akusherstvoObstetrics, Gynecology and ReproductionАкушерство, Гинекология и Репродукция2313-73472500-3194IRBIS LLC10.17749/2313-7347/ob.gyn.rep.2023.362akusherstvo-1559Research ArticleREVIEW ARTICLEНАУЧНЫЙ ОБЗОРCurrent concepts on etiology of the pathogenetic mechanisms related to chronic endometritisСовременные представления об этиологии патогенетических механизмов хронического эндометритаhttps://orcid.org/0000-0001-7516-5203ГалкинаД. Е.GalkinaD. E.

Галкина Дарья Евгеньевна – к.м.н., доцент кафедры оперативной гинекологии института последипломного образования

660022 Красноярск, ул. Партизана Железняка, д. 1

Darya E. Galkina – MD, PhD, Associate Professor, Department of Operative Gynecology, Institute of Postgraduate Education

1 Partizana Zheleznyaka Str., Krasnoyarsk 660022

dashsemch@mail.ruhttps://orcid.org/0000-0002-2899-8103МакаренкоТ. А.MakarenkoT. A.

Макаренко Татьяна Александровна – д.м.н., профессор, зав. кафедрой оперативной гинекологии института последипломного образования

660022 Красноярск, ул. Партизана Железняка, д. 1

Tatyana A. Makarenko – MD, Dr Sci Med, Professor, Heard of the Department of Operative Gynecology, Institute of Postgraduate Education

1 Partizana Zheleznyaka Str., Krasnoyarsk 660022

ФГБОУ ВО «Красноярский государственный медицинский университет имени профессора В.Ф. Войно-Ясенецкого» Министерства здравоохранения Российской ФедерацииРоссияVoino-Yasenetsky Krasnoyarsk State Medical University, Health Ministry of Russian FederationRussian Federation202305032023171115126Copyright © Galkina D.E., Makarenko T.A., 20232023Галкина Д.Е., Макаренко Т.А.Galkina D.E., Makarenko T.A.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/1559Introduction

Introduction. Due to the rapidly current reproductive technologies developing in recent years, much attention has been paid to patients who suffered from infertility (up to 55 %) mainly caused by chronic endometritis (CE). Due to the lack of prominent and specific clinical manifestations, laborious microscopic examination necessary for diagnostics, CE often receives no proper clinical attention. However, the undeniable relationship between CE and conditions associated with infertility such as repeated unsuccessful implantations and habitual miscarriage, dictates a need to expand knowledge about etiology and pathogenesis of this pathology in order to develop both highly informative diagnostic methods and create effective therapeutic regimens.  

Aim

Aim: to analyze the literature data on CE pathogenetic mechanisms.  

Materials and Methods

Materials and Methods. The available publications were searched in the databases Web of Science, eLIBRARY, Scopus, PubMed/MEDLINE released within the 1995–2022 period aimed at assessing CE pathogenetic and morphological features using query "chronic endometritis", "plasmocellular endometritis", "endometrial receptivity", "primary infertility", "secondary infertility", "implantation window". To avoid omission of suitable articles, a methodological filter was not applied. There were included full-text sources and literary reviews on the subject under study. Articles directly unrelated to CE topic were excluded from the review. In order to avoid inclusion of duplicate publications in the literature review if two studies by the same authors were found, the study period of each author was examined, and if the dates of publication coincided, most recent publication were used.  

Results

Results. New morphological, immunohistochemical, genetic and immunological aspects of СЕ were summarized. The presence of plasma cells is the "gold standard" for CE morphological diagnostics, but their similarity to fibroblasts complicates histological examination and requires using expanded range of diagnostic markers. Thus, in CE patients, were identified a reduced expression of NK cells, with increased level of CD3+, CD+8, CD20+, CD138+ cells as well as pro-inflammatory factors, such as tumor necrosis factor-α – by 3-fold, interleukin-6 – by 2.7-fold, interleukin-8 – by 1.2-fold, interferon-γ – by 1.4-fold compared to healthy women. Special attention is paid to the features of hormone receptor network in chronic endometrial inflammation regarding reproductive losses in infertile women, while a favorable marker for successful pregnancy turned out to be the ratio of progesterone and estrogen receptors ranging from 2 to 3.  

