Первичный склерозирующий холангит (ПСХ) является хроническим холестатическим заболеванием неизвестной этиологии, которое часто ассоциируется с воспалительными заболеваниями кишечника (ВЗК). Существуют различные теории, объясняющие возникновение ассоциированной патологии ПСХ-ВЗК. Предполагается, что кишечная микробиота играет важную роль в развитии ПСХ у больных, страдающих язвенным колитом, но в настоящее время нет единого мнения о роли микробной кишечной композиции в их этиологии и патогенезе. В обзоре освещается современный взгляд на участие кишечной микрофлоры в возникновении и развитии данной ассоциированной патологии.
Primary sclerosing cholangitis (PSC) is a chronic cholestatic disease of unknown etiology that is often associated with inflammatory bowel disease (IBD). There are various theories explaining the occurrence of associated pathology of PSC-IBD. It is assumed that the intestinal microbiota plays an important role in the development of PSC in patients with ulcerative colitis, but at present there is no consensus about the role of the microbial intestinal composition in their etiology and pathogenesis. The review highlights the modern view on the participation of intestinal microflora in the occurrence and development of this associated pathology.
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[Pazenko E.V., Raikhel'son K.L., Kondrashina E.A. et al. Osobennosti techeniia pervichnogo skleroziruiushchego kholangita, sochetaiushchegosia s vospalitel'nymi zabolevaniiami kishechnika. Eksperim. i klin. gastroenterologiia. 2017; 146 (10): 33–9 (in Russian).]
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27. Wu GD. Linking Long-Term Dietary Patterns with Gut Microbial Enterotypes. Science 2011; 334: 105–8.
28. Frank DN, St Amand AL, Feldman RA et al. Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci USA 2007; 104 (34): 13780–5.
29. Gevers D, Kugathasan S, Denson LA et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe 2014; 15 (3): 382–92.
30. Wang W, Chen L, Zhou R et al. Increased proportions of Bifidobacteriumand the Lactobacillusgroup and loss of butyrate-producing bacteria in inflammatory bowel disease. J Clin Microbiol 2014; 52 (2): 398–406.
31. Gophna U, Sommerfeld K, Gophna S et al. Differences between tissue-associated intestinal microfloras of patients with Crohn’s disease and ulcerative colitis. J Clin Microbiol 2006; 44: 4136–41.
32. Walker AW, Sanderson JD, Churcher C et al. High-throughput clone library analysis of the mucosa-associated microbiota reveals dysbiosis and differences between inflamed and non-inflamed regions of the intestine in inflammatory bowel disease. BMC Microbiol 2011; 11: 7–7.
33. Takahashi K, Nishida A, Fujimoto T et al. Reduced abundance of butyrate-producing bacteria species in the fecal microbial community in Crohn’s Disease. Digestion 2016; 93 (1): 59–65.
34. Zinkevich V, Beech I. Screening of sulfate-reducing bacteria in colonoscopy samples from healthy and colitic human gut mucosa. FEMS Microbiol Ecol 2000; 34: 147–55.
35. Png CW, Lindén SK, Gilshenan KS et al. Mucolytic bacteria with increased prevalence in IBD mucosa augment in-vitro utilization of mucin by other bacteria. Am J Gastroenterol 2010; 105 (11): 2420–8.
36. Peterson DA, Frank DN, Pace NR, Gordon JI. Metagenomic approaches for defining the pathogenesis of inflammatory bowel diseases. Cell Host Microbe 2008; 3: 417–27.
37. Kummen M, Holm K, Anmarkrud JA et al. The gut microbial profile in patients with primary sclerosing cholangitis is distinct from patients with ulcerative colitis without biliary disease and healthy controls. Gut 2017; 66 (4): 611–9.
38. Kevans D, Tyler AD, Holm KKK et al. Characterization of Intestinal Microbiota in Ulcerative Colitis Patients with and without Primary Sclerosing Cholangitis. J Crohn's Colitis 2016; 10 (3): 330–7.
39. Sabino J, Vieira-Silva S, Machiels K et al. Primary sclerosing cholangitis is characterised by intestinal dysbiosis independent from IBD. Gut 2016; 65 (10): 1681–9.
40. Torres J, Bao X, Goel A et al. The features of mucosa‐associated microbiota in primary sclerosing cholangitis. Aliment Pharmacol Ther 2016; 43 (7): 790–801.
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1. Kaplan GG. The global burden of IBD: from 2015 to 2025. Nat Rev Gastroenterol Hepatol 2015; 12 (12): 720–7.
