DOI: https://doi.org/10.30978/MG-2019-3-79

Кишкова мікробіота при захворюваннях печінки: сучасний стан проблеми

N. B. Gubergrits, N. V. Byelyayeva, E. V. Berezhna, A. Ye. Klochkov, P. G. Fomenko, A. V. Tsys

Анотація


Проаналізовано дані сучасної літератури, результати експериментальних і клінічних досліджень, які розкривають роль кишкової мікробіоти у патогенезі різних захворювань печінки: вірусних гепатитів, алкогольної хвороби печінки, неалкогольної жирової хвороби печінки, первинного склерозувального холангіту, цирозу печінки та гепатоцелюлярної карциноми. Особливу увагу приділено підвищенню кишкової проникності, що створює умови для транслокації бактерій, активації системної запальної відповіді, посилення гіпердинамічного кровотоку і погіршення функціонального стану печінки. Як приклад впливу кишкової мікробіоти на стан печінки наведено дані щодо синдрому надмірного бактеріального росту. Відзначено високу частоту розвитку синдрому надмірного бактеріального росту при хронічних захворюваннях печінки, залежність між підвищенням кишкової проникності та ступенем тяжкості порушення функцій печінки, розвитком і ступенем виразності печінкової енцефалопатії, ймовірністю виникнення спонтанного бактеріального перитоніту. Обговорюється роль кишкової мікробіоти у розвитку бактеріальних ускладнень цирозу печінки, зокрема спонтанного бактеріального перитоніту. Показано, що кишковий дисбіоз бере участь у дисрегуляції клітинного балансу загибель/регенерація, який лежить в основі канцерогенезу. Зроблено висновок щодо доцільності включення до складу терапії кількох захворювань печінки препаратів, які коригують склад кишкової мікробіоти. Описано переваги призначення рифаксиміну для поліпшення функціонального стану печінки при неалкогольному стеатогепатиті та печінковій енцефалопатії за допомогою корекції складу кишкового мікробіому.


Ключові слова


мікробіота; дисбіоз кишечника; синдром надмірного бактеріального росту; кишкова проникність; захворювання печінки; патогенез; лікування

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Посилання


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