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Особенности кишечной микробиоты в патогенезе и клиническом течении острого панкреатита

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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.

Ключевые слова:
поджелудочная железа, острый панкреатит, кишечная микробиота, метаболиты, предикторы инфицирования, кишечный барьер, pancreas, acute pancreatitis, intestinal microbiota, metabolites, infection predictors, intestinal barrier

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Characteristics of intestinal microbiota in the pathogenesis and clinical course of acute pancreatitis

Aim. To analyze the most promising scientific and practical directions regarding the role of intestinal microbiota and its metabolites in the pathogenesis and clinical course of acute pancreatitis.Materials and methods. The study involved a systematic literature review of the databases PubMed, EMBASE, and Cochrane for the last 20 years. A total of 5 meta-analyses, 234 clinical trials, 127 reviews, and 428 experimental studies were identified. Ultimately, 36 clinical trials, 2 reviews, and 18 experimental studies were selected for the inclusion. The systematic review was carried out in accordance with PRISMA recommendations.Results. The structure of the intestinal microbiota significantly differs in healthy control groups and patients with acute pancreatitis. The microbiota of patients with acute pancreatitis closely correlates with systemic inflammation and intestinal barrier dysfunction. Cases of severe acute pancreatitis revealed an increase in Enterococcus, Proteobacteria, Escherichia, and Shigella, alongside a decrease in overall microbiome diversity and in Bifidobacterium, Prevotella, Faecalibacterium, Blautia, Lachnospiraceae, and Ruminococcaceae. Short-chain fatty acids, the concentration of which in the blood may indicate an increase in intestinal wall permeability, are directly involved in the pathogenesis of acute lung injury associated with acute pancreatitis.Conclusion. Further study into the composition of the intestinal microbiota, its metabolites, and potential modulation strategies in various patient groups obtains high potential as a foundation for new diagnostic, therapeutic, and preventive approaches to acute pancreatitis.

Keywords:
поджелудочная железа, острый панкреатит, кишечная микробиота, метаболиты, предикторы инфицирования, кишечный барьер, pancreas, acute pancreatitis, intestinal microbiota, metabolites, infection predictors, intestinal barrier