2. Chapman RWG, Arborgh BA, Rhodes JM et al. Primary sclerosing cholangitis: a review of its clinical features, cholangiography, and hepatic histology. Gut 1980; 21 (10): 870–7.
3. Ivashkin V.T., Shirokova E.N., Maevskaia M.V. et al. Klinicheskie rekomendatsii Rossiiskoi gastroenterologicheskoi assotsiatsii i Rossiiskogo obshchestva po izucheniiu pecheni, po diagnostike i lecheniiu kholestaza. Ros. zhurn. gastroenterologii, gepatologii, koloproktologii. 2015; 2: 41–57 (in Russian).
4. Molodecky NA, Kareemi H, Parab R et al. Incidence of primary sclerosing cholangitis: a systematic review and meta-analysis. Hepatology 2011; 53 (5): 1590–9.
5. Vinnitskaia E.V., Abdulkhakov S.R., Abdurakhmanov D.T. et al. Aktual'nye voprosy diagnostiki i lecheniia pervichnogo skleroziruiushchego kholangita (po materialam Rossiiskogo Konsensusa po diagnostike i lecheniiu pervichnogo skleroziruiushchego kholangita. Moskva, 2018 g.). Terapevticheskii arkhiv. 2019; 91 (2): 8–15 (in Russian).
6. Eaton JE, Talwalkar JA, Lazaridis KN et al. Pathogenesis of primary sclerosing cholangitis and advances in diagnosis and management. Gastroenterology 2013; 145 (3): 521–36.
7. Folseraas T, Boberg KM. Cancer risk and surveillance in primary sclerosing cholangitis. Clinics Liver Dis 2016; 20 (1): 79–98.
8. De Vries AB, Janse M, Blokzijl H, Weersma RK. Distinctive inflammatory bowel disease phenotype in primary sclerosing cholangitis. World J Gastroenterol 2015; 21 (6): 1956–71.
9. Tanaka A, Takamori Y, Toda G et al. Outcome and prognostic factors of 391 Japanese patients with primary sclerosing cholangitis. Liver Int 2008; 28 (7): 983–9.
10. Pazenko E.V., Raikhel'son K.L., Kondrashina E.A. et al. Osobennosti techeniia pervichnogo skleroziruiushchego kholangita, sochetaiushchegosia s vospalitel'nymi zabolevaniiami kishechnika. Eksperim. i klin. gastroenterologiia. 2017; 146 (10): 33–9 (in Russian).
11. Goldstone R, Itzkowitz S, Harpaz N. Dysplasia is more common in the distal than proximal colon in ulcerative colitis surveillance. Inflamm Bowel Dis 2012; 18 (5): 832–7.
12. Eaton JE, Juran BD, Atkinson EJ et al. A comprehensive assessment of environmental exposures among 1000 North American patients with primary sclerosing cholangitis, with and without inflammatory bowel disease. Aliment Pharmacol Ther 2015; 41 (10): 980–90.
13. Tabibian JH, O'Hara SP, Lindor KD. Primary sclerosing cholangitis and the microbiota: current knowledge and perspectives on etiopathogenesis and emerging therapies. Scand J Gastroenterol 2014; 49 (8): 901–8.
14. Tabibian JH, O'Hara SP, Trussoni CE et al. Absence of the intestinal microbiota exacerbates hepatobiliary disease in a murine model of primary sclerosing cholangitis. Hepatology 2016; 63 (1): 185–96.
15. Tabibian JH, Weeding E, Jorgensen RA et al. Randomised clinical trial: vancomycin or metronidazole in patients with primary sclerosing cholangitis a pilot study. Aliment Pharmacol Ther 2013; 37: 604–12.
16. Paterson JC, Dillon JF. Commentary: vancomycin or metronidazole in patients with primary sclerosing cholangitis? Aliment Pharmacol Ther 2013; 37 (9): 915.
17. Davies YK, Tsay CJ, Caccamo DV et al. Successful treatment of recurrent primary sclerosing cholangitis after orthotopic liver transplantation with oral vancomycin. Case Reports Transplant 2013; 2013: 1–5.
18. Mattner J. Impact of Microbes on the Pathogenesis of Primary Biliary Cirrhosis (PBC) and Primary Sclerosing Cholangitis (PSC). Int J Molecular Sci 2016; 17 (11): 1864.
19. Grant AJ, Lalor PF, Salmi M et al. Homing of mucosal lymphocytes to the liver in the pathogenesis of hepatic complications of inflammatory bowel disease. Lancet 2002; 359: 150–7.
20. Lialiukova E.A., Livzan M.A. Disfunktsiia sfinktera Oddi i sindrom izbytochnogo bakterial'nogo rosta v kishechnike. Lechashchii vrach. 2013; 1: 61–5 (in Russian).
