The dissertation presents a new solution to a significant scientific and practical problem – improving the results of treatment in uterine leiomyoma. For this purpose, the pathogenetic substantiation and development of a set of diagnostic, therapeutic and prognostic measures in women of reproductive age with uterine leiomyoma were carried out.
The study was performed on clinical material. The study, which was conducted in the gynecological department of the Chernivtsi Regional Clinical Hospital, included 60 women of reproductive age (study group) diagnosed with symptomatic uterine leiomyoma. Patients were selected based on clear inclusion and exclusion criteria. They were questioned about the complaints and quality of life in the context of their disease. Subsequently, 30 women were randomly selected from these patients, who received melatonin orally at a dose of 3 mg at 8 pm as a single dose (treatment subgroup), the other 30 women as part of the same treatment complex did not receive melatonin (subgroup without treatment). The control group consisted of 20 healthy women of the same age group. In the examined patients, the levels of melatonin and reproductive panel hormones were studied, compared to healthy women of the same age group. In addition, the indicators of lipid peroxidation and antioxidant protection, as well as the state of angiogenesis in the blood of women with uterine leiomyoma treated with melatonin as part of the treatment complex were studied. The complaints of patients with uterine leiomyoma were studied and systematized. They were questioned using special questionnaires, which resulted in an assessment of the quality of life of women with the pathology studied. The pathogenetic mechanisms of development and progression of uterine leiomyoma observed in patients of reproductive age were evaluated.
When processing the results of the study, we found that the severity of the symptoms of uterine leiomyoma depends on the level of estradiol in the blood plasma, which is described by the linear regression equation. In addition, we established a relationship between the level of progesterone in the blood plasma of women with uterine leiomyoma and the content of malonaldehyde in their red blood cells, which can also be described using a linear regression equation.
Based on the results of the research, it can be concluded that, in our opinion, oxidative stress in the body of women with uterine leiomyoma is activated by reproductive hormones and occurs with insufficient activity of the anti-oxidant system, an integral part of which is melatonin, which leads to increased angiogenesis against the background of estrogen-induced myometrial proliferation.
Scientific novelty of the obtained results. For the first time, a comprehensive determination of the levels of melatonin, reproductive hormones (estradiol, progesterone), angiogenesis factors (VEGF, final metabolites of nitric oxide NO), indicators of lipid peroxidation and antioxidant protection in patients of reproductive age suffering from symptomatic uterine leiomyoma was carried out, and for the first time the pathogenetic relationships between groups of these indicators were tracked. For the first time, it was found that the severity of the symptoms of uterine leiomyoma depends on the level of estradiol in the blood. There is also a relationship between the plasma progesterone levels of women with uterine leiomyoma and the content of malonaldehyde in their red blood cells, and that these interdependencies can be mathematically described using linear regression equations. For the first time, it was concluded that oxidative stress in the body of women with uterine leiomyoma is activated by reproductive hormones and occurs with insufficient activity of the anti-oxidant system, an integral part of which is melatonin, which leads to increased angiogenesis against the background of estrogen-induced myometrial proliferation.
Practical significance of the results obtained. New approaches for the diagnosis, prognosis and treatment of uterine leiomyoma against the background of melatonin deficiency as an integral part of the body's antioxidant system have been developed and implemented in practical medicine. In order to reduce the oxidative stress of the body in symptomatic uterine leiomyoma, the use of melatonin as part of the therapeutic complex for this disease in women of reproductive age was proposed.
