nmpЖурнал им. Н.В. Склифосовского «Неотложная медицинская помощь»Russian Sklifosovsky Journal "Emergency Medical Care"2223-90222541-8017“N.V. Sklifosovsky Research Institute for Emergency Medicine”10.23934/2223-9022-2025-14-1-132-140nmp-2083Research ArticleПРЕДВАРИТЕЛЬНОЕ СООБЩЕНИЕPRELIMINARY REPORTМикробиом начальных отделов тонкой кишки у пациентов с тяжёлым острым панкреатитом: пилотное исследованиеMicrobiome of the Initial Small Intestine in Patients With Severe Acute Pancreatitis: a Pilot Studyhttps://orcid.org/0000-0002-0170-7775КиселевВ. В.KiselyovV. V.

Киселев Владимир Валерьевич - кандидат медицинских наук, ведущий научный сотрудник отделения неотложной хирургии, эндоскопии и интенсивной терапии ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».

129090, Москва, Большая Сухаревская пл., 3

Vladimir V. Kiselyov - Candidate of Medical Sciences, Leading Researcher, Department of Emergency Surgery, Endoscopy and Intensive Care, N.V. Sklifosovsky Research Institute for Emergency Medicine.

Bolshaya Sukharevskaya Sq. 3, Moscow, 129090

kiselevvv@sklif.mos.ruhttps://orcid.org/0000-0002-7389-0476КошечкинС. И.KoshechkinS. I.

Кошечкин Станислав Игоревич - кандидат биологических наук, директор по науке ООО «Нобиас Технолоджис».

127273, Москва, ул. Березовая аллея, д. 14Б, с. 2, пом. 2/4

Stanislav I. Koshechkin - Candidate of Biological Sciences, Director for Science, Nobias Technologies.

Berezovaya Alley Str., 14B, bldg. 2, pom. 2/4, Moscow, 127273

st.koshechkin@gmail.comhttps://orcid.org/0000-0002-6617-1967КуренковА. В.KurenkovA. V.

Куренков Алексей Валерьевич - врач–эндоскопист отделения эндоскопии и внутрипросветной хирургии, ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».

129090, Москва, Большая Сухаревская пл., 3

Alexey V. Kurenkov - Physician and Endoscopist, Endoscopy and Intraluminal Surgery Department, N.V. Sklifosovsky Research Institute for Emergency Medicine.

Bolshaya Sukharevskaya Sq. 3, Moscow, 129090

oky-doker@yandex.ruhttps://orcid.org/0000-0003-1897-4033ОдинцоваВ. Е.OdintsovaV. E.

Одинцова Вера Евгеньевна - руководитель отдела анализа ООО «Нобиас Технолоджис».

127273, Москва, ул. Березовая аллея, д. 14Б, с. 2, пом. 2/4

Vera E. Odintsova - Head of Analysis Department, Nobias Technologies.

Berezovaya Alley Str., 14B, bldg. 2, pom. 2/4, Moscow, 127273

vera.odints@gmail.comhttps://orcid.org/0000-0003-4520-1124ЖигаловаМ. С.ZhigalovaM. S.

Жигалова Мария Сергеевна - кандидат медицинских наук, старший научный сотрудник отделения неотложной хирургии, эндоскопии и интенсивной терапии ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».

129090, Москва, Большая Сухаревская пл., 3

Maria S. Zhigalova - Candidate of Medical Sciences, Senior Researcher, Department of Emergency Surgery, Endoscopy and Intensive Care, N.V. Sklifosovsky Research Institute for Emergency Medicine.

Bolshaya Sukharevskaya Sq. 3, Moscow, 129090

zhigalovams@sklif.mos.ruhttps://orcid.org/0000-0002-7358-2537ТяхтА. В.TyakhtA. V.

Тяхт Александр Викторович - кандидат биологических наук, научный сотрудник ФБГУН ИГБ РАН.

119334, Москва, ул. Вавилова, 34/5

Aleksandr V. Tyakht - Candidate of Biological Sciences, Research Fellow, Institute of Gene Biology Russian Academy of Sciences.

