akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2021.214akusherstvo-1073Research ArticleREVIEW ARTICLESНАУЧНЫЕ ОБЗОРЫLocal hemostasis disorders underlying endometric pathologyРоль нарушений локального гемостаза в генезе патологии эндометрияhttps://orcid.org/0000-0001-8945-8912ЮпатовЕ. Ю.IupatovE. Iu.

Юпатов Евгений Юрьевич – кандидат медицинских наук, доцент, заведующий кафедрой акушерства и гинекологии.

Казань 420015, ул. Бутлерова, д. 36.

Scopus Author ID: 57201192778.

Evgenii Iu. Iupatov - MD, PhD, Associate Professor, Head of the Department of Obstetrics and Gynecology, Kazan State Medical Academy.

36 Butlerova Str., Kazan 420015.

Scopus Author ID: 57201192778.

https://orcid.org/0000-0001-9683-3012МустафинИ. Г.MustafinI. G.

Мустафин Ильшат Ганиевич – доктор медицинских наук, профессор, заведующий кафедрой биохимии и клинической лабораторной диагностики.

Казань 420015, ул. Бутлерова, д. 49.

Ilshat G. Mustafin - MD, Dr Sci Med, Professor, Department of Biochemistry and Clinical Laboratory Diagnostics, Kazan State Medical University.

49 Butlerova Str., Kazan 420012.

https://orcid.org/0000-0003-0644-5767КурманбаевТ. Е.KurmanbaevT. E.

Курманбаев Тимур Ерланович - кандидат медицинских наук, преподаватель кафедры акушерства и гинекологии ФГБВОУ ВО «Военно-медицинская академия имени

194044 Санкт-Петербург, ул. Клиническая, д. 6.

Timur E. Kurmanbaev - MD, PhD, Faculty Member, Department of Obstetrics and Gynecology, Kirov Military Medical Academy, Ministry of Defense of Russian Federation.

6 Klinicheskaya Str., Saint Petersburg 194044.

timka_rus@inbox.ruhttps://orcid.org/0000-0001-5942-5335НабиуллинаР. М.NabiullinaR. M.

Набиуллина Роза Муллаяновна - кандидат медицинских наук, доцент кафедры биохимии и клинической лабораторной диагностики.

Казань 420015, ул. Бутлерова, д. 49.

Rosa M. Nabiullina- MD, Associate Professor, Head of the Department of Biochemistry and Clinical Laboratory Diagnostics, Kazan State Medical University.

49 Butlerova Str., Kazan 420012.

https://orcid.org/0000-0003-1397-8342АтаянцК. М.AtayantsK. M.

Атаянц Каринэ Маратовна - кандидат медицинских наук, преподаватель кафедры акушерства и гинекологии.

194044 Санкт-Петербург, ул. Клиническая, д. 6.

Karine M. Atayants - MD, PhD, Faculty Member, Department of Obstetrics and Gynecology, Kirov Military Medical Academy, Ministry of Defense of Russian Federation.

6 Klinicheskaya Str., Saint Petersburg 194044.

https://orcid.org/0000-0002-9848-4714ШмидтА. А.ShmidtA. A.

Шмидт Андрей Александрович - кандидат медицинских наук, доцент, полковник медицинской службы, начальник кафедры акушерства и гинекологии.

194044 Санкт-Петербург, ул. Клиническая, д. 6.

Andrey A. Smidt - MD, PhD, Associate Professor, Colonel of Medical Service, Head of the Department of Obstetrics and Gynecology, Kirov Military Medical Academy, Ministry of Defense of Russian Federation.

6 Klinicheskaya Str., Saint Petersburg 194044.

https://orcid.org/0000-0002-2513-6209ФредериксЕ. В.FrederiksE. V.

Фредерикс Елена Вадимовна - врач акушер-гинеколог, главный врач.

Санкт-Петербург 191124, ул. Костромская, д. 4.

Elena V. Frederiks - Obstetrician-Gynecologist, Chief Physician, Maternity Hospital № 13.

4 Kostromskaya Str., Saint Petersburg 191124.

Казанская государственная медицинская академия – филиал ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Министерства здравоохранения Российской ФедерацииРоссияKazan State Medical Academy – Branch of Russian Medical Academy of Continuing Professional Education, Health Ministry of Russian FederationRussian FederationКазанский государственный медицинский университет Министерства здравоохранения Российской ФедерацииРоссияKazan State Medical University, Health Ministry of Russian FederationRussian FederationВоенно-медицинская академия имени С.М. Кирова Министерства обороны Российской ФедерацииРоссияKirov Military Medical Academy, Ministry of Defense of Russian FederationRussian FederationРодильный дом № 13РоссияMaternity Hospital № 13Russian Federation202109092021154430440Copyright © Iupatov E.I., Mustafin I.G., Kurmanbaev T.E., Nabiullina R.M., Atayants K.M., Shmidt A.A., Frederiks E.V., 20212021Юпатов Е.Ю., Мустафин И.Г., Курманбаев Т.Е., Набиуллина Р.М., Атаянц К.М., Шмидт А.А., Фредерикс Е.В.Iupatov E.I., Mustafin I.G., Kurmanbaev T.E., Nabiullina R.M., Atayants K.M., Shmidt A.A., Frederiks E.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gynecology.su/jour/article/view/1073Introduction

