母乳微生物群：修订间差异

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{{link-en|母乳寡糖|Human milk oligosaccharide}}（HMO）是母乳中的主要成份之一，屬於[[益生元]]，可以增進有益的雙歧桿菌和擬桿菌的成長<ref>{{cite journal | vauthors = Bode L | title = Human milk oligosaccharides: prebiotics and beyond | journal = Nutrition Reviews | volume = 67 Suppl 2 | issue = suppl_2 | pages = S183-91 | date = November 2009 | pmid = 19906222 | doi = 10.1111/j.1753-4887.2009.00239.x }}</ref><ref>{{cite journal | vauthors = Jost T, Lacroix C, Braegger C, Chassard C | title = Impact of human milk bacteria and oligosaccharides on neonatal gut microbiota establishment and gut health | journal = Nutrition Reviews | volume = 73 | issue = 7 | pages = 426–37 | date = July 2015 | pmid = 26081453 | doi = 10.1093/nutrit/nuu016 }}</ref><ref name="Williams_2017" />。
{{link-en|母乳寡糖|Human milk oligosaccharide}}（HMO）是母乳中的主要成份之一，屬於[[益生元]]，可以增進有益的雙歧桿菌和擬桿菌的成長<ref>{{cite journal | vauthors = Bode L | title = Human milk oligosaccharides: prebiotics and beyond | journal = Nutrition Reviews | volume = 67 Suppl 2 | issue = suppl_2 | pages = S183-91 | date = November 2009 | pmid = 19906222 | doi = 10.1111/j.1753-4887.2009.00239.x }}</ref><ref>{{cite journal | vauthors = Jost T, Lacroix C, Braegger C, Chassard C | title = Impact of human milk bacteria and oligosaccharides on neonatal gut microbiota establishment and gut health | journal = Nutrition Reviews | volume = 73 | issue = 7 | pages = 426–37 | date = July 2015 | pmid = 26081453 | doi = 10.1093/nutrit/nuu016 }}</ref><ref name="Williams_2017" />。
=== 產婦的健康情形 ===

產婦的健康情形會影響母乳中的微生物組。身體質量指數較高及比較肥胖的產，其雙歧桿菌和葡萄球菌的數量會不同，細菌的多樣性也會比較少<ref name="Cabrera-Rubio_2012" /><ref>{{cite journal | vauthors = Collado MC, Laitinen K, Salminen S, Isolauri E | title = Maternal weight and excessive weight gain during pregnancy modify the immunomodulatory potential of breast milk | journal = Pediatric Research | volume = 72 | issue = 1 | pages = 77–85 | date = July 2012 | pmid = 22453296 | doi = 10.1038/pr.2012.42 }}</ref>[[乳糜泻]]產婦母乳中的擬桿菌和雙歧桿菌含量會比較少<ref>{{cite journal | vauthors = Olivares M, Albrecht S, De Palma G, Ferrer MD, Castillejo G, Schols HA, Sanz Y | title = Human milk composition differs in healthy mothers and mothers with celiac disease | journal = European Journal of Nutrition | volume = 54 | issue = 1 | pages = 119–28 | date = February 2015 | pmid = 24700375 | doi = 10.1007/s00394-014-0692-1 }}</ref>。HIV陽性的婦女其母乳中的微生物多樣性較大，而乳桿菌濃度也比較高<ref>{{cite journal | vauthors = González R, Maldonado A, Martín V, Mandomando I, Fumadó V, Metzner KJ, Sacoor C, Fernández L, Macete E, Alonso PL, Rodríguez JM, Menendez C | display-authors = 6 | title = Breast milk and gut microbiota in African mothers and infants from an area of high HIV prevalence | journal = PLOS ONE | volume = 8 | issue = 11 | pages = e80299 | date = November 2013 | pmid = 24303004 | doi = 10.1371/journal.pone.0080299 }}</ref>。[[乳腺炎]]和母乳中的微生物組的種類較少，微生物[[门 (生物)|门]]分類層級的變化，以及[[厭氧生物]]的減少有關<ref>{{cite journal | vauthors = Patel SH, Vaidya YH, Patel RJ, Pandit RJ, Joshi CG, Kunjadiya AP | title = Culture independent assessment of human milk microbial community in lactational mastitis | journal = Scientific Reports | volume = 7 | issue = 1 | pages = 7804 | date = August 2017 | pmid = 28798374 | doi = 10.1038/s41598-017-08451-7 }}</ref><ref>{{cite journal | vauthors = Delgado S, Arroyo R, Martín R, Rodríguez JM | title = PCR-DGGE assessment of the bacterial diversity of breast milk in women with lactational infectious mastitis | journal = BMC Infectious Diseases | volume = 8 | pages = 51 | date = April 2008 | pmid = 18423017 | doi = 10.1186/1471-2334-8-51 }}</ref><ref name="Jiménez_2015" />

