Кишкова проникність та її роль у патогенезі та прогресуванні неалкогольної жирової хвороби печінки. Огляд літератури
DOI:
https://doi.org/10.30978/MG-2023-1-55Ключові слова:
кишкова проникність, ліпополісахарид, неалкогольна жирова хвороба печінки, кишковий бар’єрАнотація
Проблема неалкогольної жирової хвороби печінки (НАЖХП) є актуальною для світової медицини. Виявлено її асоціацію з «нездоровим» способом життя та метаболічними порушеннями. Наголошено на важливій ролі дисбіозу кишкової мікробіоти у патогенезі НАЖХП та функціонуванні осі кишечник — печінка. Наведено дані щодо структури і функціювання кишкового бар’єра у фізіологічних умовах. Доведено, що наявність дисбіотичних змін у мікробіоті відіграє важливу роль у порушенні бар’єрної функції шлунково‑кишкового тракту, що підвищує рівень фізіологічної транслокації як бактерій, так і їхніх токсинів та продуктів життєдіяльності. Частина шкідливих продуктів надходить через портальну вену у печінку (ендотоксинемія). Перевантаження антигенами призводить до розвитку та прогресування НАЖХП (аж до цирозу печінки). Наголошено, що кишковий бар’єр є динамічним і чутливим до змін, що відбуваються в кишечнику. У пацієнтів з НАЖХП порівняно зі здоровими особами часто спостерігається підвищена кишкова проникність та синдром надмірного бактеріального росту, що є джерелом підвищеної ендотоксемії. У низці досліджень виявлено, що у пацієнтів з НАЖХП ступінь проникності кишечника корелював з тяжкістю стеатозу. Чинниками, які найбільше впливають на кишкову проникність у пацієнтів з НАЖХП, є мікробне середовище, жовчні кислоти, рівень фекальних коротколанцюгових жирних кислот (переважно бутирату), метаболізм незамінної ароматичної амінокислоти триптофану, а також характер харчування, алкоголь, лікарські препарати, стрес і рівень фізичної активності, які діють або безпосередньо, або через індукцію дисбактеріозу кишкової мікробіоти. Зазначено, що підвищена проникність кишечника та її наслідок — бактеріальна транслокація беруть участь у розвитку таких ускладнень, як спонтанний бактеріальний перитоніт, гепаторенальний синдром, тромбоз ворітної вени, печінкова енцефалопатія, гепатоцелюлярна карцинома.
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