Science and Innovations in MedicineScience and Innovations in Medicine2500-13882618-754XFSBEI of Higher Education SamSMU of Ministry of Health of the Russian Federation4376610.35693/2500-1388-2019-4-1-53-57Research ArticleNew approach to assessment and correction of intestinal microbiome imbalance in children with atopic dermatitisPechkurovDmitrii Vladimirovich<p>PhD, Professor, Head of the Department of Childhood Diseases of SamSMU</p>dmpechkurov@yandex.ruhttps://orcid.org/0000-0002-5869-2893ZaynullinaOlesya N.<p>PhD, assistant of Dermatovenerology Department with Dermatovenerology and Cosmetology Courses of the Institute of Postgraduate Education of BSMU</p>olisenok@mail.ruhttps://orcid.org/0000-0002-6366-3595TyazhevaAlena A.<p>PhD, assistant of Department of Childhood Diseases of SamSMU.</p>aatyajeva@mail.ruhttps://orcid.org/0000-0001-8552-1662LyaminArtem V.<p>PhD, Associate Professor of General and Clinical Microbiology, Immunology and Allergology Department of SamSMU.</p>avlyamin@rambler.ruSamara State Medical UniversityBashkir State Medical University1503201941535708092020Copyright © 2019, Pechkurov D.V., Zaynullina O.N., Tyazheva A.A., Lyamin A.V.2019<p><strong>Objectives</strong> to study intestinal microbiota species for differentiated approach to treatment of atopic dermatitis (AD) in children.</p>
<p><strong>Material and methods.</strong>The study included 60children, 34 girls and 26 boys aged from 3 to 12 years, with AD and concurrent intestinal dysbiosis. The experimental group consisted of 30 children assigned to differentiated correction of intestinal microbiome imbalance in addition to the standard therapy. Correction mode depended on the results of microbiological fecal examination of microbiota species using the mass spectrometry. The control group of 30 children received the standard treatment of atopic dermatitis.</p>
<p><strong>Results.</strong>Gut microbiome imbalance of different severity was revealed in all children with AD. The study ascertained the increase of the enterobacteria of various types, including true pathogenic ones, in atopic dermatitis. The direct correlation was revealed between the AD severity and the degree of dysbiosis with the coefficient value 0.69. As a result of complex treatment in the experimental group, the ratio of children with severe dysbiosis reduced from 60.0% to 20.0%, the proportion of children with moderate dysbiosis also decreased from 26.6% to 20.0%.</p>
<p>The reduced treatment time was one of the study outcomes: 14 days in the experimental group and 21 days in the standard therapy group. Clinical remission was observed in 26.7% of children.</p>
<p><strong>Conclusion.</strong>The study supported the rationale for the differentiated approach to the treatment of AD in children. The preliminary microbiological study of feces for microbiota species by MALDI-ToF mass spectrometry is necessary. Selection of probiotics depends on the deficit or overbalance of the specific types of microorganisms in a patient. Thus the treatment effectiveness is improved and the remission period is extended.</p>atopic dermatitisintestinal microflorachildrenатопический дерматитмикрофлора кишечникадети[Намазова-Баранова Л.С., Баранов А.А., Кубанова А.А. и др. Атопический дерматит у детей: современные клинические рекомендации по диагностике и терапии. Вопросы современной педиатрии. 2016;15(3):279–294. [Namazova-Baranova LS, Baranov AA, Kubanova AA et al. Atopic dermatitis in children: modern clinical guidelines for diagnosis and therapy. Voprosy sovremennoj pediatrii. 2016;15(3):279–294. (In Russ.)]. doi: 10.15690/vsp.v15i3.1566][Литяева Л.А., Носырева С.