Vavilova Str., 34/5, Moscow, 119334

a.tyakht@gmail.comhttps://orcid.org/0000-0003-3292-8789ПетриковС. С.PetrikovS. S.

Петриков Сергей Сергеевич - член-корреспондент РАН, профессор, доктор медицинских наук, директор ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ», заведующий кафедрой анестезиологии, реаниматологии и неотложной медицины Научно-образовательного института НПО им. Н.Д. Ющука ФГБОУ ВО «Российский университет медицины» МЗ РФ.

129090, Москва, Большая Сухаревская пл., 3; 127006, Москва, ул. Долгоруковская, д. 4

Sergey S. Petrikov - Corresponding Member of the RAS, Professor, Doctor of Medical Sciences, Director of N.V. Sklifosovsky Research Institute for Emergency Medicine, Head of the N.D. Yushchuk Department of Anesthesiology, Resuscitation and Emergency Medicine of the Scientific and Educational Institute of Continuous Professional Education, Russian University of Medicine.

Bolshaya Sukharevskaya Sq. 3, Moscow, 129090; Dolgorukovskaya, St. 4, Moscow, 127006

petrikovss@sklif.mos.ruhttps://orcid.org/0000-0003-1270-5414ЯрцевП. А.YartsevP. A.

Ярцев Петр Андреевич - профессор, доктор медицинских наук, заведующий научным отделением неотложной хирургии, эндоскопии и интенсивной терапии ГБУЗ «НИИ СП им. Н.В. Склифосовского ДЗМ».

129090, Москва, Большая Сухаревская пл., 3

Pyotr A. Yartsev - Professor, Doctor of Medical Sciences, Head of the Scientific Department of Emergency Surgery, Endoscopy and Intensive Care, N.V. Sklifosovsky Research Institute for Emergency.

Bolshaya Sukharevskaya Sq. 3, Moscow, 129090

yartsevpa@sklif.mos.ruГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»РоссияN.V. Sklifosovsky Research Institute for Emergency MedicineRussian FederationООО «Нобиас Технолоджис»РоссияNobias TechnologiesRussian FederationФГБУН Институт биологии гена РАНРоссияInstitute of Gene Biology Russian Academy of SciencesRussian FederationГБУЗ «Научно-исследовательский институт скорой помощи им. Н.В. Склифосовского ДЗМ»; ФГБОУ ВО «Российский университет медицины» МЗ РФ, Научно-образовательный институт непрерывного профессионального образования им. Н.Д. ЮщукаРоссияN.V. Sklifosovsky Research Institute for Emergency Medicine; Russian University of MedicineRussian Federation202515042025141132140Copyright © Киселев В.В., Кошечкин С.И., Куренков А.В., Одинцова В.Е., Жигалова М.С., Тяхт А.В., Петриков С.С., Ярцев П.А., 20252025Киселев В.В., Кошечкин С.И., Куренков А.В., Одинцова В.Е., Жигалова М.С., Тяхт А.В., Петриков С.С., Ярцев П.А.Kiselyov V.V., Koshechkin S.I., Kurenkov A.V., Odintsova V.E., Zhigalova M.S., Tyakht A.V., Petrikov S.S., Yartsev P.A.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.jnmp.ru/jour/article/view/2083ВВЕДЕНИЕ

ВВЕДЕНИЕ. Нарушение гомеостаза кишечника является ведущим фактором в патогенезе и прогрессировании системного воспаления у больных с острым тяжёлым панкреатитом. Развитие системных осложнений происходит вследствие как мезентериальной гипоперфузии и дисрегуляции моторики кишечника, так и разрушения кишечного барьера с транслокацией бактериальных тел и их субстратов. Это увеличивает риск развития полиорганной недостаточности и повышения летальности. С появлением методов высокопроизводительного секвенирования образцов микробиома — например, в формате 16S рРНК — возможности исследования структуры микробных сообществ значительно расширились. В связи с этим появляется всё больше свидетельств взаимосвязи состояния здоровья человека и микрофлоры, населяющей различные части его организма.

ЦЕЛЬ ИССЛЕДОВАНИЯ

ЦЕЛЬ ИССЛЕДОВАНИЯ. Описание состава микробиоты начальных отделов тонкой кишки у пациентов с тяжёлым острым панкреатитом.