Conclusion

Conclusion. Thus, CE rate in the pattern of the causes of infertility and unfavorable reproductive outcomes can up to reach 50 %, however, due to the difficulties of morphological diagnostics, verification of this diagnosis is complicated. The wide range of pathogenetic features of developing chronic inflammation in the endometrium highlighted here may be promising not only for identification of diagnostic markers, but also forimproving endometrialregenerative ability,whichwill increase odds for successfully executed reproductive function in infertile women. 

Введение

Введение. В связи со стремительным развитием современных репродуктивных технологий в последние годы большое внимание уделяется пациенткам, основной причиной инфертильности которых (до 55 %) является хронический эндометрит (ХЭ). Ввиду отсутствия ярко выраженных и специфических клинических проявлений, трудоемкости микроскопического исследования, необходимого для диагностики, зачастую ХЭ не уделяется должного клинического внимания. Однако неоспоримая взаимосвязь между ХЭ и состояниями, связанными с бесплодием, такими как неоднократные неудачные имплантации и привычный выкидыш, диктует необходимость расширения знаний об этиологии и патогенезе данной патологии с целью разработки как высокоинформативных методов диагностики, так и для создания эффективных схем терапии.  

Цель

Цель: проанализировать литературные данные о патогенетических механизмах ХЭ.  

Материалы и методы

Материалы и методы. Поиск литературы проводили в поисковых базах Web of Science, eLIBRARY, Scopus, PubMed/MEDLINE. Отбирали статьи за период 1995–2022 гг., посвященные патогенетическим и морфологическим особенностям ХЭ. Поиск статей проводился по ключевым словам «хронический эндометрит», «плазмоклеточный эндометрит», «рецептивность эндометрия», «бесплодие первичное», «бесплодие вторичное», «окно имплантации». Для исключения пропуска подходящих статей методологический фильтр не применялся. В исследование были включены полнотекстовые источники и литературные обзоры по изучаемой тематике. Из обзора были исключены статьи, не имеющие прямого отношения к тематике ХЭ. Чтобы избежать включения в литературный обзор дублирующихся публикаций, в случае обнаружения двух исследований одних и тех же авторов был изучен период исследования каждого автора, и если даты совпадали, выбирали самую последнюю по дате публикацию.  

Результаты

Результаты. Обобщены новые морфологические, имунногистохимические, генетические и иммунологические аспекты ХЭ. «Золотым стандартом» морфологической диагностики ХЭ является наличие плазматических клеток, однако их сходство с фибробластами затрудняет гистологическое исследование и требует расширения спектра диагностических маркеров. Так, у пациенток с ХЭ отмечается пониженная экспрессия NK-клеток при повышенной экспрессии CD3+, CD+8, CD20+, CD138+ клеток, а также повышение уровней провоспалительных факторов, таких как фактор некроза опухоли-α – в 3 раза, интерлейкина-6 – в 2,7 раза, интерлейкина-8 – в 1,2 раза, интерферона-γ – в 1,4 раза по сравнению со здоровыми женщинами. Особое значение уделяется особенностям рецепторного аппарата при хроническом воспалении в эндометрии в аспекте репродуктивных потерь у инфертильных женщин, при этом благоприятным маркером для успешной беременности является соотношение прогестероновых и эстрогеновых рецепторов в интервале от 2 до 3.  

Заключение

Заключение. Частота ХЭ в структуре причин бесплодия и неблагоприятных репродуктивных исходов может достигать 50 %, однако ввиду сложностей морфологической диагностики верификация данного диагноза затруднена. Освещенный в данном обзоре широкий спектр патогенетических особенностей формирования хронического воспаления в эндометрии может быть перспективен не только для разработки диагностических маркеров, но и для улучшения регенеративной способности эндометрия, что повысит шансы на успешную реализацию репродуктивной функции у инфертильных женщин. 

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The authors declare that there are no conflicts of interest present.