gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2025-35-3-81-93gastro-j-1585Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESОтношение нейтрофилов к лимфоцитам как микробиота-зависимый показатель иммунной дисфункции и фактор долгосрочного прогноза у больных циррозом печениNeutrophil-to-Lymphocyte Ratio as a Microbiota-Dependent Indicator of Immune Dysfunction and a Long-Term Prognostic Factor in Patients with Cirrhosishttps://orcid.org/0000-0002-1323-1751ЦветаеваЕ. К.TsvetaevaE. K.

Цветаева Екатерина Кирилловна — аспирант кафедры пропедевтики внутренних болезней

119991, г. Москва, ул. Погодинская, 1, стр. 1

Ekaterina K. Tsvetaeva — Postgraduate at the Department of Internal Medicine Propedeutics

19991, Moscow, Pogodinskaya str., 1, build. 1

vrachishka89@mail.ruhttps://orcid.org/0000-0001-7513-1636МасленниковР. В.MaslennikovR. V.

Масленников Роман Вячеславович — кандидат медицинских наук, доцент кафедры пропедевтики внутренних болезней, гастроэнтерологии и  гепатологии

119435, г. Москва, ул. Погодинская, 1, стр. 1

Roman V. Maslennikov — Cand. Sci. (Med.), Associate Professor of the Department of Internal Disease, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, build. 1

mmmm00@yandex.ruhttps://orcid.org/0000-0001-5939-1032ЖарковаМ. С.ZharkovaM. S.

Жаркова Мария Сергеевна — кандидат медицинских наук, заведующая отделением гепатологии Клиники пропедевтики внутренних болезней, гастроэнтерологии, гепатологии им. В.Х. Василенко

119435, г. Москва, ул. Погодинская, 1, стр. 1

Maria S. Zharkova — Cand. Sci. (Med.), Head of the Hepatology Department, V.Kh. Vasilenko Clinic of Internal Disease Propaedeutics, Gastroenterology and Hepatology

119435, Moscow, Pogodinskaya str., 1, build. 1

zharkova_maria_s@staff.sechenov.ruhttps://orcid.org/0000-0003-1312-120XПолуэктоваЕ. А.PoluektovaE. A.

Полуэктова Елена Александровна — доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней, гастроэнтерологии и  гепатологии

 119991, г. Москва, ул. Погодинская, 1, стр. 1 

Elena A. Poluektova — Dr. Sci. (Med.), Professor of the Department of Internal Disease, Gastroenterology and Hepatology 

119991, Moscow, Pogodinskaya str., 1, build. 1 

polouektova@rambler.ruhttps://orcid.org/0000-0002-6493-8378КрасновГ. С.KrasnovG. S.

Краснов Георгий Сергеевич — кандидат биологических наук, старший научный сотрудник лаборатории молекулярной биологии

119991, г. Москва, ул. Вавилова, 32

Georgiy S. Krasnov — Cand. Sci. (Med.), Senior Researcher at the Laboratory of Molecular Biology

119991, Moscow, Vavilova str., 32 

gskrasnov@mail.ruhttps://orcid.org/0000-0002-3722-8207КудрявцеваА. В.KudryavtsevaA. V.

Кудрявцева Анна Викторовна — доктор биологических наук, заведующая лабораторией молекулярной биологии, заместитель директора

119991, г. Москва, ул. Вавилова, 32

Anna V. Kudryavtseva — Dr. Sci. (Biol.), Head of the Laboratory of Molecular Biology, Deputy Director

119991, Moscow, Vavilova str., 32 

risamoeba@rambler.ruhttps://orcid.org/0000-0002-6815-6015ИвашкинВ. Т.IvashkinV. T.

