Патогенетические аспекты нарушений метаболома кишечника и эндотоксемии у лиц высокого кардио-метаболического риска

Abstract

Aim. To study the relationship between the functional activity of the intestinal microbiota and endotoxemia with impaired gastrointestinal motility and excessive bacterial growth in patients with metabolic syndrome (MS). Materials and methods. 64 patients with MS were examined. Comprehensive examination included collection of complaints, anamnesis of the disease, questionnaires on actual nutrition, clinical examination, anthropometric study, assessment of indicators of carbohydrate and lipid metabolism, a marker of systemic inflammatory response of the body (CRP) in the blood. Determination of the blood endotoxin level, quantitative and qualitative composition of the parietal microbiota of the small intestine was carried out on an Agilent gas chromatograph with mass selective and flame ionization detectors (Agilent Technologies, USA). A chromatographic study of metabolites of microorganisms (SCFA) in coprofiltrate was carried out. The motor function of the gastrointestinal tract (GIT) was studied using peripheral electrogastroenterocolography using a Gastroscan-GEM device. The control group consisted of 30 apparently healthy individuals aged from 18 to 62 years. Statistical processing of the obtained results was carried out using the Statistica 6.1 software. Results. In 82.9% of the examined patients with MS, clinical signs of intestinal lesions were noted. The electrical activity of the MC departments in the postprandial period was low in 70% of patients. It was found that with MS with a decrease in the daily consumption of dietary fiber in the composition of the diet, the BMI value increases, the energy value of the diet and the use of simple carbohydrates increase. During the analysis of the main biochemical blood constants, it was possible to establish that MS is accompanied by a violation of carbohydrate and lipid metabolism. The CRP level was statistically significantly different from the CG in MS regardless of the degree of excess body weight, while a direct correlation of moderate strength was established between the BMI values and the CRP level. During the chromatographic study of metabolites of microorganisms in feces, it was possible to establish statistically significant differences in the profile and concentration of short-chain fatty acids (SCFA) of persons with MS, both in comparison with CG and in comparison with groups with different BMI values. According to the results of the study of the blood endotoxin level in patients with MS, its significant increase was revealed, more than 6 times, in comparison with the CG. The electrical activity of the colon on an empty stomach was unchanged, but decreased after a food load. Discoordination of motility is observed between the small intestine (SI) and the large intestine, aggravated after food stimulation. A significant decrease in the rhythm of contractions is observed at the frequencies of the jejunum, ileum, and colon both on an empty stomach and in the postprandial period, which indicates a weakening of propulsive bowel contractions in patients with MS. In patients with MS, excessive bacterial growth in MC is observed mainly due to opportunistic microbiota strains. Correlation analysis showed a moderate negative relationship between endotoxin levels and MC electrical activity, between endotoxin levels and the colon-to-ileum ratio. Conclusion. The study of the level of endotoxin, intestinal microbiota metabolites (SCFA), indicators of bacterial overgrowth, motor-evacuation functions of the gastrointestinal tract made it possible to identify important pathogenetic patterns concerning the contributing role of the latter in the development of endotoxemia and intestinal metabolic disorders in patients with MS.