Horban N. Endometrial hyperplasia and uterine polyp in women of reproductive age (prognostication, aspects of pathogenesis, diagnostics and treatment).

The dissertation is devoted to finding a solution to the relevant scientific problem in order to increase the effectiveness of treatment of non-atypical hyperplasia and endometrial polyps, to maintain and regain reproductive health of women by means of developing and implementing a pathogenetically grounded therapeutic and diagnostic algorithm. For the first time, there were mathematically stratified risk factors for developing non-atypical hyperproliferative disorders of endometrium and endometrial polyps in women of reproductive age. The findings are as follows: chronic endometritis increases the likelihood of developing endometrial polyps by 1.8 times (in combination with stromal fibrosis up to 3.6 times). The research study established the features of microbiocenosis of the genital tract, endometrial tissue, intestinal contents of women with non-atypical hyperproliferative disorders of endometrium and their correlations (a strong positive correlation was proven between indices of genital tract contamination and the uterine cavity by coccal flora). The expression of antigens of the herpesvirus family in the endometrium was determined: cytomegalovirus (CMV) antigens are expressed in endometrial polyps tissue in 54.8%, with non-atypical endometrial hyperplasia it is accounted for 38.3%; HSV-2 antigens are expressed in endometrial tissue in 22.6%, with non-atypical endometrial hyperplasia in 8.3%. The concentration levels of IgG and IgM antibodies to herpesvirus infection depend on the degree of antigen expression in the endometrium. For the first time, the characteristics of cyclooxygenase-2 expression in patients with non-atypical endometrial hyperplasia were established: in the presence of chronic endometritis – in the stroma – in 79.0%, in the glands – in 68.4%; in the absence of chronic endometritis – in the stroma – in 7.3%, in the glands – in 53.7% of patients. The negative expression of cyclooxygenase-2 in fibrous components was immunohistochemically verified in 93.0% of women with endometrial polyps. It was established that women with morphologically proven non-atypical endometrial hyperplasia have disorders in the cyclicity of tissue changes with overexpression of estrogen receptors against the background of decreased levels of expression of progesterone receptors. It is detected that androgen receptor expression has higher levels in the absence of signs of chronic endometritis (43.9% vs. 10.5%), which proves the pathogenetic role of systemic endocrine disorders in the formation of non-atypical endometrial hyperplasia in women of reproductive age. In patients with endometrial polyps, there is a decrease in the expression of estrogen receptors (from 75.0% in the glandular cystic structure of endometrial polyps to isolated cases in their fibrous structure) and progesterone receptors (from 37.5% in the glandular cystic structure to the absence of expression in fibrous endometrial polyps), which indicates a slight sensitivity of endometrial polyps to the effects of hormone therapy. The efficiency of the developed diagnostic and treatment algorithm was proven for women with non-atypical hyperplasia and endometrial polyps in 84.24±2.69% of women, which allowed to reduce the recurrence rate by 2.5 times.