母乳喂养相关因素与婴儿非感染性腹泻病程及预后的关系研究

                         陈美星

成都大学附属医院                四川成都市               610031

摘要

为探讨母乳喂养相关因素与婴儿非感染性腹泻病程、预后的相关性，为本病临床防控与喂养指导提供参考。方法：选取2023年1月—2024年12月本院收治120例母乳喂养非感染性腹泻0～6月龄婴儿为研究对象，收集母亲饮食结构、过敏史、母乳生化指标、喂养方式、益生菌使用等临床资料，分别分析各指标对腹泻病程长短及疾病远期预后的影响，采用单因素分析与多因素Logistic回归筛选独立危险因素。结果：单因素分析显示，母亲高脂饮食、个人过敏史、母乳高脂肪、高前列腺素E₂、部分母乳喂养与患儿腹泻病程延长密切相关；母亲高糖饮食、家族过敏史、母乳高乳糖、未补充益生菌是腹泻迁延的相关因素（P＜0.05）。多因素回归表明，高脂饮食、母亲过敏史、母乳脂肪及前列腺素E₂超标、混合喂养为病程延长独立危险因素；高糖饮食、家族过敏史、高乳糖母乳、未使用益生菌为预后不良独立危险因素（P＜0.05）。结论：母乳喂养相关可控因素直接影响婴儿非感染性腹泻恢复速度与转归效果，临床需强化哺乳期母亲饮食管理、推行纯母乳喂养、合理补充益生菌，从而缩短病程、改善患儿预后。

关键词：母乳喂养；婴儿；非感染性腹泻；病程；预后

Abstract

Objective: To explore the correlation between breastfeeding-related factors and the course and prognosis of non-infectious diarrhea in infants, providing a reference for clinical prevention, control, and feeding guidance. Methods: A total of 120 infants aged 0–6 months with non-infectious diarrhea who were breastfed and admitted to our hospital from January 2023 to December 2024 were selected as study subjects. Clinical data including maternal dietary structure, allergy history, biochemical indicators of breast milk, feeding methods, and probiotic use were collected. The effects of each indicator on the duration of diarrhea and long-term prognosis were analyzed separately. Univariate analysis and multivariate logistic regression were used to screen for independent risk factors. Results: Univariate analysis showed that maternal high-fat diet, personal allergy history, high breast milk fat, high prostaglandin E₂ levels, and partial breastfeeding were closely associated with prolonged diarrhea duration in infants; maternal high-sugar diet, family allergy history, high lactose in breast milk, and lack of probiotic supplementation were factors related to persistent diarrhea (P<0.05). Multivariate regression indicated that high-fat diet, maternal allergy history, excessive breast milk fat and prostaglandin E₂, and mixed feeding were independent risk factors for prolonged disease course; high-sugar diet, family allergy history, high-lactose breast milk, and lack of probiotics were independent risk factors for poor prognosis (P<0.05). Conclusion: Breastfeeding-related controllable factors directly affect the recovery speed and outcome of non-infectious diarrhea in infants. Clinically, it is necessary to strengthen dietary management of lactating mothers, promote exclusive breastfeeding, and reasonably supplement probiotics to shorten the disease course and improve the prognosis of affected infants.

Keywords: Breastfeeding; Infant; Non-infectious diarrhea; Course; PrognosisAbstract

