Correction of large intestine dysbiosis in patients with acute Hepatitis B

Анотація

Introduction. Viral hepatitis is one of the global challenges for modern medicine. Among them, hepatitis B (GB) remains one of the most widespread viral diseases of the present day. According to the WHO estimates, more than 1/3 of the world's population (2 billion people) has serological evidence of current or transmitted HBV infection, of which 350 million are chronically infected. Separate studies have identified the state of the colon biocenosis in patients with acute hepatitis and found that dysbiotic lesions of varying degrees are found in patients with viral hepatitis in 73.3% - 96% of cases [6-8]. Disturbances of the quantitative and qualitative composition of the microflora reduce the detoxification function of the intestine and increase the toxic load on the liver, which, in turn, negatively affects the development of the basic pathological process. The aim of the work was to determine the degree of dysbiotic changes in the microflora of the large intestine and to evaluate the effectiveness of their correction with a symbiotic drug in patients with acute hepatitis B. Materials and methods. To perform the task, 108 patients with acute hepatitis B, aged 18-69 being on hospital treatment at Kharkiv Regional Clinical Hospital of Infectious Diseases, have been examined. The diagnosis has been set on the basis of clinical anamnestic, epidemiological, laboratory and instrumental data. The etiological verification of the diagnosis has been performed by detecting specific serological markers of hepatitis B (HBsAg, HBeAg, anti-HBc IgM, by the ELISA method). The diagnosis of GHB and its clinical and pathogenetic variants of the course, form and degree of severity have been determined according to the International Statistical Classification of Diseases and Related Security Problems Health (ICD-10, version 2006). According to the purpose of study the patients have been divided into groups as follows: group A - the main one, where patients have additionally been taking symbiotic besides who the basic treatment; group B - patients to whom basic therapy has been applied. Thus, 2 groups of 54 patients have been formed. The control group, which did not differ from the groups of patients by age and gender, has been made up of 17 clinically healthy persons. For patients of group A patients we have been using symbiotic — Bifilact Extra, TM "Ariadna", Ukraine, certificate of registration No. 05.08.07 / 4089 of 02.10.2000 containing Lactobacillus acidophilus and Bifidobacterium bifidum. Determination of the qualitative and quantitative composition of microbiocenosis of the large intestine has been carried out in accordance with current normative documents as per generally accepted methods. The degree of dysbiotic disturbances was determined by V.M. Bondarenko in 2007. Microbiological studies of the material have been conducted in dynamics before the treatment and 7 days after the end of the course of treatment with the symbiotic. Statistical processing of the data was carried out using the Statistics-10 software package, Microsoft Office Excel 2003. Results. In all patients, there was an acute cyclic course of HBV infection with clinically expressed jaundice in the background of cytolysis syndrome. By results of researches of the species composition of the microflora of the colon in jaundice period of AHB, a violation of the microecology of this biotope of different degrees was found in 96.3% of patients. It turned out that the degree of dysbiotic shifts did not depend on the severity of hepatitis. About half of patients had dysbiosis of grade III. Analyzing the species composition and population level of the microflora of the colon in patients with acute hepatitis B in the jaundice period, there was elimination or severe deficiency of bifidobacteria and lactobacilli and the vegetation of opportunistic bacteria. But the most common cause of local microecology was Candida spp, it was determined in 30,8 % of the total number of identified pathogenic microorganisms. In addition, the proportion of Candida spp in violation of the microecology of the large intestine increased in the dynamics of the disease to 42.3%, which was evidenced in the period of reconvalescence. The appointment of a symbiotic resulted in a reduction in the clinical manifestations of dysbiosis in 63,0 % of patients compared to patients receiving baseline therapy. The appointment of a symbiotic resulted in a reduction the length of stay of patients of mild severity and patients of average severity in the hospital compared to patients receiving baseline therapy, p ˂ 0,05. Conclusions. By results of researches of the species composition of the microflora of the colon in jaundice period of AHB, a violation of the microecology of this biotope of different degrees was found in 96.3% of patients. About half of patients had dysbiosis of grade III. The appointment of a symbiotic resulted in a reduction in the clinical manifestations of dysbiosis in 63,0 % of patients compared to patients receiving baseline therapy. The appointment of a symbiotic resulted in a reduction the length of stay of patients of mild severity and patients of average severity in the hospital compared to patients receiving baseline therapy.