Клінічні вияви неалкогольної жирової хвороби печінки та їхній взаємозв’язок з основними філотипами кишкової мікробіоти

Objective — to evaluate clinical manifestations in patients with non‑alcoholic fatty liver disease (NAFLD) and to trace their relationship with the main phylotypes of the gut microbiota. Materials and methods. The study included 120 patients with NAFLD and obesity grade I—III or overweight (body mass index (BMI) ≥ 25 kg/m2) and 20 healthy volunteers (control group) 23.50 [21.35; 24.78] kg/m2. Patients in the main group (n=120) were divided into two subgroups. The first subgroup included patients with NAFLD with concomitant obesity, BMI 36.50 [32.00; 40.60] kg/m2, and the second subgroup included patients with NAFLD and overweight 28.00 [27.10; 29.35] kg/m2. The groups were reciprocally distributed by age and gender (p <0.05). The degree of fibrosis, according to the METAVIR scale, was determined by measuring the average stiffness of the liver parenchyma during an ultrasound examination of the liver using shear wave elastography. The composition of the gut microbiota at the level of the main phylotypes was studied by identifying total bacterial DNA and DNA of Bacteroidetes (B), Firmicutes (F), as well as the Firmicutes/Bacteroidetes (F/B) ratio by quantitative real‑time polymerase chain reaction using universal primers for the 16S rRNA. Results. The maximum value of the F/B ratio was found in patients of the first subgroup, in which this indicator was 3.67 [1.51; 9.40] and significantly exceeded the control group by 5.7 times. Certain dynamics were also observed in patients of the second subgroup, in whom the ratio of F/B was 2.75 [1.45; 7.37] and exceeded the control group by 4.3 times (p 0.01). When analyzing clinical data in patients with NAFLD, a statistically significant dependence of the F/B ratio on the presence of complaints of bowel movements was found (according to the Craskell‑Wallis criterion; H=26.91; p <0.01). In patients with NAFLD with complaints of defecation disorders, a significant increase in the F/B ratio was observed more than 5 times. Conclusions. As a confirmation of the role of the gut microbiota in the formation of clinical manifestations in patients with NAFLD, we obtained data on the dependence of bowel movements and dyspeptic phenomena on the relative content of F, and defecation disorders — on the relative content of B, the ratio of F/B. Even though these clinical manifestations are nonspecific, a competent clinician will understand the need to diagnose NAFLD in this group of patients in the presence of the above symptoms.