The pathogenetic role of large intestine dysbiosis in the pathogenesis of the mutually burdened non-alcoholic fatty liver disease and chronic kidney disease

Abstract

Objective — to establish the probable influence of the microbial state of the colon cavity (MSCC) content on the degree of steatosis and liver fibrosis in patients with non-alcoholic steatohepatitis (NASH) with obesity, depending on the presence of comorbid chronic kidney disease (CKD) and its stages.Materials and methods. The study involved 168 patients with NASH, aged 42 to 55 years examined. All patients were allocated to the following groups: Group 1 consisted of 68 patients with NASH with concomitant obesity of 1st degree, Group 2 consisted of 100 patients with NASH with obesity of 1st degree and a comorbid CKD I—III stages (chronic pyelonephritis). The control groups consisted of 30 practically healthy persons (PHPs), which by age and sex were not statistically significantly different from the main group and the comparison group. Microbiocenosis of MSCC was investigated with microbiological method by sowing ten-fold dilutions of feces on differential-diagnostic nutrient media in accordance with the methodological recommendations «Microbiological diagnosis of dysbiosis» of the Ministry of Health of the USSR (1986). The main markers allowed to make conclusions about dysbiotic changes were: the type of belonging of aerobes and anaerobes, quantitative characteristic (concentration) and the frequency of growth of sown colonies. Verification of the severity of dysbiosis was carried out on the basis of the classification of I.B. Kuvaevo, K.S. Ladodo (1991).Results and discussion. The study revealed changes in the microbial state of the colon cavity (MSCC) content during the comorbid course of NASH with obesity and CKD I—III stages, characterized by the development of deep dysbiosis (II—III stages). With the appearance and prevalence of pathogenic microflora, an increase in the number of opportunistic bacteria and yeast fungi of the genus Candida, a probable deficiency of representatives of normal microbiota: lactobacilli, bifidobacteria, bacteroids. The degree of dysbiosis of MSCC correlates with the content of increases with the growth of the CKD stage, the activity of cytolysis of hepatocytes, endotoxicosis, oxidative and nitrosative stress, degree of hepatocyte steatosis and hepatic tissue fibrosis.Conclusions. An important component of the pathogenesis of non-alcoholic steatohepatitis in obese patients and CKD is metabolic intoxication, which arises as a result of a significant violation of the quantitative and qualitative composition of the microflora of MSCC with the development of deep dysbiosis (II—III stages). The degree of dysbiosis of the colon in patients with a combined course of NASH, obesity and CKD increases with the growth of the CKD stage, the degree of obesity, the activity of cytolysis of hepatocytes, endotoxicosis, oxidative and nitrosative stress, interconnected with the degree of hepatocyte steatosis and hepatic tissue fibrosis.