Komissarova O. Coronary artery disease associated with the intestinal dysbiosis: clinical, immunological and metabolic disorders and their correction techniques.

Object of research: Coronary artery disease (CAD) associated with intestinal dysbiosis. Subject of research: the indicators of clinical state, lipid peroxidation, oxidative stress - antioxidant defence system, immune-mediated inflammatory status; blood lipid parameters, systemic inflammatory response factors; interactions between them, and the shifts when exposed to treatment; predictors of treatment response; prediction methods of treatment response. Objectives: improvement in treatment response in patients with stable CAD accompanied by intestinal dysbiosis via optimization of the complex therapy, taking into account clinical features, lipid metabolism disorders, indicators of immune-mediated inflammation, oxidative stress and microbiota profile. Methods: clinical and anamnestic; laboratory - total cholesterol, triglycerides, low-, very low- and high-density lipoproteins, diene conjugate and malondialdehyde, catalase, superoxide dismutase, indicators of cell-mediated and humoral immunity; microbiological - stool test for dysbiosis; instrumental - electrocardiography, echocardiography; statistical. Scientific novelty of the results: for the first time predictive value of angina occurrence per week and level of CRP in assessing the prediction of treatment response was proved in patients with CAD accompanied by post-infarction cardiac fibrosis, functional class 2 chronic heart failure and stage 1 and 2 intestinal dysbiosis. The scientific insight into correlation between intestinal dysbiosis and coronary artery disease of higher severity, disorders of lipid metabolism, oxidative and immune-mediated inflammatory homeostasis of higher intensity, as well as the decrease in the activity of cellular component of immune system and neutrophil phagocytic activity with in-parallel activation of humoral immune response was broaden. For the first time it was scientifically grounded that in patients with CAD accompanied by intestinal dysbiosis, adding to the standard treatment regimen the combination of Linex pre- and probiotics, 2 capsules 3 times a day after meals and Duphalac, 15 - 30 ml during breakfast within the period of 8 weeks, leads to more outstanding positive shifts in the indicators of clinical status, intestinal microbiota, metabolic, catabolic and autoimmune homeostasis, when compared to the basic therapy outcomes. First-ever the complex synbiotic therapy in patients with CAD in early stages of intestinal dysbiosis was proved to contribute to improvement of intestinal microbiota status and has significant anti-inflammatory and antioxidant effects, evidenced by the decrease of CRP and increase of superoxide dismutase levels in blood.