Резюме
Карнаух Е.В., Базалєєва А.М. Пробіотики в корекції кишкового мікробіоценозу.
У статті представлений огляд та систематизація основних даних сучасної літератури з пробіотиків, які широко застосовуються для корекції дисбіотичних порушень кишкового мікробіоценозу у терапії дорослих та дітей.
Ключові слова: пробіотики, кишковий мікробіоценоз, дисбактеріоз.
Резюме
Карнаух Э.В., Базалеева А.Н. Пробиотики в коррекции кишечного микробиоценоза.
В статье представлен обзор и систематизация основных данных современной литературы по пробиотикам, широко применяемым для коррекции дисбиотических нарушений кишечного микробиоценоза во взрослой и детской терапии.
Ключевые слова: пробиотики, кишечный микробиоценоз, дисбактериоз.
Summary
Karnaukh E.V., Bazaleeva A.N. Probiotics in the intestinal microbiota correction.
The article presents a review and systematize the basic data of recent literature on probiotics, widely used for the correction of violations dysbiotic intestinal microbiota in adult and child therapy.
Key words: probiotics, intestinal microbiota, dysbiosis.

УДК 616.34–008.87–085.24

Probiotics in the intestinal microbiota CORRECTION

E.V. Karnaukh, A.N. Bazaleeva

Kharkiv National Medical University, 4 Lenin Avenue, Kharkiv,61022,Ukraine

проспект Ленина, 4, Харьков, 61022,Украина  Харьковский национальный медицинский университет

ella69k@mail.ru

The doctrine of the intestinal microbiocenosis has arisen in 1681, the inventor of the microscope A. Levenguk veins first discovered the bacteria in the feces of humans. We now know that in the human gut contains about 500 species of obligate, facultative and transient microorganisms, total biomass of which up to 3 kg, and the total amount of the order exceeds the total number of all cells of the human body. Biological balance between people and their microbial flora has developed evolutionarily and is an indicator of health. The biological role of intestinal biotsenotov extremely large and diverse. Normal flora of the intestine has a huge potential and metabolic exercise important biochemical processes and physiological functions (colonization resistance and direct antagonism to pathogenic and conditionally pathogenic microorganisms, digestion, trophic, energogenez, synthesis of vitamins, hormones, antibodies, neurotransmitters, immunization, detoxification, antikantserogenez) [1; 2].

Disruption of the intestinal microbiota contributes a lot of factors: the irrational and unbalanced diet (especially in childhood and old age), all inflammatory diseases of the intestinal mucosa of infectious and noninfectious nature, allergic and autoimmune diseases, fermentopathy (secondary lactase deficiency with enterocolitis or primary congenital hypo- and alaktaziya), neoblasticheskie processes, functional disorders of the gastrointestinal and biliary tracts, duration, intensity and / or irrational antibiotic or hormone therapy, nonsteroidal anti-inflammatory drugs, surgery, stay in environmentally adverse and stressful conditions (any redundant physical and mental stress). On intestinal biocenosis newborn adversely affected by factors such as complications during pregnancy and childbirth, bacterial vaginosis and mastitis in the mother, any infectious and somatic pathology, low Apgar score and resuscitation of a child later breastfeeding provokes aggressive bowel settlement resistant organisms in the nursing home, an early and inappropriate artificial feeding, the phenomenon diathesis, rickets, anemia, malnutrition [3; 4].

Polysymptom clinical manifestations and consequences of intestinal dysbiosis difficult differential diagnosis and timely adequate correction.

The concept of "intestinal dysbiosis" appeared in the period of rapid development of microbiology, when in 1916, A.Nissle proposed mean "inferior" strains of E. coli, and in 1918, he suggested the using of Escherichia coli as drug for the treatment of diarrhea.

Now under the intestinal dysbiosis understand any qualitative and quantitative changes of the intestinal normal flora. But in the laboratory studies of range of luminal feces (not the wall!) microflora of the distal colon should be interpretation not as a separate nosological form, but as a microbiological indicator, and therefore does not correctly convert bacteriological diagnosis in the clinical (in the International nosological classification of disease there is no such diagnosis).