足月生產及[[早產]]的孕婦，其母乳中微生物群的成份也有不同，足月生產的孕婦，其母乳中的腸球菌比早產孕婦要少，雙歧桿菌種類含量也比較高<ref name="Khodayar-Pardo_2014" />。

很少研究去分析母親飲食對母乳微生物群的影響<ref name="Gomez-Gallego_2016" />，不過可以確定飲食會影響母乳中的成份組成，例如{{link-en|脂質分佈|lipid profile}}<ref>{{cite journal | vauthors = Nishimura RY, Barbieiri P, Castro GS, Jordão AA, Perdoná G, Sartorelli DS | title = Dietary polyunsaturated fatty acid intake during late pregnancy affects fatty acid composition of mature breast milk | journal = Nutrition | volume = 30 | issue = 6 | pages = 685–9 | date = June 2014 | pmid = 24613435 | doi = 10.1016/j.nut.2013.11.002 }}</ref><ref>{{cite journal | vauthors = Peng Y, Zhou T, Wang Q, Liu P, Zhang T, Zetterström R, Strandvik B | title = Fatty acid composition of diet, cord blood and breast milk in Chinese mothers with different dietary habits | journal = Prostaglandins, Leukotrienes, and Essential Fatty Acids | volume = 81 | issue = 5-6 | pages = 325–30 | pmid = 19709866 | doi = 10.1016/j.plefa.2009.07.004 }}</ref>，而母乳成份會影響微生物組成<ref name="Gomez-Gallego_2016" />。母親飲食中脂肪及醣類的變化會影響母乳微生物群中的分類組成<ref>{{Cite journal|last=Meyer|first=Kristen M.|last2=Mohammad|first2=Mahmoud|last3=Bode|first3=Lars|last4=Chu|first4=Derrick M.|last5=Ma|first5=Jun|last6=Haymond|first6=Morey |last7=Aagaard|first7=Kjersti | name-list-format = vanc |title=20: Maternal diet structures the breast milk microbiome in association with human milk oligosaccharides and gut-associated bacteria |journal=American Journal of Obstetrics and Gynecology|volume=216|issue=1|doi=10.1016/j.ajog.2016.11.911}}</ref>

母乳微生物中的分類組成和多樣程度也依母親的地理位置有很大的不同<ref name="Gomez-Gallego_2016" /><ref name="Kumar_2016" /><ref name="Hunt_2011" />，不過還需要有更多不同地方婦女參與研究，以瞭解不同地區的差異<ref name="Gomez-Gallego_2016" />。

產婦在圍產期是否使用抗生素，和母乳中乳酸桿菌，雙歧桿菌，葡萄球菌和{{le|真桿菌|Eubacterium}}的出現率有關<ref name="Soto_2014" /><ref>{{cite journal | vauthors = Witt A, Mason MJ, Burgess K, Flocke S, Zyzanski S | title = A case control study of bacterial species and colony count in milk of breastfeeding women with chronic pain | journal = Breastfeeding Medicine | volume = 9 | issue = 1 | pages = 29–34 | date = January 2014 | pmid = 23789831 | pmc = 3903327 | doi = 10.1089/bfm.2013.0012 }}</ref><ref>{{cite journal | vauthors = Urbaniak C, Cummins J, Brackstone M, Macklaim JM, Gloor GB, Baban CK, Scott L, O'Hanlon DM, Burton JP, Francis KP, Tangney M, Reid G | display-authors = 6 | title = Microbiota of human breast tissue | journal = Applied and Environmental Microbiology | volume = 80 | issue = 10 | pages = 3007–14 | date = May 2014 | pmid = 24610844 | doi = 10.1128/aem.00242-14 }}</ref>。

