Особенности кишечной микробиоты в патогенезе и клиническом течении острого панкреатита

Цель. Анализ наиболее перспективных научно-практических направлений по изучению роли кишечной микробиоты и ее метаболитов в патогенезе и клиническом течении острого панкреатита.

Материал и методы. Проведен систематический поиск литературы в базах данных PubMed, EMBASE, Cochrane, опубликованной за 20 лет. Найдено 5 метаанализов, 234 клинических исследования, 127 обзоров, 428 экспериментальных исследований. Отобрано 36 клинических исследований, 2 обзора, 18 экспериментальных исследований. Систематический обзор подготовлен в соответствии со стандартами PRISMA.

Результаты. Структура кишечной микробиоты значительно отличается в группах здорового контроля и группах пациентов с острым панкреатитом. Микробиота пациентов с острым панкреатитом тесно коррелирует с системным воспалением и дисфункцией кишечного барьера. Наиболее часто при тяжелом остром панкреатите отмечали увеличение численности Enterococcus, Proteobacteria, Escherichia, Shigella, уменьшение общего многообразия микробиома, численности Bifidobacterium, Prevotella, Faecalibacterium, Blautia, Lachnospiraceae, Ruminococcaceae. Короткоцепочечные жирные кислоты, концентрация которых в крови может указывать на повышение проницаемости кишечной стенки, напрямую участвуют в патогенезе острого легочного повреждения при остром панкреатите.

Заключение. Дальнейшее изучение состава кишечной микробиоты, ее метаболитов и возможностей ее модуляции у разных групп пациентов может стать основой для поиска новых стратегий в диагностике, лечении и профилактике острого панкреатита.

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