Terapevticheskii arkhivTerapevticheskii arkhivТерапевтический архив0040-36602309-5342LLC Obyedinennaya Redaktsiya3235410.17116/terarkh2017898120-128Editorial articleПередовая статьяReview ArticleLiver diseases: The pathogenetic role of the gut microbiome and the potential of treatment for its modulationБолезни печени: патогенетическая роль кишечного микробиома и потенциал терапии по его модуляцииAitbaevK AАйтбаевК АMurkamilovI TМуркамиловИ ТFominV VФоминВ ВНациональный центр кардиологии и терапии Минздрава Кыргызской РеспубликиКыргызская государственная медицинская академия им. И.К. АхунбаеваФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» Минздрава России15082017898VOL 89, NO8 ()ТОМ 89, №8 (2017)12012810042020Copyright ©; 2017, Consilium MedicumCopyright ©; 2017, ООО "Консилиум Медикум"2017Consilium MedicumООО "Консилиум Медикум"https://creativecommons.org/licenses/by-nc-sa/4.0https://ter-arkhiv.ru/0040-3660/article/view/32354

The paper gives an update on the role of the gut microbiome (GM) in the development of nonalcoholic fatty liver disease, nonalcoholic steatohepatitis, alcoholic liver disease, liver cirrhosis (LC), and its complications, such as hepatic encephalopathy (HE) and hepatocellular carcinoma (HCC), and discusses the possibilities of its correction with prebiotics, probiotics, synbiotics, antibiotics, and fecal microbiota transplantation (FMT). The pathophysiology of the liver diseases in question demonstrates some common features that are characterized by pathogenic changes in the composition of the gastrointestinal tract microflora, by intestinal barrier impairments, by development of endotoxemia, by increased liver expression of proinflammatory factors, and by development of liver inflammation. In progressive liver disease, the above changes are more pronounced, which contributes to the development of LC, HE, and HCC. GM modulation using prebiotics, probiotics, synbiotics, antibiotics, and FMT diminishes dysbacteriosis, strengthens the intestinal mucosal barrier, reduces endotoxemia and liver damage, and positively affects the clinical manifestations of HE. Further investigations are needed, especially in humans, firstly, to assess a relationship of GM to the development of liver diseases in more detail and, secondly, to obtain evidence indicating the therapeutic efficacy of GM-modulating agents in large-scale, well-designed, randomized, controlled, multicenter studies.

Аннотация Представлены современные данные о роли кишечного микробиома (КМ) в развитии неалкогольной жировой болезни печени (НАЖБП), неалкогольного стеатогепатита (НАСГ), алкогольной болезни печени (АБП), цирроза печени (ЦП) и его осложнений — печеночной энцефалопатии (ПЭ) и гепатоцеллюлярной карциномы (ГЦК), а также обсуждаются возможности его коррекции с помощью пребиотиков, пробиотиков, синбиотиков, антибиотиков и трансплантации фекальной микробиоты (ТФМ). Патофизиология рассмотренных болезней печени демонстрирует некоторые общие особенности, которые характеризуются патогенными сдвигами в составе микрофлоры желудочно-кишечного тракта, нарушениями кишечного барьера, развитием эндотоксемии, повышением экспрессии печеночных провоспалительных факторов и развитием воспаления печени. При прогрессирующем заболевании печени указанные изменения более выражены, что способствует развитию ЦП, ПЭ и ГЦК. Модуляция КМ с помощью пребиотиков, пробиотиков, синбиотиков, антибиотиков и ТФМ снижает дисбактериоз, повышает барьер слизистой оболочки кишечника, уменьшает эндотоксемию и повреждения печени, позитивно влияет на клинические проявления ПЭ. Требуются дальнейшие исследования, особенно у человека, чтобы, во-первых, более детально оценить взаимосвязь КМ с развитием болезней печени, а во-вторых, получить доказательства терапевтической эффективности модулирующих КМ средств на основе проведения больших, хорошо спланированных рандомизированных контролируемых, многоцентровых исследований.

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