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Chronic endometritis in patients of reproductive age: individualized treatment capabilities

https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.157

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Abstract

Introduction. Inflammatory diseases of the pelvic organs represent one of the lead causes affecting health status in women of childbearing age. The pathogenetic mechanisms of chronic endometritis (CE) have been extensively studied, but many issues remain debatable. This disease manifests in various clinical pictures, including relapsing course, so a need to conduct combination individualized treatment rises no doubts.

Aim: to assess effectiveness of combination individualized therapy of CE.

Materials and Methods. A comprehensive analysis of clinical data was performed in 107 patients with morphologically verified CE, examining microflora composition in the uterus, cervical canal, urinary tract, and intestine by using a wide range of laboratory research methods; assessing cell subset composition of peripheral blood lymphocytes by using immunocytochemistry (CD3+, CD4+, CD8+, CD19+, CD95+, CD3+CD4+, CD3+CD8+, CD3+CD95+), measuring level of serum cytokines – interleukin-1β, tumor necrosis factor-α, interleukin 8, and interleukin 10. For this, all patients were subdivided into 2 groups: 53 patients (group I, main received treatment according to the original protocol (antibiotics and bacteriophages, immune preparations, herbal medicines), 54 patients (group II, control) received conventional therapy (antibiotics, immunomodulatory drugs, hormones).

Results. It was found that urogenital tract microbiota was profoundly altered in patients with CE, also featured with dysregulated immune system. In addition, associated changes in the leukocyte-lymphocytic arm of the immune system and features of clinical and anamnestic data were obtained, which is important in combination treatment of patients with this pathology. Composition microflora in the vagina, cervical canal and uterine cavity was markedly improved that was confirmed by bacteriology data, vaginal pH value and menstrual function were by 2-fold more often in group 1 vs. group 2. A 12-month follow-up revealed in group 1 no complaints of pelvic pain requiring pain killers, with pronouncedly lowered amount of doctor visits due to inflammatory pathology of the urinary tract additionally confirming effectiveness of individualized treatment.

Conclusion. The data of the study evidence about a need to individualize diagnostic and therapeutic approaches while managing patients with CE. The treatment strategy for patients of childbearing age with CE should be based on minimizing drug aggression, taking into account concomitant pathologies, features of microbiota composition in the genitourinary organs and changes in the immune system. An combination and individualized therapeutic approach provides an opportunity to substantially better results after treatment of CE.

About the Author

E. G. Kobaidze
Perm State Medical University named after Academician E.A. Wagner, Health Ministry of Russian Federation
Russian Federation

Ekaterina G. Kobaidze - MD, Dr Sci Med, Associate Professor, Department of Obstetrics and Gynecology № 1

26 Petropavlovskaya Str., Perm 614990

Author ID: 344752.



References

1. Kobaidze E. G. Individualized therapy tactics of patients with chronic endometritis based on comprehensive study of clinical and anamnestic, microbiological, immunological and genetic factors. [Individualizaciya lechebnoj taktiki bol’nyh s hronicheskim endometritom na osnovanii kompleksnogo izucheniya kliniko-anamnesticheskih, mikrobiologicheskih, immunologicheskih i geneticheskih faktorov]. Avtoref. dis. dokt. med nauk. Volgograd, 2019. 46 s. (In Russ.).

2. Kobaidze E. G. Features of vaginal and intestinal microflora in patients with chronic endometritis in the context of a study of cellular immunity. [Osobennosti vlagalishchnoj i kishechnoj mikroflory u bol’nyh s hronicheskim endometritom v kontekste issledovaniya kletochnogo immuniteta]. Rossijskij vestnik akushera-ginekologa. 2019;19(1):80–5. (In Russ.). https://doi.org/10.17116/rosakush20191901180.

3. Hillier S., Marrazzo J., Holmes K. K. Bacterial vaginosis. In: Sexually transmitted diseases. Eds. K. K. Holmes, P. F. Sparling, V. E. Stamm et al. 4th ed. New York: McGraw-Hill, 2008. 737–68.