21. Il'chenko A.A. Zhelchnye kisloty v norme i patologii. Eksperim. i klin. gastroenterologiia. 2010; 4: 3–13 (in Russian).
22. Livzan M.A., Makeikina M.A. Vospalitel'nye zabolevaniia kishechnika: sovremennye aspekty diagnostiki i lecheniia. Gastroenterology (Suppl. Consilium Medicum). 2010; 2: 60–5 (in Russian).
23. Ng SC. Epidemiology of inflammatory bowel disease: focus on Asia. Best Pract Res Clin Gastroenterol 2014; 28: 363–72.
24. Quigley EM. Commensal bacteria: the link between IBS and IBD? Curr Opin Clin Nutr Metab Care 2011; 14 (5): 497–503.
25. Bikbavova G.R., Livzan M.A., Lopatina O.E. Vliianie defitsita mikronutrientov i pishchevykh privychek na immunnyi otvet i kishechnyi mikrobiotsenoz u bol'nykh vospalitel'nymi zabolevaniiami kishechnika: obzor. Farmateka. 2019; 26 (2): 30–5 (in Russian).
26. Bikbavova G.R., Livzan M.A., Sovalkin V.I. et al. Psikhologicheskii stress – faktor riska razvitiia iazvennogo kolita? Dokazatel'naia gastroenterologiia. 2019; 8 (2): 37–42 (in Russian).
27. Wu GD. Linking Long-Term Dietary Patterns with Gut Microbial Enterotypes. Science 2011; 334: 105–8.
28. Frank DN, St Amand AL, Feldman RA et al. Molecular-phylogenetic characterization of microbial community imbalances in human inflammatory bowel diseases. Proc Natl Acad Sci USA 2007; 104 (34): 13780–5.
29. Gevers D, Kugathasan S, Denson LA et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe 2014; 15 (3): 382–92.
30. Wang W, Chen L, Zhou R et al. Increased proportions of Bifidobacteriumand the Lactobacillusgroup and loss of butyrate-producing bacteria in inflammatory bowel disease. J Clin Microbiol 2014; 52 (2): 398–406.
31. Gophna U, Sommerfeld K, Gophna S et al. Differences between tissue-associated intestinal microfloras of patients with Crohn’s disease and ulcerative colitis. J Clin Microbiol 2006; 44: 4136–41.
32. Walker AW, Sanderson JD, Churcher C et al. High-throughput clone library analysis of the mucosa-associated microbiota reveals dysbiosis and differences between inflamed and non-inflamed regions of the intestine in inflammatory bowel disease. BMC Microbiol 2011; 11: 7–7.
33. Takahashi K, Nishida A, Fujimoto T et al. Reduced abundance of butyrate-producing bacteria species in the fecal microbial community in Crohn’s Disease. Digestion 2016; 93 (1): 59–65.
34. Zinkevich V, Beech I. Screening of sulfate-reducing bacteria in colonoscopy samples from healthy and colitic human gut mucosa. FEMS Microbiol Ecol 2000; 34: 147–55.
35. Png CW, Lindén SK, Gilshenan KS et al. Mucolytic bacteria with increased prevalence in IBD mucosa augment in-vitro utilization of mucin by other bacteria. Am J Gastroenterol 2010; 105 (11): 2420–8.
36. Peterson DA, Frank DN, Pace NR, Gordon JI. Metagenomic approaches for defining the pathogenesis of inflammatory bowel diseases. Cell Host Microbe 2008; 3: 417–27.
37. Kummen M, Holm K, Anmarkrud JA et al. The gut microbial profile in patients with primary sclerosing cholangitis is distinct from patients with ulcerative colitis without biliary disease and healthy controls. Gut 2017; 66 (4): 611–9.
38. Kevans D, Tyler AD, Holm KKK et al. Characterization of Intestinal Microbiota in Ulcerative Colitis Patients with and without Primary Sclerosing Cholangitis. J Crohn's Colitis 2016; 10 (3): 330–7.
39. Sabino J, Vieira-Silva S, Machiels K et al. Primary sclerosing cholangitis is characterised by intestinal dysbiosis independent from IBD. Gut 2016; 65 (10): 1681–9.
40. Torres J, Bao X, Goel A et al. The features of mucosa‐associated microbiota in primary sclerosing cholangitis. Aliment Pharmacol Ther 2016; 43 (7): 790–801.
Авторы
Г.Р. Бикбавова*, М.А. Ливзан, В.С. Перекопская
ФГБОУ ВО «Омский государственный медицинский университет» Минздрава России, Омск, Россия