МАТЕРИАЛ И МЕТОДЫ

МАТЕРИАЛ И МЕТОДЫ. В исследование включены 7 пациентов с диагнозом: тяжёлый острый панкреатит (6 мужчин, 1 женщина), средний возраст составил 54,1±14,4 года. Пациенты были разделены на две группы. В 1-ю группу (n=4) вошли пациенты, поступившие на 2–4-е сутки от начала болевого приступа. Во 2-ю группу (n=3) — пациенты, поступившие не позднее 24 часов от начала заболевания. Бактериальный состав образцов смывов из тощей кишки был изучен путём применения 16S РНК-секвенирования. Тяжесть состояния оценивали по интегральным шкалам APACHE II, SOFA, SAPS II. У пациентов основной группы APACHE II составила 22±2,83 балла, SOFA — 6,8±0,5 балла, SAPS II — 32,9±6,4 балла, у пациентов группы сравнения APACHE II равно 18,0±3,7 балла, SOFA — 4,0±2,6 балла, SAPS II — 24,4±5,0 балла.

Забор материала осуществляли в момент установки стерильного многофункционального интестинального катетера за связку Трейтца, не позднее 6 часов от момента поступления в отделение реанимации и интенсивной терапии. На момент проведения забора материала пациенты не получали антибактериальную терапию и энтерального питания.

РЕЗУЛЬТАТЫ

РЕЗУЛЬТАТЫ. Более тяжёлое течение было ассоциировано со сниженной представленностью в микробиоме видов Nesseria mucosa и Parvimonas micra, населяющих мукозный слой, а также Megasphaera micronuciformis. Доля родов Streptococcus (видов S. rubneri/parasanguinis/australis) и Actinomyces и ряда родов из семейства Enterobacteriaceae у таких пациентов была, наоборот, выше.

Disruption of intestinal homeostasis is a leading factor in the pathogenesis and progression of systemic inflammation in patients with acute severe pancreatitis. The development of systemic complications occurs due to both mesenteric hypoperfusion and dysregulation of intestinal motility, as well as destruction of the intestinal barrier, with translocation of bacterial bodies and their substrates. This increases the risk of developing multiple organ failure and increased mortality. With the advent of high-throughput sequencing methods for microbiome samples, for example, in the 16S rRNA format, the possibilities for studying the structure of microbial communities have expanded significantly. In this regard, there is increasing evidence of the relationship between human health and the microflora inhabiting various parts of the body.

AIM OF THE STUDY

AIM OF THE STUDY. Description of the microbiota composition of the initial sections of the small intestine in patients with severe acute pancreatitis.

MATERIAL AND METHODS

MATERIAL AND METHODS. The study included 7 patients with a diagnosis of severe acute pancreatitis (6 men, 1 woman), the average age was 54.1±14.4 years. Patients were divided into two groups. Group 1 (n=4) included patients admitted on the 2nd–4th day from the onset of a pain attack. Group 2 (n=3) included patients admitted no later than 24 hours from the onset of the disease. The bacterial composition of jejunal swab samples was studied using 16S RNA sequencing. The severity of the condition was assessed using the integral APACHE II, SOFA, SAPS II scales. In patients of the main group, APACHE II was score 22±2.83, SOFA was score 6.8±0.5, SAPS II was score 32.9±6.4, in patients of the comparison group, APACHE II was score 18.0±3.7, SOFA was score 4.0±2.6, SAPS II was score 24.4±5.0.

The material was collected at the time of insertion of a sterile multifunctional intestinal catheter behind the Treitz ligament, no later than 6 hours after admission to the intensive care unit. At the time of material collection, the patients did not receive antibacterial therapy or enteral nutrition.

RESULTS

RESULTS. More severe disease was associated with reduced representation of Nesseria species in the microbiome mucosa and parvimonas micra, inhabiting the mucosal layer, as well as Megasphaera micronuciformis. The proportion of the genera Streptococcus (species S. rubneri / parasanguinis / australis) and Actinomyces and a number of genera from the Enterobacteriaceae family in such patients was, on the contrary, higher.

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The authors declare that there are no conflicts of interest present.