A pairwise comparison of the clinical characteristics of patients with external genital endometriosis (EGE) stages I–III was carried out using Fisher's exact test. Patients with the most common (and newly diagnosed) stage II showed the greatest number of statistically significant correlations between clinical signs: dysmenorrheas with primary infertility (p = 0,0201), with localization of endometrioid heterotopias in the pouch of Douglas (p = 0,0214) and sacro-uterine ligaments (p = 0,0259); in addition, a relationship was found between the symptom of chronic pelvic pain and the presence of endometrioid heterotopias in the uterovesical space (p = 0,0071) and on the sacro-uterine ligaments (p = 0,0228). Along with this, they have a combination of foci of adenomyosis with multiple myoma of the uterine body was noted (p = 0,0000). In patients with stage III EGE, only one statistically significant (p = 0,0139) contingency of clinical signs was revealed — dyspareunia and heterotopias on the sacro-uterine ligaments.
Th e aim of the research. To study markers of angiogenesis and infl ammation in dominant fi broids and myometrium. Material and methods. Myomectomy in 226 patients of reproductive age with uterine myoma was carried out. Th e resected samples of dominant myomatous nodules and perifocal myometrium of 35 females including 12 treated using selective progesterone receptor (PgR) modulator were examined for the content of granulocyte-macrophage colony-stimulating factor (GM-CSF), vascular endothelial growth factor (VEGF) and 17-hydroxyprogesterone in the incubation medium using enzyme-linked immunosorbent assay (ELISA). Spontaneous and stimulated by polyclonal activators (PA) levels of the markers were studied. Additionally, the expression of PgR and VEGF was analysed through immunohistochemistry (IHC). Nonparametric statistics methods were used. Th e Wilcoxon test was used for intragroup comparison, the Mann-Whitney test was used for intergroup comparison. Th e correlations between biomarkers were studied using the Spearman correlation coeffi cient. Results. In the surgical specimens of leiomyoma and myometrium treated without hormone therapy, statistically signifi cant diff erences were revealed for PA-stimulated GM-CSF production incubated in vitro (2-fold lower in the nodule than in the myometrium), as well as for VEGF expression in tissue samples (2-fold higher in the nodule than in the myometrium). PgR expression in the myometrium directly correlated with the infl ammatory infi ltration of the nodule. Th e use of the selective PgR modulator contributed to the downregulation of GM-CSF production and VEGF expression in the nodule with no eff ect on the myometrium, as well as to a decrease in 17-OH-progesterone in the myometrium without changes in the nodules, and to a negative correlation between PgR expression and VEGF production in leiomyomas. Conclusion. For the dominant fi broid, application of the selective PgR modulator contributed to a downregulation of VEGF expression and to the decrease of in-vitro production of GM-CSF without infl uence on the perifocal myometrium, which demonstrates its proangiogenic and proinfl ammatory potential in patients with uterine myoma.
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