4. Global strategy for prevention and control of sexually transmit ted infections: WHO document. [Global’naya strategiya profilaktiki infekcij, peredavaemyh polovym putem, i bor’by s nimi]. VOZ: Zheneva, 2006–2015. 70 s. (In Russ.). A vailable at: https://www.who.int/reproductivehealth/publications/rtis/9789241563475/ru/. [Accessed: 10.06.2020].

5. Workowski K. A., Bolan G. A. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1–137.

6. Das B., Ronda J., Trent M. Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infect Drug Resist. 2016;2016(9):191–7. https://doi.org/10.2147/IDR.S91260.

7. Moreno I., Codoner F. M.., Vilella F. et al. Evidence that the endometrial microbiota has an effect on implantation success or failure. Am J Obstet Gynecol. 2016;215(6):684–703. https://doi.org/10.1016/j.ajog.2016.09.075.

8. Franasiak J. M., Scott R. T. Introduction: microbiome in human reproduction. Fertil Steril. 2015;104(6):1341–3. https://doi.org/10.1016/j.fertnstert.2015.10.021.

9. Swidsinski A., Verstraelen H., Loening-Baucke V. et al. Presence of a polymicrobial endometrial biofilm in patients with bacterial vaginosis. PLoS One. 2013;8(1):e53997. https://doi.org/10.1371/journal.pone.0053997.

10. Walther-Antonio M.R.S., Chen J., Multinu F. et al. Potential contribution of the uterine microbiome in the development of endometrial cancer. Genome Med. 2016;8(1):122. https://doi.org/10.1186/s13073-016-0368-y.

11. Onderdonk A. B., Delaney M. L., Fichorova R. N. The human microbiome during bacterial vaginosis. Clin Microbiol Rev. 2016;29(2):223–38. https://doi.org/:10.1128/CMR.00075-15.

12. Rudney J. D., Chen R., Sedgewick G. J. Intracellular Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in buccal epithelial cells collected from human subjects. Infect Immun. 2001;69(4):2700–7. https://doi.org/:10.1128/IAI.69.4.2700-2707.2001.

13. Ravel J., Gajer P., Abdo Z. et al. Vaginal microbiome of reproductiveage women. Proc Natl Acad Sci USA. 2011;108(1):4680–7. https://doi.org/:10.1073/pnas.1002611107.

14. Verstraelen H., Vilchez-Vargas R., Desimpel F. et al. Characterisation of the human uterine microbiome in nonpregnant women through deep sequencing of the 16S rRNA gene. Peer J. 2015;4:e1602.

15. Immunology. Workshop. Study guide. Eds. L. V. Kovalchuk, G. A. Ignatieva, L. V. Gankovskaya. [Immunologiya. Praktikum. Uchebnoe posobie. Pod red. L. V. Koval’chuka, G. A. Ignat’evoj, L. V. Gankovskoj]. Moskva: GEOTAR-Media, 2012. 176 s. (In Russ.).

16. Laveti D., Kumar M., Hemalatha R. et al. Anti-inflammatory treatments for chronic diseases: a review. Inflamm Allergy Drug Targets. 2013;12(5):349–61. https://doi.org/:10.1128/IAI.69.4.2700-2707.2001.

17. Prasad S., Sung B., Aggarwal B. B. Age-associated chronic diseases require age-old medicine: role of chronic inflammation. Prev Med. 2012;(54):29–37.

18. Chereshnev V. A., Gusev E. Yu. Immunology of inflammation: the role of cytokines. [Immunologiya vospaleniya: rol’ citokinov]. Medicinskaya immunologiya. 2001;3(3):361–8. (In Russ.).

19. Baryshnikov A. Yu., Shishkin Yu.V. Immunological problems of apoptosis. [Immunologicheskie problemy apoptoza]. Moskva: Editorial URSS, 2002. 309 s. (In Russ.).

