Аннотация
В настоящее время хронический тонзиллит (ХТ) продолжает занимать одно из ведущих мест в общей структуре ЛОРпатологии. Основой для интегрального подхода к проблеме с позиции всего организма к возможному решению проблемы ХТ служит вышедшая в свет из стен НИКИО им. Л.И.Свержевского унитарная концепция эпителиально-эндотелиального дистресс-синдрома (ЭЭДС). К настоящему времени известны механизмы обеспечения микробиомом (МБ) гомеостаза и поддержания здоровья, а также активного его участия в системном вялотекущем воспалении и обусловленных им заболеваниях. Нарушение сбалансированности МБ организма сопровождается эндотоксинемией, которая приводит к формированию эндотоксиновой хронической агрессии и поддерживает хроническое системное воспаление.
Цель исследования. Расширение представлений о системных этиопатогенетических механизмах развития ХТ, а также повышение достоверности критериев диагностики и эффективности профилактики и лечения ХТ с помощью технологии микробиом-ассоциированной метаболомики и метаэкспосомики.
Материалы и методы. Комплексно обследованы 60 пациентов со всеми формами ХТ по классификации Б.С.Преображенского – В.Т.Пальчуна с использованием технологии микробиом-ассоциированной метаболомики и метаэкспосоники биотопов ротоглотки, кишечника и инициированной системной эндотоксинемии.
Результаты. Выявлены дисбалансы микробиоценозов ротоглотки и кишечника у пациентов с ХТ характеризующиеся ответным подавлением функциональной активности анаэробной части микрофлоры ротоглотки и увеличению протеолитической активности микрофлоры кишечника. Данные изменения у пациентов с ХТ всех форм сопровождаются повышением эндотоксина в слюне и крови, что инициирует и поддерживает хроническое системное воспаление.
Выводы. Теория ЭЭДС позволяет определить и выделить ключевые механизмы этиопатогенеза ХТ, а также полученные результаты подтверждают необходимость комплексного и системного исследования взаимодействия макроорганизма и микробиома методами ОМИК-технологий в биотопах ротоглотки и кишечника у пациентов с ХТ.
Annotation
Currently, chronic tonsillitis (CT) continues to occupy one of the leading places in the general structure of ENT pathology. The basis for an integral approach to the problem from the position of the whole organism to a possible solution to the problem of CT is the one published from the walls of NIKIO named after. L.I. Sverzhevsky’s unitary concept of epithelial-endothelial distress syndrome (EDDS). To date, the mechanisms for ensuring homeostasis and maintaining health by the microbiome (MB), as well as its active participation
in systemic low-grade inflammation and related diseases, are known. An imbalance in the body's MB is accompanied by endotoxemia, which leadsto the formation of chronic endotoxin aggression and maintains chronic systemic inflammation.
Objective. Expanding the understanding of the systemic etiopathogenetic mechanisms of the development of CT, as well as increasing the reliability of diagnostic criteria and the effectiveness of prevention and treatment of CT using the technology of microbiome-associated metabolomics and metaexposomics.
Materials and methods. 60 patients with all forms of CT according to the classification of B.S. Preobrazhensky — V.T. Palchun were comprehensively examined using the technology of microbiome-associated metabolomics and metaexposonics of biotopes of the oropharynx, intestines and initiated systemic endotoxemia.
Results. Imbalances in the microbiocenoses of the oropharynx and intestines were identified in
patients with CT, characterized by a response suppression of the functional activity of the anaerobic part of the microflora of the oropharynx and an increase in the proteolytic activity of the intestinal microflora. These changes in patients with CT of all forms are accompanied by an increase in endotoxin in saliva and blood, which initiates and maintains chronic systemic inflammation.
Conclusions. The theory of EDS makes it possible to identify and highlight the key mechanisms of the etiopathogenesis of CT, and the results obtained confirm the need for a comprehensive and systematic study of the interaction between the macroorganism and the microbiome using OMIK-technologies in biotopes of the oropharynx and intestines in patients with CT.
Key words: chronic tonsillitis; oropharyngeal microbiocenosis; intestinal microbiocenosis; bacterial endotoxin; endotoxemia
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