Дисбіоз кишечника, ожиріння і метаболічний синдром: як вибратися із підступного трикутника?

Автор(и)

  • N. B. Gubergrits Донецький національний медичний університет, Лиман, Україна
  • N. V. Byelyayeva Донецький національний медичний університет, Лиман, Україна
  • O. V. Tsys Запорізький державний медичний університет, Україна
  • V. S. Rachmetova Медичний університет Астана, Республіка Казахстан, Україна

DOI:

https://doi.org/10.30978/MG-2019-4-45

Ключові слова:

мікробіота, дисбіоз кишечника, сидром надлишкового бактеріального росту, ожиріння, метаболічний синдром, патогенез, лікування

Анотація

Проаналізовано дані світової літератури та результати доказових експериментальних і клінічних досліджень про взаємозв’язок особливостей харчування і мікробіоти кишечника. Особливу увагу приділено участі дис­біо­зу кишечника та синдрому надлишкового бактеріального росту в тонкій кишці в патогенезі ожиріння і метаболічного синдрому. Наведено аргументи на користь двох основних гіпотез: метаболічної ендотоксемії та «зберігання». Перша розглядає механізми впливу ліпополісахариду грамнегативної кишкової флори, підвищення проникності кишкової стінки, ендоканабіноїдної системи і кишкової лужної фосфатази. Гіпотеза «зберігання» враховує особливості ферментації харчових полісахаридів, абсорбцію моносахаридів і роль кишкової мікробіоти та метаболітів її життєдіяльності (зокрема коротколанцюгових жирних кислот) у регуляції ліпідного обміну. Особливу увагу приділено лікуванню: зміні харчового раціону, використанню про- і пребіотиків, фекальній трансплантації. Проаналізовано вплив компонентів їжі на кишкову мікробіоту, зокрема харчових волокон, таких як резистентний крохмаль та інулін, а також жиру і білків. Показано, що склад кишкової мікробіоти відображує харчові звички та склад раціону. Дієта з високим вмістом жирів різко збільшує кишкову проникність завдяки механізму, пов’язаному зі зниженою експресією білків епітеліального щільного з’єднання, зокрема зонуліну та оклюдину. Обґрунтовано гіпотезу про те, що кишковий мікробіом, пов’язаний з ожирінням, має підвищену здатність до отримання енергії з раціону («ефект накопичення»). Проаналізовано переваги антибіотика з низькою кишковою абсорбцією — рифаксиміну. Наведено результати досліджень, які доводять еубіотичні властивості рифаксиміну та його ефективність при дисбіозі кишечника.

Біографії авторів

N. B. Gubergrits, Донецький національний медичний університет, Лиман

Губергріц Наталя Борисівна, д. мед. н., проф., проф. кафедри внутрішньої медицини №2

N. V. Byelyayeva, Донецький національний медичний університет, Лиман

Н. В. Бєляєва

O. V. Tsys, Запорізький державний медичний університет

О. В. Цис

V. S. Rachmetova, Медичний університет Астана, Республіка Казахстан

В. С. Рахметова

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2019-09-30

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