[[中非共和國]]的研究發現母乳中的微生物多樣性越廣，越會觀察到母嬰{{link-en|二人組|Dyad (sociology)|dyads}}的社會網絡密度<ref>{{cite journal | vauthors = Meehan CL, Lackey KA, Hagen EH, Williams JE, Roulette J, Helfrecht C, McGuire MA, McGuire MK | display-authors = 6 | title = Social networks, cooperative breeding, and the human milk microbiome | journal = American Journal of Human Biology | volume = 30 | issue = 4 | pages = e23131 | date = July 2018 | pmid = 29700885 | doi = 10.1002/ajhb.23131 }}</ref>。

=== 哺乳階段 ===
母乳中的微生物群也會隨哺乳階段而不同，初乳中的微生物群多樣性比較高<ref name="Gomez-Gallego_2016" /><ref name="Cabrera-Rubio_2012" />。母乳中微生物群的的分類組成也有不同。一開始的母乳，其中的微生物以{{link-en|魏斯氏菌屬|Weissella}}、{{link-en|明串珠菌屬|Leuconostoc}}、葡萄球菌、鏈球菌、及{{link-en|乳酸乳球菌|Lactococcus}}為主<ref name="Cabrera-Rubio_2012" />，後期的母乳的微生物主要是{{link-en|韦荣氏球菌属|Veillonella}}、{{link-en|普雷沃氏菌属|Prevotella}}、纖毛菌、乳桿菌屬、葡萄球菌、雙歧桿菌及腸球菌屬<ref name="Cabrera-Rubio_2012" /><ref name="Khodayar-Pardo_2014">{{cite journal | vauthors = Khodayar-Pardo P, Mira-Pascual L, Collado MC, Martínez-Costa C | title = Impact of lactation stage, gestational age and mode of delivery on breast milk microbiota | journal = Journal of Perinatology | volume = 34 | issue = 8 | pages = 599–605 | date = August 2014 | pmid = 24674981 | doi = 10.1038/jp.2014.47 }}</ref>。


== 相關條目 ==
== 相關條目 ==

2019年10月31日 (四) 13:36的版本

母乳樣本中的微生物

母乳微生物群（human milk microbiota）也稱為母乳益生菌，是在人類母乳及乳腺中的微生物群（英语：Microbiota）[1]。以往曾認為母乳無菌（英语：Asepsis）[1][2]，不過近來不論透過微生物培養（英语：microbial culture），或是其他的技術，都已確定母乳中含有許多和人類微生物群系不同的细菌群[3][4][5]。

母乳微生物群可能是嬰兒體內，偏利共生、互利共生，或潛在益生菌之腸道菌群的來源[2]。世界卫生组织（WHO）對益生菌的定義是：「當達到足夠數量時，能對宿主的健康有益的微生物。」[6]。

來源

母乳中的微生物群，以及十種最常見的菌種

母乳是乳酸菌的自然來源，初生嬰兒透過母乳餵養可以獲取乳酸菌，母乳也可視為是共生食物[7]。健康母親的母乳中，正常細菌含量約為每毫升103菌落形成單位（CFU）[8]。母乳中的菌種非常複雜[8]。在所有母乳樣本中可檢測的超過100種可操作的分類單位（英语：Taxonomy (biology)）中，只有9種菌類是所有樣本共有的（鏈球菌，葡萄球菌，沙雷氏菌（英语：Serratia），假單胞菌，棒狀桿菌（英语：Corynebacterium），羅爾斯頓菌（英语：Ralstonia），丙酸桿菌，鞘氨醇單胞菌（英语：Sphingomonas）和慢生根瘤菌科），但個別母體裏的母乳細菌群落多半都是穩定的[9]。母乳是嬰兒腸道中葡萄球菌、鏈球菌、乳酸菌、雙歧桿菌（英语：Bifidobacterium）、丙酸桿菌、棒狀桿菌和其他相關革蘭氏陽性菌的來源[2]。

