Vereshchagina T. Clinical and pathogenetic aspects of diagnosis and treatment of endometrial hyperplastic processes

Due to the tendency to increase the frequency of hormone-dependent diseases and tumors of the reproductive system, the dissertation presents data and a new solution to the scientific problem of modern gynecology - increasing the effectiveness of treatment of endometrial hyperplastic processes by developing and implementing pathogenetically based diagnostic and treatment algorithm considering psychosomatic condition of patients, viral infection, immunohistochemical and receptor characteristics of the endometrium. Updated data on the links in the pathogenesis of hyperplastic processes of the endometrium due to systemic disorders associated with hormonal imbalance of the endometrium, morphogenesis and the presence of viral associates, based on which a pathogenetically sound diagnostic and treatment algorithm was developed. Risk factors for endometrial hyperplastic processes have been scientifically substantiated, taking into account psycho-somatic, clinical-amnestic and molecular-morphological mechanisms in the studied patients. Also, the role of viral etiology in the implementation of endometrial hyperplastic processes has acquired further scientific development. A prognostic model of endometrial hyperplastic processes was revealed on the basis of a study of the pathophysiological role of viral associates, immunohistochemical markers of receptor proliferation and expression. The significance of morphological changes taking into account viral pathogens in hyperplastic processes of the endometrium on the basis of examination, pathogenetically sound treatment and dynamic monitoring for recurrence of GPE and normalization of the psycho-somatic state. The results indicate that viral associates in combination with the expression of receptors have a direct impact on the occurrence of endometrial hyperplastic processes, which have anxiety and depressive disorders, which allowed to develop a comprehensive advanced therapy and prevent recurrence. Statistically significant predictors of endometrial hyperplastic processes in patients with viral associates, morphological confirmation of viral infection of the endometrium, impaired expression of Ki-67, ER and PR and the presence of psychosomatic disorders, which required individualization of pathogenetic therapy for counteraction. As a result of the conducted researches tactics of diagnostics and treatment of women with hyperplastic processes of endometrium of childbearing age are improved. The expediency of expanding the medical-diagnostic algorithm on the basis of a multidisciplinary approach with the definition of psycho-somatic profile, hormonal, morphological, immunohistochemical examination is substantiated.