Mielikhova T. Improvement of early diagnosis for predicting the development of adenomyosis and determining the criteria of treatment effectiveness

The dissertation is devoted to the improvement of early diagnosis to predict the development of adenomyosis and to determine the criteria for the effectiveness of its treatment. The study involved 129 patients who were examined and treated at the Municipal Non-Profit Institution of Kharkiv Regional Council “Regional Clinical Hospital”, Kharkiv Regional Perinatal Center, women's welfare center, department of operative gynecology with minimally invasive technologies. The first group included 38 (29.6%) patients diagnosed with grade I-II adenomyosis, in the second group 42 (32.1%) patients were diagnosed with a combination of grade I-II adenomyosis and hyperplastic endometrial processes (HEP) and/or leiomyoma of the uterus, the third group included 39 (30.5%) women only with endometrial hyperplastic processes and/or uterine leiomyoma, the fourth control group included 10 women without endometrial disorders, who required medical attention for primary infertility. The subject of the study was clinical manifestations, hormonal and immunological indicators, morphological changes of biopsies of the endometrium and underlying myometrium, immunohistochemical indicators of vascular endothelial growth factor (VEGF), endothelial cell marker CD-34, intracellular protein factor Bcl-2, proliferation protein Ki-67 in biopsies and vascular endothelial growth factor (VEGF) in venous blood, shear wave elastography in patients with adenomyosis and in patients with endometrial hyperplasia and/or uterine leiomyoma. Thus, to improve the effectiveness of adenomyosis diagnosis, as well as to carry out differential diagnosis of the above-mentioned disease with abnormal changes of the endometrium in the form of endometrial hyperplasia and polyps, it is necessary to use hysteroscopy with targeted biopsy of the myometrium. A significant increase in the value of vascular endothelial growth factor (VEGF) in groups with isolated adenomyosis exceeded control values by 5 times, and in the group of adenomyosis combined with hyperplastic processes of the endometrium and/or uterine leiomyoma by 6 times, which indicates the possible use of this marker for diagnosis adenomyosis The obtained results indicate an improvement in quality of life indicators after uncomplicated surgical intervention followed by hormonal therapy in all women based on the answers to the SF-36 questionnaire and the questionnaire developed by us. However, significant changes (p<0.05) occurred in relation to indicators of physical activity, vitality and psychological health. In the first group, the vitality indicator improved by 2.34 times, the patients of the second group noted an improvement in the psychological health indicator by 1.65 times, and the patients of the 3rd group with hyperplastic processes of the endometrium and/or leiomyoma of the uterus after surgery showed the greatest growth physical activity index – 1.73 times. We considered it necessary to develop a scale that would take into account indicators of general health, menstrual function, sexual life and work capacity, which can be used to determine the quality of life of patients with adenomyosis. The developed questionnaire contains the main sections – general health, menstrual function and sexual life, which are determined by answers to 6 questions each. The obtained results indicate a significant improvement in the quality of life of the patients involved in the study. In particular, according to all indicators, a transition from the category of low level of quality of life (16-24 points) to average (8-15.5 points) and almost high level of quality of life was noted. Patients noted the ease of filling out the questionnaire, the specific questions that bothered them most of all. Therefore, we believe that the developed questionnaire will help doctors in assessing the time course of the quality of life of patients and correcting treatment tactics. Thus, the scientific novelty lies in the fact that the doctoral student investigated the peculiarities of hormonal and immunological disorders in women with adenomyosis and revealed a 5-fold increase in the vascular endothelial growth factor (VEGF) index (438.21 ±86.17 pg/ml), compared with a control group, indicating the possible use of serum VEGF as a marker for early diagnosis of adenomyosis. The value of the obtained results for practical use in health care is that the use of sonoelastography allows optimizing the diagnostic algorithm of adenomyosis and is recommended for use in practice. The questionnaire about the quality of life of patients with adenomyosis, personally developed by the doctoral student, will help doctors in evaluating the time course of the main indicators of patients and correcting treatment tactics. The algorithm for managing patients with adenomyosis, developed on the basis of the obtained data, will help in its early diagnosis to predict the development and determine the criteria for the effectiveness of treatment.