Bazyuta L. Justification of prevention, early diagnosis and treatment of endometrial hyperplasia in reproductive age women.

The work is dedicated to multimodal study of reproductive function of women of fertile age with endometric hyperplasia considering heredity, molecular-genetic, immune, hormonal, morphological features and immunohystochemical types of endometrial hyperplasia. It is established that hormonal homeostasis prevents complete transformation of the endometrium. It is shown that in 74% of surveyed persons, violations of immune homeostasis exist, in which the increase in the content of PK cells observed, marked reduction of T-helper cells, which considered as a criterion of oncological risk for endometrial hyperplasia. For immunophenotyping marker of persons with increased risk of endometrial pathology, the natural resistance indexes below 4 and over 9 were accepted. By means of clinical-genealogical study of patients with non-complicated and burdened oncological background autosomal dominant inheritance of disease is set. The level of spontaneous chromosome aberrations in patients without burdened oncological background does not significantly differ from that in women with a burdened history with the exception of patients with glandular endometrial hyperplasia. However, under burdened family history in women chromatid type aberrations were more common: 1,46 ± 0,3%; 4,5 ± 1,7%; 6,5 ± 2,0%, compared to women without a family history - 1,6 ± 0,5%; 1,7 ± 0,7%; 2,4 ± 0,6% of persons. It is proved that the increase in expression of proliferation marker Ki-67 and apoptosis inhibitor survivin (BIRC5) promote the development of structural defects of endometrium, changes of which are most pronounced in atypical endometrial hyperplasia. According to these markers it is possible to predict the course of endometrial hyperplasia depending on heredity. The algorithm of formation of increased cancer risk groups and treatment of patients with endometrial hyperplasia is developed, implementation of which has reduced the number of relapses of endometrial hyperplasia by 1,92 times and the frequency of menstrual cycle disorders - by 2,46 times and increased the number of planned pregnancies a year by 1,81 times compared with the traditional method of treatment.