Objective. To perform comparative analysis of clinical data, serum levels of acute-phase proteins, cytokines, steroid hormones, and expression of genes encoding sex hormone receptors in tissues of patients with proliferative diseases of the uterus. Patients and methods. We analyzed clinical data of 349 patients with various proliferative diseases of the uterus. We also evaluated their serum levels of α2-macroglobulin, pregnancy-associated α2-glycoprotein, their immunocomplexes with IgG, lactoferrin, VEGF, IL-6, TNFa, IL-8, and sex hormones. Uterine tissue samples were tested for the expression of genes encoding estrogen receptors α and β (ЕRα, ЕRβ) and progesterone receptors (PGR). Data analysis was performed using the statistical packages of SAS 9.4, STATISTICA12, and IBM-SPSS Statistics 22. Results. The changes in the level of acute-phase proteins indicated inflammation. In isolated uterine fibroids, expression of genes encoding progesterone receptors prevailed, whereas in isolated adenomyosis, expression of genes encoding estrogen receptors prevailed. Patients with both uterine fibroids and adenomyosis demonstrated similar levels of expression of genes encoding sex steroid hormone receptors. Tissues of uterine leiomyosarcoma were characterized by downregulated expression of genes encoding sex steroid hormone receptors. Conclusion. Upregulation of genes encoding progesterone receptors in isolated uterine fibroids confirms that therapy with progesterone receptor blockers is appropriate in this case. The predominance of expression of genes encoding estrogen receptors in isolated adenomyosis indicates local hyperestrogenism, justifying the use of progestogens and antiestrogens. Equal expression of genes encoding estrogen and progesterone receptors in patients with combined disease, as wells as high frequency of inflammatory changes in tissues and increased serum levels of inflammatory markers, proves the need for antiinflammatory therapy. Key words: adenomyosis, inflammation, steroid receptor genes, leiomyosarcoma, uterine fibroids, gene expression
Миома тела матки -одно из самых распространенных гинекологических заболеваний у женщин перименопау-зального периода [1]. Это заболевание способно негативно влиять на общее состояние женщины, вызывая гормональ-ные, вегетососудистые и психоэмоциональные расстрой-ства [2]. При этом около 80% пациенток с миомой матки подвергаются радикальному оперативному лечению [3]. Механизмы развития и роста этой доброкачественной опу-e-mail: balkoshka@mail.ru холи окончательно не установлены и остаются дискуссион-ными. В настоящее время обсуждается роль в патогенезе миомы иммунных нарушений [4][5][6]. Доказано, что рост миомы сопровождается ослаблением иммунной защиты [7] на фоне повышения уровня провоспалительных цитоки-нов [8], которые являются регуляторами процессов проли-ферации и апоптоза, медиаторами действия половых сте-роидов [2]. Участие многих факторов в развитии миоматоз- Цель исследования -изучить сывороточные уровни иммунорегуляторных белков (ассоциированного с беременностью α 2 -гликопротеина, α 2 -макроглобулина, лактоферрина, α 1 -антитрипсина), некоторых провоспалительных цитокинов (ИЛ-6, ИЛ-8, ФНО-α) и сосудисто-эндотелиального фактора роста (VEGF) у женщин перименопаузального периода с миомой тела матки в зависимости от размеров опухоли. Материал и методы. В сыворотке крови 20 женщин с миомой матки малых размеров и 27 женщин с миомой матки больших размеров, а также 25 женщин контрольной группы методом количественного ракетного иммуноэлектрофореза определялись ассоциированный с беременностью α 2 -гликопротеин, α 1 -антитрипсин и α 2 -макроглобулин; методом иммуноферментного анализа определялись цитокины, лактоферрин и VEGF. Результаты. Установлено, что у женщин с миомой матки малых размеров все изучаемые показатели достоверно не отличались от их значений в контрольной группе. У женщин с миомой тела матки больших размеров выявлялись статисти-чески значимое повышение уровней цитокинов (ИЛ-6, ИЛ-8, ФНО-α 1 ), лактоферрина и VEGF, а также снижение содер-жания α 1 -антитрипсина по сравнению с показателями контрольной группы и со значениями в группе пациенток с миомой матки малых размеров. Выявлена прямая корреляция между лактоферрином и ИЛ-8. Заключение. Нами выявлены особен-ности изменений содержания в сыворотке крови иммунорегуляторных белков, провоспалительных цитокинов и VEGF в зависимости от размеров миоматозных узлов. Показано, что с увеличением размера опухоли увеличивается содержание провоспалительных цитокинов и появляется дисбаланс модулирующих их синтез белков.Авторы заявляют об отсутствии конфликта интересов.Ключевые слова: миома тела матки, цитокины, ассоциированный с беременностью α 2 -гликопротеин, α 2 -макроглобулин, α 1 -антитрипсин, лактоферрин, сосудисто-эндотелиальный фактор роста.Objective -to study the serum levels of immunoregulatory proteins (pregnancy-associated α 2 -glycoptotein, α 2 -macroglobulin, lactoferrin, and α 1 -antitrypsin), some proinflammatory cytokines (IL-6, IL-8, TNF-α), and vascular endothelial growth factor (VEGF) in perimenopausal women with myoma of the corpus uteri accor...