In the foreign literature can be found such definitions as "a syndrome of excessive growth of the intestinal microflora" (bacterial overgrowth), "blind loop syndrome", "syndrome expansion of microbial growth". They all imply that the only flora in the small intestine and does not equal dysbacteriosis, by which we understand the historical changes in the microbial landscape as small intestine and colon. Besides, we can often come across the term "intestinal dysbiosis", whose adherents believe that the name "dysbacteriosis" means a violation of the bacterial flora and completely ignores the numerous representatives of protozoa, fungi and viruses, also living normally in the intestines.

Correction of a dysbiotic changes begins with the identification of the causes and treatment of the underlying disease. At this stage it is important an adequate diet. To reduce microbial contamination of the small intestine in adult practice to the use of antibiotics and intestinal antiseptic drugs, but in young children in the absence of clinical and laboratory signs of enterocolitis outlined preferably not use antibiotics, but to use of probiotics. The next stage of therapy is to restore the normal flora of the intestine with subsequent normalization of digestion, intestinal motility and detoxification of the body. [5; 6; 7].

Among the principles of treatment of intestinal dysbiosis, along with the use of immunomodulating drugs (plant adaptogens Ginseng, Eleutherococcus, Leuzea, Echinacea, Miyelopid as a peptide of the bone marrow cells of animals; Likopid as a muramildipeptide immunostimulation; Sodium nukleinat; α-interferon with cytokines - Leukinferon, Reaferon, Viferon; comprehensive immunoglobulin preparation instrumentation with high concentrations of antibodies to enterobacterias, T-Activin, Timalin, Timogen, Immunal, Immunofar and other), phagotherapy (advanced domestic direction of strain-specific bacteriophages with bactericidal action for the treatment of dysbiosis and acute intestinal infections), enzymes and adsorbents, but probiotics and prebiotics are primary importance [8; 9; 10].

F. Vergio in 1954 for the first time in his book «Anti- und Probiotika» made ​​a comparison of different compounds with antimicrobial as well as positive effects on the intestinal microflora, and coined the term "probiotics." Lilly and Stillwell in 1965 offered this term mean living microbes, enhancing the growth of other microorganisms. Already at the beginning of the XX century I.I.Mechnikov made ​​yogurt with live acidophilus bacteria. [11].

Probiotics (eubiotics) - are the live (freeze-dried) apatogenic strains of intestinal bacteria of normal flora of healthy human contained in drugs or food. Prebiotics – are the nondigestible food ingredients or waste products of normal intestinal bacteria for stimulation the growth and functional activity of the intestinal normal flora (lysozyme, lactulose, inulin, oligosaccharides, glycoproteins, vitamins, organic acids) [12; 13].

Probiotics are classified by generations on incomplete of the drug:

Probiotics of the I generation (Fig. 1) are used as monopreparations (with Bifidobacterium, Lactobacillus, Escherichia) for the prevention of disease or for the correction of the microflora in dysbiosis of I degree. In the treatment of acute intestinal infection this probiotics use with other biological drugs and sorbents.

Probiotics of the II generation (Fig. 2) consists of a spore bacillus (Bacillus subtilis, Bacillus licheniformis, Bacillus cereus) and yeasts Saccharomyces boulardii. Spore preparations contain strain IP-5832 (Bactisubtil, Flonivin), or in the form of hay stick strains 3H (Baktisporin) and 534 (Sporobacterin), or in combination with lihienia bacilli (Biosporin). The preparation Enterol contains of yeasts Saccharomyces. The Esterozhermina contains spores Bacillus clausii. These probiotics are not obligate human microflora. Once in the gastrointestinal tract, they competitively displace pathogenic and conditionally pathogenic bacteria, but do not then gut colonization. These antagonists are themselves eliminated and prescribed for light and medium-severe forms of acute intestinal infections, acute noninfectious diarrhea, subcompensated dysbacteriosis, usually a short course of 5-7 days, with subsequent follow-up care probiotics of the normal microflora. Enterol recommended for the treatment of diarrhea after antibiotic, as proved its antagonistic activity against clostridia.