成份

以前科學界都認為母乳是無菌的，後來才從健康女性身上，以衛生方式採集的母乳中發現了乳桿菌[7]。研究指出母乳中的多個菌類，包括乳桿菌屬，葡萄球菌屬，腸球菌屬和雙歧桿菌屬的細菌菌株，會透過母乳喂哺傳到嬰兒體内，因此由母乳喂哺的嬰兒的腸道微生物群成分與其母親的母乳成分相近似.[2]。研究亦指出母乳微生物群及嬰兒腸道微生物群具有相似性，因此認為飲食攝取（包括母乳益生菌）可以幫助建立嬰兒腸道微生物群，也對其免疫發展有益[10]。

母乳樣本中常見的菌種有雙歧桿菌屬（英语：Bifidobacterium）、乳桿菌屬、葡萄球菌属、鏈球菌屬、擬桿菌屬、梭菌屬、微球菌屬（英语：Micrococcus）、肠球菌及埃希氏菌屬（英语：Escherichia）[3][3][5]。有關母乳的元基因組學分析發現其中主要以葡萄球菌属、擬桿菌屬及缓慢爱德华氏菌（英语：Edwardsiella）為主[11][12]。母乳微生物群會隨族群及女性的個體差異而不同[13]，不過在一個以美國女性為基礎的研究中，觀察到在其研究樣本中有相同的九種菌種，因此認為在母乳微生物群中有主要菌種，至少在美國是這樣的情形[8]。人類初乳中的菌種比一般母乳的更加分散[1][14]。

在母乳中，可以分離出三種有益生功效的乳桿菌種，分別是發酵乳桿菌（英语：L. fermentum） CECT5716、加氏乳桿菌（英语：L. gasseri） CECT5714及唾液乳桿菌（英语：L. salivarius） CECT5713[15]，其中發酵乳桿菌是最常見的菌種[9]。早期有在配方奶粉中加入發酵乳桿菌，宣稱安全，適合一到六個月的嬰兒[16]，且適合長期使用[17]。

起源

有關母乳微生物群的啟源還不完全清楚[1]，目前有許多相關的假說。母乳中的微生物群可能是源自乳房的皮膚微生物群（英语：skin flora）[18][19]，或是嬰兒的口腔微生物群（英语：Oral microbiology）[8][12][20][21]。在哺乳或是嬰兒吸吮乳頭時的母乳倒流也可能導致乳腺中的細菌形成[22]，透過紅外線攝影（英语：infrared photography）發現在哺乳時有一定程度的母乳倒流[23]。另外，微生物群也可能從母親的消化道，透過樹突狀細胞產生的腸-乳途徑（entero-mammary pathway）進入乳腺[2][3][24]。

環境因素

人體母乳益生菌會收到不同因素的影響，例如母親自身的身體質量指數（BMI）、嬰兒性別、生產方式及母乳喂哺模式等等[25][26]。Soto等人的研究表明，在懷孕和哺乳期間未接受任何抗生素治療的婦女的母乳中有更多的乳酸桿菌和雙歧桿菌含量[9]。

母乳寡糖（英语：Human milk oligosaccharide）（HMO）是母乳中的主要成份之一，屬於益生元，可以增進有益的雙歧桿菌和擬桿菌的成長[27][28][29]。

產婦的健康情形

產婦的健康情形會影響母乳中的微生物組。身體質量指數較高及比較肥胖的產，其雙歧桿菌和葡萄球菌的數量會不同，細菌的多樣性也會比較少[14][30]乳糜泻產婦母乳中的擬桿菌和雙歧桿菌含量會比較少[31]。HIV陽性的婦女其母乳中的微生物多樣性較大，而乳桿菌濃度也比較高[32]。乳腺炎和母乳中的微生物組的種類較少，微生物门分類層級的變化，以及厭氧生物的減少有關[33][34][12]

足月生產及早產的孕婦，其母乳中微生物群的成份也有不同，足月生產的孕婦，其母乳中的腸球菌比早產孕婦要少，雙歧桿菌種類含量也比較高[35]。

很少研究去分析母親飲食對母乳微生物群的影響[1]，不過可以確定飲食會影響母乳中的成份組成，例如脂質分佈（英语：lipid profile）[36][37]，而母乳成份會影響微生物組成[1]。母親飲食中脂肪及醣類的變化會影響母乳微生物群中的分類組成[38]