20. Colotta F., Allavena P., Sica A. et al.Cancer-related inflammation, the seventh hallmark of cancer: links to genetic instability. Carcinogenesis. 2009;30(7):1073–81. https://doi.org/10.1093/carcin/bgp127.

21. O’Connor W., Zenewicz L. A., Flavell R. A. The dual nature of Th17 cells: shifting the focus to function. Nature Immunology. 2010;11(6):471–6. https://doi.org/10.1038/ni.1882.

22. Dubnitskaya L. V., Nazarenko T. A. Chronic endometritis: the possibility of diagnosis and therapy. [Dubnickaya L.V., Nazarenko T. A. Hronicheskij endometrit: vozmozhnosti diagnostiki i lecheniya]. Consilium medicum. 2007;9(6):25–8. (In Russ.).

23. Ershov F. I., Kiselev O. I. Interferons and their inducers (from molecules to drugs): monograph. [Interferony i ih induktory (ot molekul do lekarstv): monografiya]. Moskva: GEOTAR-Media, 2005. 356 s. (In Russ.).

24. Luzin A. A. Optimization of medical tactics in patients of reproductive age with abnormal uterine bleeding associated with chronic endometritis. [Luzin A. A. Optimizaciya vrachebnoj taktiki u pacientok reproduktivnogo vozrasta s anomal’nymi matochnymi krovotecheniyami, associirovannymi s hronicheskim endometritom]. Avtoref. dis. kand. med. nauk. Omsk, 2009. 23 s. (In Russ.).

25. Mikhnina E. A. Endometrium morphofunctional state in women with infertility and miscarriage. [Morfofunkcional’noe sostoyanie endometriya u zhenshchin s besplodiem i nevynashivaniem beremennosti]. Avtoref. dis. dokt. med. nauk. SPb., 2009. 40 s. (In Russ.).

26. Serova O. F., Zarochentseva N. V., Kapustina M. V. Treatment of patients with chronic endometritis before in vitro fertilization. [Morfofunkcional’noe sostoyanie endometriya u zhenshchin s besplodiem i nevynashivaniem beremennosti]. Rossijskij vestnik akushera-ginekologa. 2008;(5):80–2. (In Russ.).

27. Cicinelli E., Matteo M., Tinelli R. et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014(5);21:640–7. https://doi.org/:10.1177/1933719113508817.

28. Bacteriological analysis of urine. Clinical guidelines: Rules for clinical laboratory tests. [Bakteriologicheskij analiz mochi. Klinicheskie rekomendacii: Pravila provedeniya klinicheskih laboratornyh issledovanij]. Moskva, 2014. 33 s. (In Russ.). Available at: http://www.fedlab.ru. (In Russ.). [Accessed: 10.06.2020].

29. Padrul M. M., Zakharova Yu.A., Kobaidze E. G. A method for diagnosing a microbial factor in chronic nonspecific endometritis. [Sposob diagnostiki mikrobnogo faktora pri hronicheskom nespecificheskom endometrite]. Patent RF na izobretenie № 2624855 ot 07.2017. Byul. № 19. 6 s. (In Russ.).

30. Kobaidze E. G., Padrul M. M., Zakharova Yu.A. Method for the treatment of chronic nonspecific endometritis. [Sposob lecheniya hronicheskogo nespecificheskogo endometrita]. Patent RF na izobretenie № 2603624 ot 11.2016. Byul. № 33. 7 s. (In Russ.).


For citation:


Kobaidze E.G. Chronic endometritis in patients of reproductive age: individualized treatment capabilities. Obstetrics, Gynecology and Reproduction. 2020;14(3):283-295. (In Russ.) https://doi.org/10.17749/2313-7347/ob.gyn.rep.2020.157

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ISSN 2313-7347 (Print)
ISSN 2500-3194 (Online)