Aim. To determine the clinical, anamnestic, and immunological predictors of adenomyosis by developing a prognostic model of uterine fibroids with concomitant adenomyosis. Materials and methods. A retrospective single-center study was conducted at Kurbatov Novokuznetsk City Clinical Hospital №1, from 2012 to 2019. The model included 284 women with histologically confirmed uterine fibroids, of which 34.9% (99/284) were fibroids with adenomyosis and 65.1% (185/284) were isolated uterine fibroids. Logistic regression was used to develop the mathematical model. Results. Predictors of adenomyosis in patients with uterine fibroids have been established: age 43 years and older, concomitant endometrial hyperplasia, chronic inflammatory diseases of the cervix, menometrorrhagia, history of childbirth, history of endometrial disorders, varicose veins of the lower extremities, history of appendectomy, blood serum lactoferrin of more than 1.8 mg/L, interleukin-6 levels more than 2.8 pg/mL. The model has an accuracy of 91%, a sensitivity of 90%, a specificity of 92%, a positive predictive value of 85%, and a negative predictive value of 94%. Conclusion. The established predictors of adenomyosis allow for predicting the risk of adenomyosis in patients with uterine fibroids, facilitating effective treatment choices.
RELEVANCE Pregnant uterus perforation during laparoscopy is a rare complication, accompanied by a higher risk of infection and miscarriage. Clinical management of pregnancy and its outcome have practical interest and need discussion.AIM To provide a clinical case of pregnant uterus perforation during laparoscopy.MATERIAL AND METHODS Patient L., 34 years old, with a tumor of the right ovary and 21–22 weeks of pregnancy. Result The article describes a clinical case of independent childbirth on time after pregnant uterus perforation during laparoscopy with removing a significant volume of amniotic fluid in a 21–22 weeks pregnant woman.CONCLUSION The prolongation of pregnancy and independent childbirth on time after uterus perforation with a gestation period of 21 or 22 weeks is possible in case of timely diagnosis of the complication, careful restoration of uterine integrity and rational management of the postoperative period.
Pathogenetic mechanisms of uterine leiomyoma, adenomyosis and their combination are complicated and poorly understood, a differential diagnosis of leiomyosarcoma of the uterus is difficult. Our study aimed for a comparative analysis of the serum contents of α2-MG, PAG, some cytokines, sex steroids and the expression of steroid receptor genes in the patients with different variants of uterine proliferative diseases, in order to determine their pathological role, diagnostic and prognostic value. Expression of estrogen receptor genes adenomyosis nodes was 1.5 to 2-fold higher than in leiomyoma, the combined pathology showed intermediate values, and expression of ER and PGR genes in leiomyosarcoma was minimal. In cellular leiomyoma, expression of ER receptor genes in the surrounding myometrium was 2 to 3-fold higher than in cases of simple leiomyomas. At the same time, concentration of estrogen and progesterone in the blood is comparable between the groups and control groups. All the patients have a deficiency of immunomodulatory α2-MG (12-13% for leiomyomas, 20% for adenomyosis, and 23% for malignant pathology). The concentration of immunosuppressive PAG is increased in combined conditions and leiomyosarcoma. In addition, the contents of IL-6 and TNFα increase, the VEGF levels exceed normal values 4 to 4.5-fold, in leiomyoma, 5.5-fold, in combined pathology, 6.5, in adenomyosis, and 10-fold, in leiomyosarcoma.The obtained results confirm that immunomodulatory proteins, cytokines and cell-targeting sex hormones exert an interdependent influence upon each other in the studied diseases, and their significant changes may be used in diagnostics and prognosis.
Purpose of the study. To assess the influence of main clinical risk factors on the effectiveness of the in vitro fertilization (IVF) program.Materials and methods. The study included 3,969 IVF programs conducted in the “Medica” clinic of the “Mother and Child” group of companies in Novokuznetsk for 2010–2015. The inclusion criterion was the availability of information on the results of the procedure conducted.Results.The structure of the considered risk factors was identified, their key features were identified: the majority of women who underwent IVF procedure were under the age of 34, inclusive, more than half of all procedures were performed at the first attempt. The main causes of female infertility were: tubal factor, including those associated with chronic endometritis, polycystic ovary syndrome, external genital endometriosis and adenomyosis. In a number of cases, as a concomitant gynecological disease, uterine fibroids have been extirpated, which is not the main cause of infertility, but the presence of which can influence the effectiveness of IVF programs. Statistically significantly more often, fibroids were found in adenomyosis and tubal factors associated with chronic endometritis. A quantitative assessment of the degree of influence of the considered risk factors on the effectiveness of IVF programs was considered, and the influence of both individual factors and their combination was considered.Conclusion.The main factors statistically significantly increasing the risk of a negative outcome of the program are: the age of a woman over 30; repeated attempt at the age of up to 30 years inclusive (in comparison with the first attempt); tubular factor associated with chronic endometritis; presence of uterine fibroids in the tubular factor associated with chronic endometritis; The presence of fibroids in the tubular factor, complicated by adenomyosis.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.