Endometrial hyperplasia accounts for almost 15,0 % to 50,0 % of women of reproductive age among all gynecological pathologies. Its frequency depends on the morphological form and age of patients (10,0 – 30,0 %), progressively increasing during periods of hormonal changes and creating prerequisites for recurrence, reproductive health disorders and reduced reproductive potential.
The dissertation is an independent scientific work. According to the results of the study, the author established a high proportion of endometrial hyperplasia as one of the causes of subfertility (44.19 %) in the structure of intrauterine pathology. The following main predictors of reduced reproductive potential were identified: patient’s age (over 35 years old) (OR=2,59; 95% СІ: (1,54-4,35); р<0,05), chronic pelvic inflammatory disease with relapse (OR=5,17; 95 % СІ: (1,68-15,98); р<0,05), obesity I-II degree (OR=8,31; 95 %; СІ: 2,99-23,01; р<0,05) and endocrinopathy (thyropathy) (OR=5,29; 95 %; СІ: 1,26-20,53; р<0,05), reproductive losses in anamnesis (OR=4,27; 95 %; СІ: 1,53-11,89; р<0,05), high parity of intrauterine interventions (OR=4,75; 95 % СІ: 1,04-23,98; р<0,05), The list of the main factors of resistance to therapy and the probability of recurrence includes comorbidity of proliferative processes of the endomyometrium (OR=7,82; 95 %: 1,78-43,42; р<0,05), benign tumors and ovarian retention formations (OR=13,78; 95 %: 4,71-40,28; р<0,05), as well as metabolic disorders (OR=8,31; 95%; СІ:2,99-23,01; р<0,05) and endocrinopathy (thyropathy) (OR=5,29; 95 %; СІ:1,26-20,53; р<0,05). The diagnostic algorithm was supplemented with the use of compression sonoelastography, which allowed to improve the assessment of the depth of the lesion, the state of the myometrium, the clarity of the localization of the process and to reduce the number of false-positive results.
Based on the obtained results, the scientific concept of the pathogenesis of reproductive health disorders in women with endometrial hyperplasia, the multifaceted manifestations of which depend on a complex of parameters, where, along with indicators of somatic health and metabolic homeostasis, reproductive behavior, infectious status and comorbidity of gynecological diseases play an important role, was supplemented and expanded. In the study, for the first time, the main predictors of the increase in the share of hyperplastic processes of the endometrium as a cause of subfertility were identified.
New data were obtained regarding the role of an infectious factor in the genesis of endometrial hyperplastic processes, based on the diagnosis of activation of the pro-inflammatory cytokine pool, depression of sIg A synthesis and exhaustion of the functional activity of IFN-γ, as well as a deficiency of local production of lactoferrin as one of the leading factors of anti-infective protection.
For the first time, differences in the level of alpha2-microglobulin of fertility (decrease in its level by 2.5 times, p<0.05) and certain markers of neoangiogenesis – activation of the synthesis of vascular endothelial growth factor (VEGF) and hypoxia-inducible factor (HIF-1α) at the stage of formation of the implantation window, which serves as a significant predictor of the risk of early reproductive losses and can be a prognostic criterion for the effectiveness of preconceptional preventive measures were established.
For the first time, the probability of verification of the differentiation cluster 138+ (in 61.7 %) and a low content of immunocompetent CD56+ cells as the main immunohistochemical markers of the inflammatory response in patients with various clinical forms of endometrial hyperplasia was established, which allowed, along with the assessment of the infectious status, to supplement the pathogenetic concept of reactive proliferation as a consequence chronic inflammatory process of the endometrium and to optimize the program of therapeutic options and rehabilitation measures.
A treatment-prophylactic complex was developed and implemented into practice, which includes the use of minimally invasive surgical techniques, optimization of antibiotic therapy, supplemented by the use of bacteriophages, enzyme therapy and immunomodulatory agents, a personalized program of preconception preparation, which allowed not only to reduce the frequency of recurrences of hyperplastic processes of the endometrium, but also to improve the reproductive prognosis in this category of patients.
Key words: reproductive health, infertility, menstrual cycle disorders, hyperplastic processes, chronic endometritis, metabolic disorders and thyropathies, morphometric characteristics of ovaries and polycystosis, microbiocenosis, inflammatory markers and cytokines, medical and rehabilitation measures, pregravid preparation. Branch- Medicine.
