The dissertation presents a theoretical generalization and a new solution to the current scientific and practical problem of internal diseases, which is to improve the treatment of patients with irritable bowel syndrome (IBS), combined with obesity (Ob), based on new scientific data clinical and pathogenetic features of this comorbidity by differentiated use of atorvastatin, taking into account the C159T polymorphism of the CD14 gene.
Scientific data have been supplemented that in IBS due to diarrhea combined with obesity there is a pronounced imbalance of adipocytokines, manifested by high levels of leptin and resistin at low levels of adiponectin in the serum, accompanied by dysfunction. high levels of endothelin-1, the number of circulating exfoliated endothelial cells, with total NO and intercellular adhesion molecules ICAM-1). In patients with IBS, inhibition of urinary fibrinolytic activity and proximal reabsorption of sodium ions is observed due to the benefits of diarrhea.The TT genotype is characterized by a higher content of proinflammatory cytokines (TNFα), lower levels of anti-inflammatory cytokines (IL-10), increased CRP, more pronounced changes in the prooxidant and antioxidant blood systems (higher levels of 8-isoprostane and ceruloplasmin, local inflammation (increase in calprotectin content) and severity of endotoxicosis (higher content of medium molecules). B.Lactis, reduction of plasma proinflammatory cytokines, intoxication syndrome, lipid peroxidation, improvement of general condition of patients on the Likert scale and restoration of functional status of the kidneys with a decrease in the manifestations of tubular proteinuria and increased proximal ion reabsorption. It is specified that the differentiated use of probiotic "Alflorex" and mesalazine in the complex therapy of patients with IBS, combined with obesity taking into account the polymorphic variant of the CD 14 gene (C-159T) and the phenotype of the disease according to the proposed scheme helps to improve clinical symptoms .
It is proved that the use in the complex therapy of probiotic "Alflorex and mesalazine in patients with irritable bowel syndrome with concomitant obesity with a predominance of diarrhea in patients with the T allele of the polymorphic variant of the CD 14 gene (C-159T) leads to normalization of IL -10, TGFβ1 and medium molecules with a decrease in the level of tumor necrosis factor-α, C-reactive protein, 8-isoprostane, ceruloplasmin and calprotectin. In irritable bowel syndrome combined with obesity, the addition of probiotics and mesalazine to standard therapy significantly increases the effectiveness of therapy in patients with genotypes CT and TT.
The practical significance of the results. To predict the development of intestinal irritation syndrome in obese patients and the personalization of probiotic "Alflorex" and mesalazine to determine the genotype of the polymorphic variant of the CD14 (C-159T) gene. Patients with IBS with concomitant obesity due to diarrhea in the presence of the T allele of the polymorphic variant CD14 (C-159T) gene is recommended to add to the complex therapy probiotic "Alflorex" in a dose of 1 capsule per day in the morning after meals, drinking a glass of water and mesalazine in 1.5 g per day for four weeks. In case of predominance of constipation in patients with IBS, combined with obesity by CT and TT genotype, it is recommended to add to the complex therapy probiotic "Alflorex" in a dose of 1 capsule per day in the morning after meals, drinking a glass of water and mesalazine at a dose of 1.0 g days lasting four weeks.