Introduction. Hemostasis is an equilibrium system that performs 2 bidirectional tasks: on the one hand, it prevents bleeding development, whereas on the other hand, it counters thrombogenesis. Shifting the balance leads to development of various complications, and also serves as a key link in the pathogenesis of a number of diseases. Currently, the issue of changing the state of local endometrial hemostasis in various pathologies is of high priority. Unfortunately, publications available on this problem are limited.

Aim

Aim: to conduct a literature search and systematize the data analysis to expand understanding regarding a role of local hemostasis disorders in formation of endometrial pathology.

Materials and Methods

Materials and Methods. There has been performed a systematic analysis of full-text scientific reviews and original articles published in English and Russian in the modern literature. The review includes the 1995-2020 data published in the international abstract and bibliographic databases eLibrary, Google Scholar, Web of Science, Scopus and PubMed/MEDLINE.

Results

Results. Hemostatic changes in the endometrium that occur under the influence of estrogens and progesterone, and create a local hemostatic environment, which disturbance contributes to emergence of various endometrial pathologies, are described. It was found that for the physiological course of pregnancy, complex changes in the local hemostasis are necessary, which are aimed at facilitating the processes of chorionic invasion and maintaining metabolic processes in the mother-fetus interface, whereas alteration of the aforementioned processes contributes to development of abnormal chorionic invasion as the basis for development of insufficient placental function, preeclampsia (PE), and pregnancy termination. Moreover, there have been summarized the data on key changes in the state of local endometrial hemostasis that play a role in the pathogenesis of endometriosis, as well as underlying abnormal uterine bleeding (AUB).

Conclusion

Conclusion. Current research publications provide sparse evidence that the state of the local hemostasis in the endometrium is an important aspect of the physiological course of the menstrual cycle, as well as formation of endometrial pathology. In this review, it is shown that local hemostasis is inextricably linked with the state of the systemic hemostasis, but at the same time, its functioning depends on the level of hormones estrogens and progesterone. Impaired function of local endometrial hemostasis is an important aspect of the pathogenesis of miscarriage, as well as conditions such as PE, endometriosis, AUB.

Введение

Введение. Система гемостаза является равновесной системой, выполняющей 2 разнонаправленные задачи: с одной стороны, предотвращает развитие кровотечения, с другой, тромбозов. Нарушение равновесия приводит к развитию осложнений, а также является ключевым звеном патогенеза ряда заболеваний. В настоящее время актуальным является вопрос изменения состояния местного гемостаза эндометрия при различных патологиях. К сожалению, публикации, посвященные данной проблеме, ограничены.

Цель исследования

Цель исследования: провести литературный поиск и систематизировать полученные данные для расширения представлений о роли нарушений локального гемостаза в формировании патологии эндометрия.

Материалы и методы

Материалы и методы. Проведен систематический анализ опубликованных в современной литературе полнотекстовых научных обзорных и оригинальных статей на английском и русском языках. В обзор включены данные, опубликованные в международных реферативных и библиографических базах данных eLibrary, Google Scholar, Web of Science, Scopus и PubMed/MEDLINE за период 1995-2020 гг.

Результаты

Результаты. Описаны гемостатические изменения в эндометрии, возникающие под влиянием эстрогенов и прогестерона и создающие локальную гемостатическую среду, нарушение которой способствует возникновению различных патологий эндометрия. Выяснено, что для физиологического течения беременности необходимы сложные изменения в системе местного гемостаза, направленные на облегчение процессов инвазии хориона и поддержание процессов обмена в системе «мать-плод», а нарушение вышеописанных процессов способствует развитию аномальной инвазии хориона, что является основой для развития недостаточной функции плаценты, преэклампсии (ПЭ), прерывания беременности. Кроме этого, обобщены сведения о ключевых изменениях в состоянии локального гемостаза в эндометрии, играющих роль в патогенезе эндометриоза, а также в генезе аномальных маточных кровотечений (АМК).

Заключение

Заключение. В современной научной литературе есть разрозненные данные о том, что состояние системы местного гемостаза в эндометрии является важным аспектом физиологического течения менструального цикла, а также формирования патологии эндометрия. В настоящем обзоре показано, что локальный гемостаз неразрывно связан с состоянием системного, но в тоже время его функционирование зависит и от уровня гормонов - эстрогенов и прогестерона. Нарушение функции местного гемостаза в эндометрии является важным аспектом патогенеза невынашивания беременности, а также таких состояний, как ПЭ, эндометриоз, АМК.

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