Objective: To explore the correlation between breastfeeding-related factors and the course and prognosis of non-infectious diarrhea in infants, providing a reference for clinical prevention, control, and feeding guidance. Methods: A total of 120 infants aged 0–6 months with non-infectious diarrhea who were breastfed and admitted to our hospital from January 2023 to December 2024 were selected as study subjects. Clinical data including maternal dietary structure, allergy history, biochemical indicators of breast milk, feeding methods, and probiotic use were collected. The effects of each indicator on the duration of diarrhea and long-term prognosis were analyzed separately. Univariate analysis and multivariate logistic regression were used to screen for independent risk factors. Results: Univariate analysis showed that maternal high-fat diet, personal allergy history, high breast milk fat, high prostaglandin E₂ levels, and partial breastfeeding were closely associated with prolonged diarrhea duration in infants; maternal high-sugar diet, family allergy history, high lactose in breast milk, and lack of probiotic supplementation were factors related to persistent diarrhea (P<0.05). Multivariate regression indicated that high-fat diet, maternal allergy history, excessive breast milk fat and prostaglandin E₂, and mixed feeding were independent risk factors for prolonged disease course; high-sugar diet, family allergy history, high-lactose breast milk, and lack of probiotics were independent risk factors for poor prognosis (P<0.05). Conclusion: Breastfeeding-related controllable factors directly affect the recovery speed and outcome of non-infectious diarrhea in infants. Clinically, it is necessary to strengthen dietary management of lactating mothers, promote exclusive breastfeeding, and reasonably supplement probiotics to shorten the disease course and improve the prognosis of affected infants.

Keywords: Breastfeeding; Infant; Non-infectious diarrhea; Course; Prognosis

一、引言

婴幼儿时期消化系统发育尚未成熟，肠道屏障功能脆弱，是非感染性腹泻的高发人群。婴儿非感染性腹泻无细菌、病毒等病原体感染依据，主要由消化功能紊乱、肠道菌群失调、食物不耐受等因素诱发，在小月龄母乳喂养婴儿中极为常见。该病临床表现为大便次数增多、性状稀溏，轻症可短期自愈，部分患儿腹泻迁延反复，长期可造成营养摄入不足、生长发育迟缓，严重影响婴幼儿身心健康。

母乳是婴儿最天然、安全的理想食物，富含免疫球蛋白、益生元、活性酶及多种抗炎因子，能够维护肠道微生态稳定，降低腹泻等消化道疾病发病风险。但临床实践发现，同为母乳喂养婴儿，发生非感染性腹泻后病程长短、恢复效果存在明显个体差异。近年来研究发现，母乳喂养并非单一变量，母亲饮食习惯、过敏体质、母乳营养成分波动、喂养模式等多种母乳喂养相关指标，均可作用于婴儿肠道内环境，参与腹泻发生与进展。

目前国内多数研究仅单独分析母亲饮食或喂养方式与婴儿腹泻的关系，针对母乳喂养综合因素对腹泻病程及预后的系统性探究较少。本研究结合临床病例，全面分析母乳喂养相关危险因素，明确各类指标的影响价值，为儿科临床开展个体化喂养指导、制定腹泻早期干预方案提供循证依据。

二、资料与方法

1. 研究对象

选取2023年1月—2024年12月我院儿科收治120例0～6月龄母乳喂养非感染性腹泻婴儿。纳入标准：符合非感染性腹泻诊断标准，粪便常规、病原学检测结果阴性，无发热及脓血便；喂养方式为纯母乳或部分母乳喂养；临床病历资料完整。排除标准：合并感染性腹泻、先天消化道畸形、遗传代谢病；近两周使用抗生素、激素等影响肠道功能药物；母亲合并严重肝肾功能异常、自身免疫性疾病。

2. 调查与检测方法

统一制定调查表，收集母亲基础资料：年龄、文化程度、饮食结构（高脂、高糖、致敏食物摄入）、个人及家族过敏史；记录喂养方式分为纯母乳喂养、部分混合喂养。采集母乳标本，实验室检测脂肪、乳糖、前列腺素E₂水平；统计患儿腹泻治疗期间益生菌补充情况。

按病程分为短病程组（≤7d）、长病程组（＞7d）；按预后分为痊愈组（7d内症状完全缓解、无复发）、迁延组（腹泻持续＞14d或短期内反复发作）。

3. 统计学处理

采用SPSS 26.0软件进行数据分析，计量资料以均数±标准差表示，组间比较采用t检验；计数资料以百分比表示，采用χ²检验；多因素影响因素采用Logistic回归分析，P＜0.05为差异具有统计学意义。

三、结果

1. 腹泻病程单因素分析

本次研究中，短病程组68例，长病程组52例。组间对比显示，母亲高脂饮食、既往过敏史、母乳脂肪与前列腺素E₂含量升高、部分母乳喂养占比对比差异显著（P＜0.05）。