Probiotics of the III generation are multicomponent and combination drugs. This may be probiotics-simbiotiks (Fig. 3) consisting of several strains of symbiotic one (Acilakt, Acipol) or different species, reinforcing each other's action (Linex, Bifiform, Bifilong, Symbiter, Hilak forte). Combination synbiotics (Fig. 4) in addition to active prebiotic bacteria contain special additives that promote their growth, reproduction and metabolic activity: bifidogenic lactose monosaccharide or a factor of nonspecific protection lysozyme (Bifiliz, Kipatsid, Acipol), lactulose (Bifiform) polysaccharide from the kefir fungus as immunomodulation substance (Acipol), carob extract for the normalized intestinal motility (Bifiform), hyaluronic acid with anti-inflammatory action (Gialakt), a comprehensive immunoglobulin in combination with L.acidophilus (Kipatsid). These probiotics are appointed with acute intestinal infections medium-heavy form at dysbacteriosis with chronic gastroenterological diseases.

Probiotics of the IV generation (Fig. 5) are live B.bifidum1 (Bifidumbacterin forte, Probifor) or B.bifidum1+L.plantarum 8RA-3 (Florin forte), adsorbed (immobilized) on particles of crushed charcoal. Number of bifidobacteria in Probifor order of magnitude greater than Bifidumbacterin forte. Through this structure immobilized sorbed bifidobacteria effectively colonize the intestinal mucosa, and compared to nonsorbed counterparts have a more pronounced protective effect - as quickly and efficiently inhibit pathogenic and conditionally pathogenic microorganisms, and restore the balance of the protective microflora. In clinic this is reflected in the reduction of the duration of diarrhea and intoxication, rapid normalization of stool and relieve pain. These probiotics are clinically proven antidiarrheal and detoxifying effects, and are used to correct microflora in disbakterios varying degrees and genesis (even short 3-5-days courses of Bifidumbacterin forte or Probifor in increased doses significantly reduce the frequency of recurrent respiratory infections). Contraindications for high-dose lactase deficiency is not recommended for rotavirus gastroenteritis in children.

The newest V generation of recombinant representative of probiotics obtained by genetic engineering is Subalin. It is created by a group of Ukrainian scientists SIL "Vector", based on the strain Bifidobacterium subtilis 2335/105, a recombinant plasmid containing the gene of human α₂-interferon (deponised in collection of industrial microorganisms), and has no analogues in the world medical practice. Exhibits polytropic therapeutic effect (immunomodulation, antibacterial, antiviral and anti-cancer action).

Probiotics can be shared not only by the completeness of the drug, but also by the generic composition of their constituent bacteria. Allocated probiotics with Bifidobacterium (Fig. 6), probiotics with Lactobacillus (Fig. 7), probiotics with Escherichia coli (Colibacterin, Bifikol, Bioflor), probiotics from the genera Bacillus, Aerococcuses and yeasts Saccharomyces (Bactisubtil, Baktisporin, Sporobacterin, Biosporin, Enterol). Enterococci contain only imported probiotics Simbioflor, Linex, Bifiform, Hilak forte (Fig. 8).

Among imported and domestically produced probiotics many registered as the food biologically active additives (BAA), and haven’t the status of the drug (Vitanar, Biobakton, Floradofilyus, Primadofilyus, Polibakterin, Gialakt).

Unfortunately, more than 20% of tested expensive brands do not contain the labeled amount of living organisms, many production strains are adapted to the long-term persistence in the human body for a long time and are not able to colonize the colon. The principal drawback of foreign manufacturers of probiotics is unadjusted strains used in them for a population of people of Ukraine. When improperly applying even the best probiotic can cause serious complications (allergic reactions, cytokine dysbalance, cholelithiasis and urolithiasis, obesity, cancer of Prostata) [1; 5; 6; 10; 14].

So, data of modern literature about the popularity and clinical expediency of the pharmacological group of probiotics to correct violations dysbiotic intestinal microbiota (dysbiosis different stages) in adult and child therapy. Presented systematization of probiotics on five generations of descent composition of the microbiota within them, the data on manufacturers, different forms of production and price category are of practical interest for the selection of adequate preparation for the restoration of the intestinal normal flora for each clinical case.

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