The paper presents a new solution to the current problem of pediatric and adolescent gynecology - improving the rate of reproductive function in adolescent girls with chronic diffuse liver disease.
Additional data were obtained to reduce all mean uterine sizes in adolescent girls in all groups with chronic diffuse liver disease, while ovarian size in NAFLD increased, and in girls with CVH and AIH decreased. The length and width of the uterus have been correlated with estradiol, luteinizing hormone and follicle-stimulating hormone. The increase in anterior-posterior size of the uterus directly correlates with the severity of dysmenorrhea. Ultrasound examination of the ovaries records multiple small cystic fluid inclusions, the number of which is greatest in patients with NAFLD. The number of small cystic inclusions in the ovaries directly depends on the levels of free testosterone and the insulin resistance index of HOMA.
It is shown that chronic diffuse liver disease contributes to the dysfunction of the pituitary-ovarian system: in CVH, NAFLD and AIH, a probable increase in luteinizing hormone levels of 1.16, 1.95 and 1.14 times, prolactin - in 1, 28, 1.95 and 1.19 times, free testosterone - 1.90, 1.70 and 1.46 times on the background of a decrease in globulin, which binds sex steroids, in 1.20, 1.57 and 1.69 times and progesterone - 1.51, 1.88 and 1.89 times. The level of FSH is probably reduced in CVH by 1.18 and AIH by 1.28 times. Reduced E2 production is 3.65 times and 3.66 times distinguishes girls with NAFLD and AIH. The pituitary-thyroid system is characterized by a probable increase in CVH, NAFLD and AIH levels of thyroid-stimulating hormone in 1.28, 3.61 and 2.61 times, triiodothyronine - in 1.09, in 1.39 and in 1.08, antibodies to thyroperoxidase - in 2,56, in 3,34 and in 3,83 times against decrease in levels of free triiodothyronine in 1,10, in 1,10 and in 1,54 times and free thyroxine - 1.11, 1.11 and 1.29 times. The content of antibodies to thyroperoxidase is increased in patients with HCV in 30.19% of cases, with NAFLD - in 29.09% and with AIH - in 41.94%
Determined the role of determining the role of anti-ovarian antibodies in the initiation of menstrual disorders in adolescent girls with chronic diffuse liver disease. It was determined that the level of anti-ovarian antibodies depends on the degree of clinical remission of liver disease, and is also associated with the level of prolactin, thyroid-stimulating hormone, antibodies to thyroperoxidase. Their highest level is observed in the presence of hypomenstrual syndrome in patients with AIH. It is established that the personal profile of all girls with chronic diffuse liver disease is characterized by an increased level of depression and neuroticism, personal and situational anxiety and autonomic dysfunction. It has been proven that the characteristic features of the quality of life of girls with chronic diffuse liver disease are a probable decrease in all its indicators with a statistically significant decrease in integrated self-esteem of mental health against higher values of physical, role physical and social functioning.
Decreased bone mineral density and bone mass accumulation in all girls with chronic diffuse liver disease, which is most pronounced in AIH. Disorders of bone metabolism occur against the background of a probable decrease in serum content of 25(OH)D. There is a direct correlation between the decrease in bone mineral density and age of girls, body length, estradiol levels and the inverse of 25(OH)D.
For the first time the efficiency of the developed complex system of diagnostic and treatment-and-prophylactic measures for preservation of reproductive health at girls of pubertal age with chronic diffuse diseases of a liver is proved and its efficiency is estimated.
