Физическая активность и желчнокаменная болезнь

Цель обзора: представить данные отечественных и зарубежных исследований об ассоциации физической активности (ФА) и желчнокаменной болезни (ЖКБ).

Основные положения. Низкая ФА является одним из четырех основных факторов риска развития хронических неинфекционных заболеваний (ХНИЗ). Частота низкой ФА у мужчин и женщин РФ (по данным диспансеризации 2016 г.) составляет 19 %. Глобальная распространенность ЖКБ составляет до 20 % среди взрослых. Во многих систематических обзорах и метаанализах подтверждена обратная ассоциация между ЖКБ и ФА в мире независимо от потенциальных факторов риска ЖКБ, при этом наблюдался четкий дозозависимый эффект — относительный риск (RR) ЖКБ составлял 0,87 (95 % ДИ 0,83–0,92) на 20 метаболических эквивалентов (МЕТ) ФА в неделю. По нашим результатам эпидемиологического обследования в рамках программы ВОЗ “MONICA” в г. Новосибирске (n = 870 чел.) среди женщин 25–64 лет с низкой общей ФА (менее 800 МЕТ-мин/нед), а также при наличии первого класса ФА в свободное время ЖКБ встречалась значительно чаще (1-й класс — 33 %, 2–4-й классы — 8,7–11,0 %, p < 0,01). ФА благоприятно влияет практически на все механизмы желчекамнеобразования: улучшает метаболизм холестерина в желчи, повышает сывороточный ХС ЛВП, синтез желчных кислот, стимулирует выброс холецистокинина, снижает гиперсекрецию муцина, увеличивает разнообразие и богатство кишечной микробиоты. Ежедневная ФА служит мерой профилактики ЖКБ: риск ЖКБ снижается на 66 % (95 % ДИ; 0,18–0,86).

Заключение. ФА признана защитным агентом против образования камней в желчном пузыре.

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