Violation of the Intestinal Microbiocenosis in Patients with Chronic Hepatitis C with Concomitant Type 2 Diabetes Mellitus andthe Possibility of its Correction
Introduction. In recent years, a combination of chronic hepatitis C with concomitant endocrinological pathology has been increasingly found. Today, the fact of the participation of the balance of intestinal microflora in the elimination of hepatotropic viruses is indisputable, as a result of the property of lactobacilli to change the phenotype of T-helper cells towards cellular defense. Normalization of the intestinal microflora positively affects the balance of cytokine system, function of the liver. The purpose of the study. To study the state of intestinal microflora in patients with chronic hepatitis C with concomitant type 2 diabetes and the possibility of increasing the efficiency of treatment of patients by involving lactulose drugs in complex therapy. Materials and methods. Were examined 20 patients with chronic hepatitis C without concomitant pathology (comparison group) and 167 patients with chronic hepatitis C with concomitant type 2 diabetes (main group). Depending on the treatment, 43 patients of main group were divided into 2 groups: Ia - 20 patients who received only antiviral therapy; Ib - 23 patients who were prescribed lactulose along with antiviral therapy. To determine the degree of intestinal dysbiosis, an index of dysbiosis was used.Results. In patients with chronic hepatitis C with concomitant diabetes mellitus, 4.2 times more often dysbacteriosis of the second degree was noted (63.47±3.73% of cases versus 15.00±7.98% of cases, respectively; p<0.001), and the percentage of patients with a normal balance of intestinal microflora was only 5.39±1.75% and was also significantly lower than in the comparison group (p<0.05). In our study, we found a relationship between the dysbiosis index, which was more reduced in patients of the main group (0.69±0.08 units against 0.89±0.02 units, p<0.05) and correlated with the level of IL-2 (r=+0.42; p<0.05), which may indicate the role of intestinal mirobiocenosis in the regulation of the immune response. The use of lactulose in the complex treatment also contributed to the restoration of the normal state of the intestinal microflora. Conclusion. The combined course of CHC with CD-2 was characterized by a decrease in the frequency of detection of patients with a normal balance of intestinal microflora and an increase in the frequency of detection of patients with a low level of intestinal dysbiosis. The use of lactulose preparations in such patients helped to restore the balance of intestinal biocinosis and positive dynamics in the cytokine system.