Структурно-функциональные нарушения кишечного барьера и хроническая болезнь почек. Обзор литературы. Часть I

Кишечная микробиота представляет собой неотъемлемую часть человеческого организма, которая играет важнейшую роль в поддержании его гомеостаза. Мирное сосуществование с триллионами микроорганизмов во многом зависит от нормального функционирования клеточных и внеклеточных компонентов слизистой оболочки кишечника, часто называемых «кишечным барьером». Он не только защищает организм от патогенных инфекций, но и одновременно удовлетворят его потребности в переваривании и усвоении питательных веществ. Неудивительно, что изменения в структуре и функциях кишечного барьера вовлечены в патогенез множества заболеваний, в том числе различных нефропатий. Патогенетическая взаимосвязь между кишечником и почками является двунаправленной. С одной стороны, уремия влияет на состав микробиоты и целостность кишечного эпителия. Качественные и количественные изменения состав кишечной микробиоты оказывают значимое влияние на состояние барьерной функции и проницаемости кишечной стенки за счет регуляции толщины слоя слизи и ее состава, скорости циркуляции энтероцитов, а также модуляции экспрессии белков, формирующих плотные контакты. С другой, уремические токсины, образующиеся в результате аномального микробного метаболизма, способствую прогрессированию почечной дисфункции. Кроме того, дисбактериоз и синдром повышенной эпителиальной проницаемости кишки, по мнению ряда исследователей, рассматривается как одна из ведущих причин анемии, нарушений нутриционного статуса, сердечно-сосудситых и многих других осложнений, нередко выявляемых у больных с хронической болезнью почек. В I части настоящего обзора отражены современные представления относительно нормальной структуры и физиологии кишечного барьера, а также методов исследования проницаемости кишечной стенки. Делается акцент на роли микробиоты в регуляции барьерных свойств слизисто-эпителиального кишечного слоя. Представлены основные отличия микробиоты больных с различными нефропатиями от здоровых людей, обсуждаются возможные причины их возникновения.

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