20.500.12556/RUL-181497 ​Vpliv eradikacijske terapije okužbe s Helicobacter pylori na črevesni mikrobiom, rezistom, dejavnike tveganja za srčno-žilna obolenja in regulatorne hormone sitosti Effects of Helicobacter pylori eradication therapy on intestinal microbiome, resistome, risk factors for cardiovascular disease and body weight regulating hormones Uvod: Z bakterijo Helicobacter pylori je okuženih približno 43 % svetovnega prebivalstva. Pri okuženih povzroča aktivni kronični gastritis in v 1–3 % primerov MALT limfom ali adenokarcinom želodca. Eradikacija je priporočena pri vseh okuženih odraslih, vendar lahko vpliva na črevesni mikrobiom in rezistom. Hkrati lahko odprava kroničnega vnetja ugodno vpliva na presnovne dejavnike tveganja za srčno-žilne bolezni (SŽB). Namen: Cilj doktorske naloge je bil oceniti dolgoročni vpliv uspešne eradikacije H. pylori na črevesni mikrobiom, rezistom, dejavnike tveganja za SŽB, hormona grelin in leptin, ter opredeliti reverzibilnost sprememb po enem letu. Metode: V randomizirano prospektivno raziskavo smo med julijem 2020 in novembrom 2022 vključili 72 bolnikov, starih 20–70 let, z dokazano okužbo H. pylori. Bolniki so prejeli eno od dveh 14-dnevnih terapij (skupina 1: ezomeprazol, amoksicilin, klaritromicin; skupina 2: ezomeprazol, amoksicilin, metronidazol, koloidni bizmutov subcitrat). Po dveh mesecih smo opravili urea dihalni test. Meritve antropometričnih parametrov, lipidnega profila, trimetilamin N-oksida (TMAO), grelina, leptina ter analize mikrobioma, rezistoma in KMK so bile opravljene pred zdravljenjem, po dveh mesecih in po enem letu. Rezultati: Od 72 bolnikov je 13,9 % (10/72) izpadlo iz nadaljnjega spremljanja. Po uspešni eradikaciji je bilo zaznano značilno zmanjšanje skupnega holesterola (p = 0,003), LDL (p = 0,010), majhnih gostih LDL delcev (p = 0,037), TMAO (p = 0,048) ter serumskega grelina (p < 0,001), brez sprememb v ITM, obsegu pasu, inzulinski odpornosti ali leptinu. Alfa in beta pestrost mikrobioma sta se po dveh mesecih zmanjšali, po enem letu pa približali izhodišču. V skupini 1 smo po dveh mesecih zaznali povišanje genov, ki kodirajo odpornost proti makrolidom, vrednosti so nato upadle. Zaključek: Uspešna eradikacija H. pylori izboljša lipidni profil, zniža TMAO ter grelin, brez vpliva na telesno težo ali inzulinsko odpornost. Prehodne spremembe v mikrobiomu in rezistomu se večinoma povrnejo, kar potrjuje varnost eradikacijskega zdravljenja tudi dolgoročno. Introduction: Helicobacter pylori infects ~43% of the global population, causing active chronic gastritis in infected individuals and gastric MALT lymphoma or adenocarcinoma in 1–3% of cases. Eradication therapy is recommended for all infected adults, but may alter the gut microbiome and resistome. Conversely, resolution of chronic inflammation may improve metabolic risk factors for cardiovascular disease (CVD). Aim: The objective was to evaluate the long-term effects of successful H. pylori eradication on the gut microbiome, resistome, CVD risk factors, and the hormones ghrelin and leptin, and to determine the reversibility of changes after one year. Methods: In this randomized prospective study (July 2020–November 2022), 72 patients aged 20–70 years with confirmed H. pylori infection were enrolled. Participants received one of two 14-day regimens (group 1: esomeprazole, amoxicillin, clarithromycin; group 2: esomeprazole, amoxicillin, metronidazole, colloidal bismuth subcitrate). Treatment success was confirmed by urea breath test at two months. Anthropometric parameters, lipid profile, trimethylamine N-oxide (TMAO), ghrelin, leptin, as well as microbiome, resistome, and short-chain fatty acid analyses were performed at baseline, two months, and one year. Results: Of the 72 patients, 13.9% (10/72) were lost to follow-up. After successful eradication, significant reductions were observed in total cholesterol (p = 0.003), LDL cholesterol (p = 0.010), small dense LDL particles (p = 0.037), TMAO (p = 0.048), and serum ghrelin (p < 0.001), with no changes in BMI, waist circumference, insulin resistance, or leptin. Both alpha and beta diversity decreased at two months but approached baseline after one year. In group 1, macrolide resistance genes increased at two months, with decline at one year. Conclusion: Successful eradication of H. pylori improved lipid profiles, reduced TMAO and ghrelin, without effects on body weight or insulin resistance. Transient microbiome and resistome changes largely reverted, supporting the long-term safety of eradication therapy. Ključne besede: Helicobacter pylori eradikacija grelin dislipidemija mikrobiom rezistom Key words: Helicobacter pylori eradication ghrelin dyslipidemia microbiome resistome true false false Slovenski jezik Angleški jezik Doktorsko delo/naloga 2026-04-09 07:15:10 2026-04-09 07:15:52 2026-04-10 04:38:53 0000-00-00 00:00:00 2026 0 0 0000-00-00 NiDoloceno NiDoloceno NiDoloceno 0000-00-00 0000-00-00 0000-00-00 1970-01-01 39006 8983.pdf 8983.pdf 1 7D4DD2B15D861F936F2AA38A91FC9FED 55dd5c7f901893cc68afa310b4ff9cf927ecda0618281d0f996dca74b527fc5f fcf98f95-33d2-11f1-b0ab-0050569b8976 https://repozitorij.uni-lj.si/Dokument.php?lang=slv&id=232008 Medicinska fakulteta 0 0 0