Влияние кишечной микробиоты на развитие инсулинорезистентности

Инсулинорезистентность (ИР) – важная проблема человечества, ведущая к развитию многих метаболических нарушений. Патогенетический механизм развития ИР в настоящее время полностью не изучен. Тем не менее существует ряд гипотез, объясняющих развитие данного состояния. К ним относятся такие гипотезы, как гипотеза бережливого генотипа, бережливого фенотипа, гормональная, стрессовая, хороших и плохих калорий, хронического метаболического воспаления, микробиотическая и комплексная модель, предложенная профессором Райнером Штраубом. В данной статье подробно рассмотрена микробиотическая теория, которая объясняет механизм развития нечувствительности периферических тканей к инсулину при дисбиозе за счет увеличения трансмиссии провоспалительных молекул из кишечника в кровоток и активации системного воспаления, нарушения механизма «кишечник – мозг – периферия» и нарушения рецепторных взаимодействий активных метаболитов кишечной микробиоты (КМ) на уровне клеток метаболических органов. Ценность данной теории состоит в том, что ее факторы воздействуют на все звенья патогенеза развития ИР, отраженные в интегрированной комплексной модели профессора Штрауба. В обзоре подробно рассмотрено взаимовлияние КМ и метаболических процессов организма человека на развитие ИР, приведены данные клинических исследований влияния КМ (ее состава, активных метаболитов, отдельных штаммов бактерий) на развитие ИР и роли хронического метаболического воспаления в данном процессе. Кроме этого, уделено внимание двунаправленным влияниям КМ и метформина, приведены данные клинических исследований об изменении КМ здоровых людей и людей с ИР под воздействием метформина. Рассмотрено, как КМ влияет на фармакокинетику данного препарата. Также показана возможность коррекции ИР путем использования пищевых волокон.

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