Метаболизм микробиоты при критических состояниях (обзор и постулаты)

В данном обзоре обсуждается вопрос, почему нужно изучать механизмы действия и учитывать метаболизм микробиоты в организме тяжелобольного пациента, и каким образом специалисты в области клинического питания могут принять в этом самое активное участие

При критических состояниях дисрегуляция эндогенных обменных процессов и белково-энергетический дефицит усугубляются изменением направленности метаболических процессов микробиоты. Растет понимание важности изучения микробного метаболизма в общем метаболическом процессе. Перспективность развития этого направления для повышения эффективности лечения в реаниматологии и успешной реабилитации пациентов очевидна.

Существующие международные рекомендации по интенсивной терапии со временем могут быть пересмотрены в связи с появлением новых научных данных о механизмах критических состояний, связанных с метаболической активностью микробиоты человека. Идет поиск способов активного управления метаболическими процессами через подчинение метаболизма бактерий интересам хозяина. И антимикробные, и биопрепараты (пребиотики, метабиотики) в перспективе будут применяться целенаправленно, под контролем ключевых микробных метаболитов, с использованием доступных методов лабораторного мониторинга.

На основе данных литературы и результатов собственных исследований автор формулирует постулаты о метаболизме микробиоты при критических состояниях, вводит понятия «дисфункции невидимого органа» и «сигнальных молекул бактерий», отвечает на вопрос «что делать?» и в качестве интегрального показателя предлагает использовать ряд микробных метаболитов ароматических аминокислот.

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