New approaches to the correction of immune disorders in adenomyosis

Keywords: adenomyosis, immune homeostasis, immunocorrective and hormonal treatment

Abstract

ABSTRACT. A large number of studies have been devoted to the study of the problem of genital endometriosis, however, the etiology and mechanisms of the disease remain unresolved. Adenomyosis affects about 10% of women of reproductive age, occurs in 30% of women with pelvic pain syndrome and up to 50% of patients with female infertility. Numerous theories of the origin of endometriosis cannot explain the key points in the development of the disease, namely the penetration of the basal layer of the endometrium into the adjacent myometrium. This makes it difficult to choose an adequate treatment strategy for patients with adenomyosis. Treatment of adenomyosis is one of the most difficult issues in modern gynecology, one of the promising approaches in increasing the effectiveness of treatment of patients with adenomyosis is immunocorrective therapy. The aim of the work was to increase the effectiveness of treatment of adenomyosis patients by improving the diagnostic and prognostic tactics of patient management based on the study of pathogenetic aspects. Materials and methods. 115 patients of reproductive age were included in the study. The effectiveness of complex compared to traditional treatment was evaluated. Clinical and laboratory, instrumental and immunological indicators were evaluated in dynamics. Research results and their discussion. Taking into account the peculiarities of pathogenetic mechanisms, which indicate a violation of the cellular and macrophage links of immunity, cytokine imbalance, which contribute to the development of the disease and its persistence, we have developed a comprehensive approach to increasing the effectiveness of the treatment of patients with adenomyosis, which aims to reduce the pro-inflammatory immunological potential. Against the background of the comprehensive treatment, the activity of autoimmune reactions is reduced, the indicators of phagocytic and oxygen activity of neutrophils and monocytes are normalized, cytokine imbalance is reduced - the level of production of pro-inflammatory cytokines and VEGF is normalized. Conclusions. Based on the results of the work, the approaches to the treatment of adenomyosis patients were optimized, the feasibility of using corrective drugs in complex therapy was substantiated.

Downloads

Download data is not yet available.

Author Biographies

Mykola Scherbina, Kharkiv National Medical University

MD, PhD, DSc, Professor Kharkiv National Medical University, Head of Department of Obstetrics and Gynecology №1,  Pr-t Nauki, 4, Kharkiv, 61022, Ukraine

Lilya Potapova, Kharkiv National Medical University

MD, PhD, DSc, Professor Kharkiv National Medical University, Department of Obstetrics and Gynecology №1, Pr-t Nauki, 4, Kharkiv, 61022, Ukraine

Irina Scherbina, Kharkiv National Medical University

MD, PhD, DSc, Professor Kharkiv National Medical University, Department of Obstetrics and Gynecology №1, Pr-t Nauki, 4, Kharkiv, 61022, Ukraine

Olga Mertsalova, Kharkiv National Medical University

MD, PhD, DSc, Professor, Kharkiv National Medical University, Department of Obstetrics and Gynecology №1, Pr-t Nauki, 4, Kharkiv, 61022, Ukraine

Anastasiia Chekhunova, Kharkiv National Medical University

MD, PhD student, Department of obstetrics and gynecology№1 Kharkiv National Medical University, Pr-t Nauki, 4, Kharkiv, 61022, Ukraine

References

Parazzini F, Esposito G, Tozzi L, Noli S, Bianchi S. Epidemiology of endometriosis and its comorbidities. Eur J Obstet Gynecol Reprod Biol. 2017 Feb;209:3-7. DOI: https://doi.org/10.1016/j.ejogrb.2016.04.021

Johnson NP, Hummelshoj L; World Endometriosis Society Montpellier Consortium. Consensus on current management of endometriosis. Hum Reprod. 2013 Jun;28(6):1552-68. DOI: https://doi.org/10.1093/humrep/det050

Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril. 2018 Mar;109(3):380-388.e1. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.006

Nikitina IM, Mykytyn KV, Diadiushka YuV. Analiz faktoriv ryzyku rozvytku hiperproliferatyvnykh protsesiv endometriia u zhinok rannoho reproduktyvnoho viku. Bukovynskyi medychnyi visnyk. 2022;26(2):27-31. DOI: https://doi.org/10.24061/2413-0737.XXVI.2.102.2022.5 (in Ukraine)

Yeung P, Gupta S, Gieg S. Endometriosis in adolescents: a systematic review. J. Endometr. Pelvic Pain Disord. 2017;9(1):17–29. doi: https://doi.org/10.5301/je.5000264

Koninckx PR, Ussia A, Adamyan L, Wattiez A, Gomel V, Martin DC. Pathogenesis of endometriosis: the genetic/epigenetic theory. Fertil Steril. 2019 Feb;111(2):327-340. doi: https://doi.org/10.1016/j.fertnstert.2018.10.013

Vannuccini S, Tosti C, Carmona F, Huang SJ, Chapron C, Guo SW, Petraglia F. Pathogenesis of adenomyosis: an update on molecular mechanisms. Reprod Biomed Online. 2017 Nov;35(5):592-601. doi: https://doi.org/10.1016/j.rbmo.2017.06.016

Fan YY, Chen HY, Chen W, Liu YN, Fu Y, Wang LN. Expression of inflammatory cytokines in serum and peritoneal fluid from patients with different stages of endometriosis. Gynecol Endocrinol. 2018 Jun;34(6):507-512. doi: https://doi.org/10.1080/09513590.2017.1409717

Lin WC. Chang CY, Hsu YA. Increased Risk of Endometriosis in Patients With Lower Genital Tract Infection. Text: electronic.Medicine Baltimore. 2016;95(10): URL:https: //insights.ovid.com /article/00005792-201603080-00012

Tatarchuk TF, Kaluhina LV, Danylova AO, Pavlova KS. Kompleksnyi pidkhid do likuvannia bolovoho syndromu pry adenomiozi. Reproduktyvna endokrynolohiia 2021;(3):53-60. (in Ukraine)

Casper RF. Progestin-only pills may be a better first-line treatment for endometriosis than combined estrogen-progestin contraceptive pills. Fertil Steril. 2017 Mar;107(3):533-536. doi: https://doi.org/10.1016/j.fertnstert.2017.01.003

Sokolenko VL, Sokolenko SV. Prykladna imunolohiia. 2-e vyd. Cherkasy: LEMAR-PROM; 2015. 66 s. (in Ukraine)

Kolisnyk NV, Omelianchyk LO. Metody laboratornoi imunolohii. Zaporizhzhia: ZNU; 2010. 116 s. (in Ukraine)

Published
2023-11-28
How to Cite
Scherbina, M., Potapova, L., Scherbina, I., Mertsalova, O., & Chekhunova, A. (2023). New approaches to the correction of immune disorders in adenomyosis. Actual Problems of Modern Medicine, (12). https://doi.org/10.26565/2617-409X-2023-12-05
Section
Original Researches