨人乳中不同脂肪酸组分与新生儿母乳性黄疸(BMJ)的相关性。方法 选取2016年10月至2017年10月入住该院新生儿重症监护室,临床诊断为晚发性母乳性黄疸的足月儿作为BMJ组,同期入住月子会所的无黄疸或无病理性黄疸健康新生儿为对照组,每组30例。分别收集两组新生儿的临床资料(包括性别、出生方式、喂养方式、胎龄、出生体重、胎次、产次及总胆红素峰值)及其母亲乳汁,使用MIRIS母乳分析仪检测人乳脂肪、蛋白质、碳水化合物等宏量营养素含量和热卡,采用气相色谱法分析母乳中不同脂肪酸组分含量。结果 对照组人乳各种宏量营养素组分均高于BMJ组,其中脂肪、干物质和热卡差异有统计学意义(P<0.05)。另测得母乳脂肪酸共25种,其中饱和脂肪酸9种,单不饱和脂肪酸6种,多不饱和脂肪酸10种。比较两组不同脂肪酸百分含量发现,BMJ组人乳中C15:0、C16:0、C17:0、C18:0、C20:0、C18:1n9t、C20:1n9、C18:3n6、C22:2、C22:6n3(DHA)等10种长链脂肪酸百分含量均低于对照组,3种脂肪酸C10:0、C12:0、C14:0百分含量均高于对照组(P<0.05)。结论 部分人乳宏量营养素及脂肪酸组分可能与新生儿母乳性黄疸发生机制有关。
Objective To study the association of fatty acid composition in human milk with breast milk jaundice (BMJ) in neonates. Methods A total of 30 full-term neonates who were admitted to the neonatal intensive care unit from October 2016 to October 2017 and were diagnosed with late-onset BMJ were enrolled as the BMJ group. Thirty healthy neonates without jaundice or pathological jaundice who were admitted to the confinement center during the same period of time were enrolled as the control group. Related clinical data were collected, including sex, mode of birth, feeding pattern, gestational age, birth weight, gravida, parity, and peak level of total serum bilirubin. Breast milk was collected from the mothers, and the MIRIS human milk analyzer was used to measure macronutrients (fat, protein, and carbohydrate) and calorie. Gas chromatography was used to analyze the content of different fatty acids in breast milk. Results The control group had higher levels of macronutrients in human milk than the BMJ group, with significant differences in fat, dry matter, and calorie (P<0.05). In addition, 25 fatty acids were detected in breast milk, including 9 saturated fatty acids, 6 monounsaturated fatty acids, and 10 polyunsaturated fatty acids. The comparison of the percentage composition of different fatty acids showed that compared with the control group, the BMJ group had significantly lower percentage compositions of C15:0, C16:0, C17:0, C18:0, C20:0, C18:1n9t, C20:1n9, C18:3n6, C22:2, and C22:6n3 (DHA) and higher percentage compositions of C10:0, C12:0, C14:0 in breast milk (P<0.05). Conclusions Some macronutrients and fatty acid composition in human milk may be associated with the pathogenesis of BMJ in neonates.
Breast milk jaundice / Human milk / Fatty acid / Association / Neonate
[1] 中华医学会儿科学分会新生儿学组. 中国住院新生儿流行病学调查[J]. 中国当代儿科杂志, 2009, 11(1):15-20.
[2] 莫忠得. 530例新生儿病理性黄疸病因分析[J]. 中国医药导刊, 2013, 15(7):1164-1165.
[3] 陈素梅, 李明霞. 晚发型母乳性黄疸发病机制新进展[J]. 中国新生儿科杂志, 2015, 30(2):152-154.
[4] 余洁红. 母乳性黄疸发病机制的探讨[J]. 国际医药卫生导报, 2015, 21(22):3298-3300.
[5] 彭程, 侯新琳. 《2018昆士兰产科与新生儿临床指南:新生儿黄疸》要点介绍[J]. 中华围产医学杂志, 2020, 23(4):285-288.
[6] Maruo Y, Morioka Y, Fujito H, et al. Bilirubin uridine diphosphate-glucuronosyltransferase variation is a genetic basis of breast milk jaundice[J]. J Pediatr, 2014, 165(1):36-41.e1.
[7] Fujiwara R, Maruo Y, Chen SJ, et al. Role of extrahepatic UDP-glucuronosyltransferase 1A1:advances in understanding breast milk-induced neonatal hyperbilirubinemia[J]. Toxicol Appl Pharmacol, 2015, 289(1):124-132.
[8] 陆岸锋, 钟丹妮. 有机阴离子转运体1B1基因与新生儿黄疸关系的研究进展[J]. 中国当代儿科杂志, 2014, 16(11):1183-1187.
[9] Zhou SM, Wang ZX, He FS, et al. Association of serum bilirubin in newborns affected by jaundice with gut microbiota dysbiosis[J]. J Nutr Biochem, 2019, 63:54-61.
[10] Han JR, Hamilton JA, Kirkland JL, et al. Medium-chain oil reduces fat mass and down-regulates expression of adipogenic genes in rats[J]. Obes Res, 2003, 11(6):734-744.
[11] Shibuya A, Itoh T, Tukey RH, et al. Impact of fatty acids on human UDP-glucuronosyltransferase 1A1 activity and its expression in neonatal hyperbilirubinemia[J]. Sci Rep, 2013, 3:2903.
[12] 张伟利, 吴圣楣, 钱继红, 等. 母乳中二十二碳六烯酸及花生四烯酸含量的观察[J]. 中华围产医学杂志, 2002, 5(1):52-55.
[13] 郭薇薇, 杨丽菲, 王剑, 等. 病因不明高胆红素血症新生儿尿苷二磷酸葡萄糖醛酸转移酶1A1基因变异分析[J]. 上海医学, 2017, 40(10):608-613.