2. 腹泻预后单因素分析

痊愈组82例，迁延组38例。迁延组母亲高糖饮食比例、家族过敏史占比显著更高，母乳乳糖含量明显升高，未补充益生菌患儿数量更多，组间差异有统计学意义（P＜0.05）。

3. 多因素Logistic回归分析

以病程延长为因变量，纳入单因素有意义指标，结果显示：母亲高脂饮食、过敏史、母乳脂肪＞4.5g/100mL、前列腺素E₂＞30ng/L、部分母乳喂养，是婴儿非感染性腹泻病程延长的独立危险因素（P＜0.05）。

以预后不良为因变量，回归分析得出：母亲高糖饮食、家族过敏史、母乳乳糖过量、未常规补充益生菌，为腹泻迁延不愈的独立危险因素（P＜0.05）。

四、讨论

婴儿非感染性腹泻的核心发病机制为肠道消化吸收能力不足、菌群结构失衡、肠道黏膜屏障受损。母乳喂养作为婴儿主要营养来源，母亲身体状态与饮食行为会直接改变母乳理化性质与营养构成，进而调控婴儿肠道生理功能，最终影响腹泻恢复进程。

母亲长期高脂饮食会造成母乳脂肪负荷超标，婴儿肠胃消化能力有限，过量脂肪无法完全分解吸收，会增加肠道渗透压，加快肠道蠕动，加重稀便、腹泻症状，延长恢复时间。存在过敏体质的母亲，乳汁中易存在微量致敏蛋白，持续刺激婴儿娇嫩的肠道黏膜，诱发慢性过敏性肠黏膜水肿，降低肠道耐受能力，导致腹泻久治不愈。母乳中前列腺素E₂是重要的肠道调节介质，浓度异常升高会促进肠道平滑肌收缩，加速肠道分泌，持续性刺激肠道，造成腹泻病程迁延。

相较于纯母乳喂养，母乳联合配方奶的混合喂养模式会打破肠道营养稳态，外来异种蛋白易增加肠道消化负担，破坏母乳原有免疫保护优势，不利于腹泻快速恢复。

在疾病预后层面，哺乳期母亲长期高糖饮食会导致母乳乳糖含量超标，小月龄婴儿体内乳糖酶分泌不足，无法完全降解乳糖，未被吸收的乳糖进入大肠后发酵产气，引发渗透性腹泻，是腹泻反复的重要诱因。家族过敏性疾病遗传背景会提升婴儿肠道高反应性，一旦发生腹泻，更易转为慢性迁延性腹泻，复发风险显著增加。

肠道益生菌是维持肠道微生态平衡的核心菌群，腹泻发生后肠道有益菌大量流失，若未及时补充益生菌，菌群紊乱难以自行纠正，肠道屏障无法快速修复，直接造成预后变差。

结合本次研究结论，临床需完善哺乳期健康宣教，指导母亲建立清淡、均衡、低脂低糖的合理饮食结构，严格规避海鲜、蛋奶等高致敏食物；针对存在过敏史的母婴群体，开展早期喂养风险评估。大力倡导6月龄内纯母乳喂养，减少不必要的配方奶添加；对于非感染性腹泻母乳喂养患儿，早期规范联用益生菌制剂，调节肠道菌群，加速肠道功能修复。通过多维度干预母乳喂养相关危险因素，从源头降低腹泻迁延风险。

五、结论

母乳喂养相关各类因素是影响0～6月龄婴儿非感染性腹泻病程与预后的关键可调控因素。母亲不合理饮食、过敏体质、母乳成分异常、混合喂养、缺乏益生菌干预，均会阻碍腹泻康复。临床儿科与妇幼保健工作中，应重视母乳喂养全程管理，针对性开展饮食指导、健康宣教与合理药物干预，科学优化喂养方案，有效缩短腹泻病程，降低迁延性腹泻发生率，保障母乳喂养婴儿健康生长发育。

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