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.
Violation of the extracellular matrix components synthesis regulation contributes to the formation and growth of uterine fbroids (MM). Changes of collagen metabolism in connective tissue may be associated with polymorphism of matrix metalloproteinase (MMP) genes. Aim of the study was to analyze of the association of regulatory regions of matrix metalloproteinase genes MMP2 (rs243865), MMP3 (rs3025058), MMP9 (rs3918242) with the development of uterine myoma, its histological form, several concomitant gynecological diseases. Material and methods. The clinical study of 69 patients (23–54 years old) with uterine myoma was conducted. According to the anamnesis, 57.9 % of patients had childbirth, 46.4 % of women had an artifcial termination of pregnancy, and 15.9 % of women had endometriosis. In histological examination, in 48.14 % the nodes corresponded to the phenotype of simple fbroids with a large proportion of fbrous tissue, 51.6 % with the phenotype of proliferating fbroids. The comparison group is represented by a random population sample of women from Western Siberia. 183 women without pronounced gynecological pathologies were examined. MMP2-1306 C/T polymorphism was analyzed by TaqMan, MMP3-1171 5A/6A, MMP9-1562 C/T by restriction fragment length polymorphism method. Results. The genotype frequencies of the analyzed genes did not signifcantly differ between the groups. The complex genotype MMP2-1306CC:MMP3-11715A6A:MMP9-1562CT was decreased in women with uterine myoma relative to the persons of the comparison group. In endometriosis patients MMP9-1562CC genotype was reduced and heterozygosity was increased relative to patients without endometriosis. The frequency of MMP2-1306CC:MMP9-1562CT complex genotype is signifcantly higher in women who gave birth than in women who did not give birth. Complex genotypes differences between histological variants of uterine myoma were revealed. Conclusions. The results of the study show the signifcance of polymorphism effect of the regulatory regions of the MMP genes in the development and nature of the course of uterine myoma.
Endometriosis, or endometrioid disease, is a chronic estrogen-dependent gynecological disease caused by ectopic localization of endometrial tissue, mainly in the pelvis and ovaries. However, at the present stage of development of reproductive medicine, the classical topographic definition of endometriosis should be expanded with new significant characteristics established using the achievements of cell and molecular biology, which allowed a more detailed study of the pathogenesis of this disease. In addition, the introduction of personalized approaches to the treatment of patients with endometriosis and infertility, more attention should be paid to the search for disease predictors and the formation of risk groups with the observation of patients from puberty to menopause. In this review, we have analyzed the literature data and our own studies with an emphasis on factors and markers of decreased receptivity of eutopic endometrium in women with endometriosis, as well as pain, the manifestations of which can contribute to the exact diagnosis of external genital endometriosis.
The expression of heparan sulfate proteoglycans in eutopic and heterotopic endometrium in patients with ovarian endometriosis was studied using the method of immunohistochemistry. The simultaneous increase in the level of expression of core proteins of all studied heparan sulfate proteoglycans and the content of heparan sulfate in pathological tissues indicates the important role of glycosylated molecules in the pathogenesis of ovarian endometriosis.
Лейомиома матки (миома, или фиброма)-доброкачественная опухоль, наиболее часто встречающаяся у женщин, в том числе репродуктивного возраста, значительно влияющая на детородную функцию и качество жизни [1-3]. Заболевание характеризуется вариабельной клинической картиной. Тактика ведения зависит от возраста и репродуктивных задач пациентки, а также анатомо-топографических особенностей миоматозных узлов [4]. До 50-70% пациенток с миомой подвергаются хирургическому лечению [5], и по-прежнему актуальны патогенетически обоснованные методы консервативного лечения. Высокая распространенность заболевания (до 80% у афроамериканских и 50% у европейских женщин) [6, 7] индуцировала многочисленные научные исследования, тем не менее этиопатогенез лейомиомы матки привлекает пристальное внимание. В настоящее время наряду с представлениями о моноклональной гиперплазии и циклической механотрансдукции гладких миоцитов [8, 9], о влиянии стероидных гормонов [10-12] признана роль патологической васкуляризации опухолевых узлов миометрия [13], что позволило разработать метод эмболизации маточных артерий и ФУЗ-аблацию, однако не решило про
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