Ю. Особенности формирования кишечной микробиоты у детей с наследственной предрасположенностью к аллергическим заболеваниям. Актуальная инфектология. 2016;2(11):151–153. [Lityaeva LA, Nosyreva SYu. Peculiarities of the formation of the intestinal microbiota in children with hereditary predisposition to allergic diseases. Aktualnaya infektologiya. 2016;2(11):151–153. (In Russ.)].][Aagaard K, Ma J, Antony KM et al. The placenta harbors a unique microbiome. Sci. Transl. Med. 2014;6:237. doi: 10.1126/scitranslmed.3008599][Смирнова Г.И. Современные принципы патогенетической терапии атопического дерматита у детей. Вопросы современной педиатрии. 2006;5(2):50–6. [Smirnova GI. Modern principles of pathogenetic therapy of atopic dermatitis in children. Voprosy sovremennoj pediatrii. 2006;5(2):50–6. (In Russ.)].][Зайнуллина О.Н, Печкуров Д.В., Хисматуллина З.Р. Роль и особенности микробиоценоза кишечника у детей с атопическим дерматитом. Медицинский вестник Башкортостана. 2017;12.4(70):109–115. [Zaynullina ON, Pechkurov DV, Khismatullina ZR. The role and features of intestinal microbiocenosis in children with atopic dermatitis. Medicinskij vestnik Bashkortostana. 2017;12.4(70):109–115. (In Russ.)].][Печкуров Д.В., Турти Т.В., Беляева И.А., Тяжева А.А. Микробиота кишечника у детей: от профилактики нарушений к предупреждению неинфекционных заболеваний. Педиатрическая фармакология. 2016;13(4):377–383. [Pechkurov DV, Turti TV, Belyaeva IA, Tyazheva AA. Microbiota in children: from prevention to prevention of noncommunicable diseases. Pediatricheskaya farmakologiya. 2016;13(4):377–383. (In Russ.)]. doi: 10.15690/pf.v13i4.1611][Сенцова Т.Б., Денисова С.Н., Белицкая М.Ю. и др. Мукозальный иммунитет и микрофлора кишечника в патогенезе атопического дерматита у детей. Вопросы детской диетологии. 2010;8:20–28. [Sencova TB, Denisova SN, Belickaya MYu et al. Mucosal immunity and intestinal microflora in the pathogenesis of atopic dermatitis in children. Voprosy detskoj dietologii. 2010;8:20–28. (In Russ.)].][Kamada N, Nunrez G. Role of microbiota in development and function of lymphoid cells. J. Immunil. 2013;190(4):1389–1395. doi: 10.4049/jimmunol.1203100][Дисбиоз кишечника. Руководство по диагностике и лечению. Под ред. Ткаченко Е.И., Суворова А.Н. СПб: ИнформМед, 2009. [Disbioz kishechnika. Rukovodstvo po diagnostike i lecheniyu. Eds. Tkachenko EI, Suvorov AN. SPb: InformMed, 2009. (In Russ.)].][Nomura F. Proteome-based bacterial identification using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS): A revolutionary shift in clinical diagnostic microbiology. Biochim Biophys Acta. 2015;1854(6):528–537.][Мигачева Н.Б., Печкуров Д.В., Зайнуллина О.Н. Иммунологические эффекты пробиотиков в профилактике аллергических заболеваний у детей. Вопросы детской диетологии. 2016;14(6):25–32. [Migacheva NB, Pechkurov DV, Zainullina ON. Immunological effects of probiotics in the prevention of allergic diseases in children. Voprosy detskoj dietologii. 2016;14(6):25–32. (In Russ.)].][Чикин В.В., Знаменская Л.Ф., Монахов К.Н. и др. Федеральные клинические рекомендации по ведению больных атопическим дерматитом. Российское общество дерматовенерологов и косметологов. М., 2013. [Chikin VV, Znamenskaya LF, Monahov KN et al. Federal'nye klinicheskie rekomendacii po vedeniyu bol'nyh atopicheskim dermatitom. Rossijskoe obshchestvo dermatovenerologov i kosmetologov. M., 2013. (In Russ.)]. URL: http://www.cnikvi.ru/docs/clin_recs/bolezni-kozhi-i- pridatkov-kozhi/][Отраслевой стандарт «Протокол ведения больных. Дисбактериоз кишечника» (ОСТ 91 500.11.0004-2003). М., 2003. [Otraslevoj standart "Protokol vedeniya bol'nyh. Disbakterioz kishechnika" (OST 91 500.11.0004-2003). M., 2003. (In Russ.)].]