母乳微生物中的分類組成和多樣程度也依母親的地理位置有很大的不同[1][13][8]，不過還需要有更多不同地方婦女參與研究，以瞭解不同地區的差異[1]。

產婦在圍產期是否使用抗生素，和母乳中乳酸桿菌，雙歧桿菌，葡萄球菌和真桿菌（英语：Eubacterium）的出現率有關[9][39][40]。

中非共和國的研究發現母乳中的微生物多樣性越廣，越會觀察到母嬰dyads（英语：Dyad (sociology)）的社會網絡密度[41]。

哺乳階段

母乳中的微生物群也會隨哺乳階段而不同，初乳中的微生物群多樣性比較高[1][14]。母乳中微生物群的的分類組成也有不同。一開始的母乳，其中的微生物以魏斯氏菌屬（英语：Weissella）、明串珠菌屬（英语：Leuconostoc）、葡萄球菌、鏈球菌、及乳酸乳球菌為主[14]，後期的母乳的微生物主要是韦荣氏球菌属、普雷沃氏菌属、纖毛菌、乳桿菌屬、葡萄球菌、雙歧桿菌及腸球菌屬[14][35]。

相關條目

參考資料

  1. ^ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 Gomez-Gallego C, Garcia-Mantrana I, Salminen S, Collado MC. The human milk microbiome and factors influencing its composition and activity. Seminars in Fetal & Neonatal Medicine. December 2016, 21 (6): 400–405. PMID 27286644. doi:10.1016/j.siny.2016.05.003. 
  2. ^ 2.0 2.1 2.2 2.3 2.4 Fernández L, Langa S, Martín V, Maldonado A, Jiménez E, Martín R, Rodríguez JM. The human milk microbiota: origin and potential roles in health and disease. Pharmacological Research. March 2013, 69 (1): 1–10. PMID 22974824. doi:10.1016/j.phrs.2012.09.001. 
  3. ^ 3.0 3.1 3.2 3.3 Martín R, Jiménez E, Heilig H, Fernández L, Marín ML, Zoetendal EG, Rodríguez JM. Isolation of bifidobacteria from breast milk and assessment of the bifidobacterial population by PCR-denaturing gradient gel electrophoresis and quantitative real-time PCR. Applied and Environmental Microbiology. February 2009, 75 (4): 965–9. PMC 2643565 可免费查阅. PMID 19088308. doi:10.1128/aem.02063-08. 
  4. ^ Díaz-Ropero MP, Martín R, Sierra S, Lara-Villoslada F, Rodríguez JM, Xaus J, Olivares M. Two Lactobacillus strains, isolated from breast milk, differently modulate the immune response. Journal of Applied Microbiology. February 2007, 102 (2): 337–43. PMID 17241338. doi:10.1111/j.1365-2672.2006.03102.x. 
  5. ^ 5.0 5.1 Collado MC, Delgado S, Maldonado A, Rodríguez JM. Assessment of the bacterial diversity of breast milk of healthy women by quantitative real-time PCR. Letters in Applied Microbiology. May 2009, 48 (5): 523–8. PMID 19228290. doi:10.1111/j.1472-765x.2009.02567.x. 
  6. ^ Food and Agriculture Organization and World Health Organization Expert Consultation. Evaluation of health and nutritional properties of powder milk and live lactic acid bacteria. (报告). Córdoba, Argentina: Food and Agriculture Organization of the United Nations and World Health Organization. 2001. 
  7. ^ 7.0 7.1 Martín R, Langa S, Reviriego C, Jimínez E, Marín ML, Xaus J, et al. Human milk is a source of lactic acid bacteria for the infant gut. The Journal of Pediatrics. December 2003, 143 (6): 754–8. PMID 14657823. doi:10.1016/j.jpeds.2003.09.028. 
  8. ^ 8.0 8.1 8.2 8.3 8.4 Hunt KM, Foster JA, Forney LJ, Schütte UM, Beck DL, Abdo Z, et al. Characterization of the diversity and temporal stability of bacterial communities in human milk. PLOS ONE. 2011, 6 (6): e21313. Bibcode:2011PLoSO...621313H. PMC 3117882 可免费查阅. PMID 21695057. doi:10.1371/journal.pone.0021313. 
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