Ивашкин Владимир Трофимович — доктор медицинских наук, академик РАН, профессор, заведующий кафедрой пропедевтики внутренних болезней, гастроэнтерологии и гепатологии

119991, г. Москва, ул. Погодинская, 1, стр. 1

Vladimir T. Ivashkin — Dr. Sci. (Med.), Professor, Academician of the Russian Academy of Sciences, Head of the  Department of Propaedeutics of Internal Diseases,Gastroenterology and Hepatology

119991, Moscow, Pogodinskaya str., 1, build. 1

ivashkin_v_t@staff.sechenov.ruФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Министерства здравоохранения Российской Федерации (Сеченовский Университет)РоссияI.M. Sechenov First Moscow State Medical University (Sechenovskiy University)Russian FederationФГБУН «Институт молекулярной биологии им. В.А. Энгельгардта» Российской академии наукРоссияEngelhardt Institute of Molecular Biology of the Russian Academy of SciencesRussian Federation2025130820253538193Copyright © Цветаева Е.К., Масленников Р.В., Жаркова М.С., Полуэктова Е.А., Краснов Г.С., Кудрявцева А.В., Ивашкин В.Т., 20252025Цветаева Е.К., Масленников Р.В., Жаркова М.С., Полуэктова Е.А., Краснов Г.С., Кудрявцева А.В., Ивашкин В.Т.Tsvetaeva E.K., Maslennikov R.V., Zharkova M.S., Poluektova E.A., Krasnov G.S., Kudryavtseva A.V., Ivashkin V.T.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/1585

Цель: оценить отношение нейтрофилов к лимфоцитам как микробиота-зависимый показатель иммунной дисфункции и фактор долгосрочного прогноза у больных циррозом печени.Материалы и методы. В проспективное исследование были включены 47 пациентов с циррозом печени. Кишечная микробиота изучена с помощью секвенирования гена 16S рРНК. Долгосрочный прогноз для жизни был оценен в течение периода наблюдения длительностью 4 года, среднесрочный — 1 год.Результаты. За 4-летний период наблюдения из 47 пациентов, включенных в исследование, умерли 15 пациентов, в том числе 6 в течение первого года. У умерших пациентов отношение нейтрофилов к лимфоцитам было выше, чем у выживших. Это было справедливо как в отношении долгосрочного, так и в отношении среднесрочного прогноза (р = 0,021 и р = 0,048 соответственно). При проведении многофакторного регрессионного анализа высокие цифры отношения нейтрофилов к лимфоцитам и низкий уровень альбумина в крови были независимыми предикторами летального исхода при оценке долго- и среднесрочного прогноза. Отношение нейтрофилов к лимфоцитам обратно коррелировало с содержанием в кишечной микробиоте Roseburia, Alistipes, Rikkenellaceae, Parabacteroides, Robinsoniella, Paraprevotella, Odoribacter и прямо коррелировало с совокупным уровнем бактерий, которые образуют этанол. Значение отношения нейтрофилов к лимфоцитам значимо не различалось между пациентами, принимавшими и не принимавшими глюкокортикостероиды.Выводы. Отношение нейтрофилов к лимфоцитам коррелирует с содержанием в кишечной микробиоте про- и противовоспалительных таксонов, а также является независимым фактором, определяющим средне- и долгосрочный прогноз у пациентов с циррозом печени.

Aim: to evaluate the neutrophil-to-lymphocyte ratio (NLR) as a microbiota-dependent indicator of immune dysfunction and a long-term prognostic factor in patients with cirrhosis.Materials and methods. A prospective study included 47 patients with cirrhosis. Gut microbiota was analyzed using 16S rRNA gene sequencing. Long-term survival prognosis was assessed over a 4-year follow-up period, and medium-term survival prognosis was assessed over 1 year follow-up period.Results. During the 4-year follow-up period, 15 patients died, including 6 who died within the first year. Deceased patients had a higher neutrophil-to-lymphocyte ratio compared to survivors. This was significant for both long-term and medium-term prognoses (p = 0.021 and p = 0.048, respectively). Multivariate regression analysis identified a high NLR and low serum albumin levels as independent predictors of mortality for both long- and medium-term outcomes. The NLR was inversely correlated with the abundance of Roseburia, Alistipes, Rikenellaceae, Parabacteroides, Robinsoniella, Paraprevotella, and Odoribacter in the gut microbiota, and positively correlated with the cumulative level of ethanol-producing bacteria. NLR values did not differ significantly between patients who received glucocorticosteroids and those who did not.Conclusions. The neutrophil-to-lymphocyte ratio correlates with the composition of pro- and anti-inflammatory taxa of the gut microbiota and serves as an independent factor for medium- and long-term prognosis in patients with cirrhosis.

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