卷 21, 编号 1 (2019)
Articles
Vasoactive genes as molecular and genetic predictors of severe preeclampsia
摘要
Aim. To analyze an incidence rate of polymorphisms and combinations of genes AGT-704T> C, AGT-521C> T, AGTR1-1166A> C, AGTR2-1675G> A, еNO3-786T> C, еNOS3-894G> C, ADD1-1378G> T, CYP11B2 -304C> T, GNB3-825C> T and to assess their association with a risk of severe pre-eclampsia. Materials and methods. The study included women of early fertile age (20-35 years old) with spontaneous singleton pregnancy, no bad habits (smoking, alcohol or drug use), no extragenital diseases and no family (mother or sister) or an individual history of pre-eclampsia and with body mass index in the first trimester of pregnancy less than 35 kg/m2. The study group consisted of 100 patients with severe preeclampsia and the control group included 100 women with uncomplicated pregnancy. Genotyping was carried out by method of polymerase chain reaction. Data analysis included compliance with the Hardy - Weinberg law, Cramer's V criterion, χ2 test, odds ratio (OR) and its 95% confidence interval (CI). To assess a distribution of stated polymorphisms of genes and their alleles a general (χ2 test, df=2) and multiplicative (χ2 test, df=1) inheritance models were used. Results and discussion. Patients with severe pre-eclampsia had statistically significantly higher incidence rate of mutant homozygous genotypes AGTR1-1166CC (χ2=5,54; p=0,05) and еNO3-786CC (χ2=23,05; p=1,0E-5). A significant association between a carrier of the mutant homozygous genotype eNO3-786СC (χ2=19,780; p=0,000) and severe pre-eclampsia (OR 45,07, 95% CI 2,68-759,30) was found out. Combinations of mutant alleles of potentially predictive polymorphisms of vasoactive genes in women with preeclampsia were recorded 7,7 times more often (23% vs 3%; χ2=17,683, p=0,000; average Cramer's V link) which led to a significant association link with a risk of a disease complication (OR 9,658, 95% CI 2,795-33,367). Conclusion. A synergistic interaction between polymorphic loci in severe preeclampsia was established. The mutant homozygous genotype eNO3-786СC as well as a combination of at least two mutant alleles of genes - candidates for arterial hypertension or their combination with the mutant gene ADD1-1378TT or GNB3-825TT can claim a role of molecular and genetic predictors of severe preeclampsia.
Gynecology. 2019;21(1):10-13
10-13
New in a diagnosis and treatment of chronic endometritis at infertility
摘要
Background. Chronic endometritis is one of the causes of infertility, miscarriage, failed in vitro fertilization and embryo transfer attempts. Treatment of chronic endometritis is quite complicated due to a multifactorial nature of endometrium morpho-functional disorders. There are lots of approaches to a comprehensive treatment of chronic endometritis which indicates a lack of a single algorithm for a management of such patients to date. One of the modern, perspective and high-tech methods for treatment of chronic endometritis is photodynamic therapy (PDT). Aim. To study chronic endometritis treatment efficacy in patients with infertility when using the method of PDT and low doses of 17b-estradiol. Materials and methods. 85 female patients of reproductive age with chronic endometritis were examined and treated. All patients were divided into 2 groups: group 1 (43 patients) got treated by a method of intravenous PDT with low-dose transdermal 17b-estradiol; group 2 (42 patients) received low-dose transdermal therapy with 17b-estradiol. Clinical examination and laboratory tests, pelvic ultrasound, endometrial aspiration biopsy followed by pathomorphlogical and immunohistochemical examination were carried out to all patient. Results. Ultrasound examination revealed an increase in endometrium thickness at 12th day following PDT session in group 1 and following transdermal therapy with 17b-estradiol in group 2 resulting in endometrium state improvement almost 2 times compared with baseline values before treatment. Conclusions. PDT is a minimally invasive, gentle and safe treatment method. Due to a diffuser design laser radiation is evenly distributed in the uterine cavity. PDT reliably restores receptor function to progesterone in the endometrial glands.
Gynecology. 2019;21(1):14-18
14-18
Pelvic floor muscle training in women with a history of breast cancer
摘要
Relevance. The issue of pelvic floor muscle dysfunction (PFMD) is common in female population. It causes severe moral suffering and reduces both social activity and a quality of patient’s life. In this regard PFMD management with modern methods for training of pelvic floor muscles using devices is the "first line" method. Aim. To study treatment effectiveness and a quality of life in women with PFMD followed radical treatment for breast cancer (BC). Outcomes and methods. A prospective clinical study on clinical efficacy of a biofeedback method in combination with electrical stimulation of pelvic floor muscles using a device “Urostim” in patients with mild PFMD followed combined treatment fpr BC was carried out at Department of Aesthetic Gynecology of V.I.Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology. The study included 15 postmenopausal women. Results. It was established that 10 sessions of pelvic floor muscles training in a mode of biofeedback result in beneficial effects on for all clinical indicators. Conclusion. PFMD treatment by training of pelvic floor muscles using devices is one of the most promising ways to reduce surgical interventions number in urogynecology and to provide a rehabilitation of women who had surgery for BC.
Gynecology. 2019;21(1):19-22
19-22
The results of assisted reproductive technology programs in patients with “thin” endometrium
摘要
Relevance. Effectiveness of assisted reproductive technology (ART) programs is quite high, but for couples who have already had failed attempts of ART programs the likelihood of getting pregnant decreases with each subsequent attempt. Low endometrial thickness is a common cause of a decline in a possibility of getting pregnant. However, data on predictive value of this index in ART programs are contradictory. Some researchers do not find a correlation between the endometrium thickness and ART programs outcomes. Other researchers revealed a statistically significant relationship between endometrium thickness and pregnancy rate in ART cycles. Aim. To evaluate an effect of “thin” endometrium on pregnancy rate in ART programs. Materials and methods. 154 couples who applied for infertility treatment in ART programs were included in this prospective study. The patients were stratified into groups depending on whether a pregnancy to occur: Group 1 (n=43) - pregnancy occurred and Group 2 (n=111) - pregnancy did not occur. Then the endometrial thickness threshold determining pregnancy occurrence was identified by ultrasound and two additional groups were formed: Group 3 (n=85) - patients with “thin” endometrium, Group 4 (n=69) - patients with normal endometrial thickness. Results. The endometrial thickness threshold at which pregnancy probability, as well as the model and area under the curve (AUC) reliability were maximum, was 8.0 mm (AUC=86.7%, sensitivity - 97.7%, specificity - 75.7%). The adjusted odds ratio of pregnancy occurrence depending on endometrial thickness given the excellent quality blastocysts obtained, was 9.1 (95% confidence interval 4.3-19.3). Factors affecting endometrial thickness were endometrial polyps with polypectomy and spontaneous miscarriages in anamnesis that was undoubtedly associated with an inflammatory genesis of endometrial damage Conclusions. "Thin" endometrium plays a negative role in ART programs reducing pregnancy likelihood by 9.1 times.
Gynecology. 2019;21(1):23-27
23-27
Local cytokine therapy in a comprehensive treatment of HPV-associated cervical diseases
摘要
Aim. To analyze an efficacy of monotherapy and combined therapy (an immunomodulator + radio wave ablation) in patients with low-grade squamous intraepithelial lesion (L-SIL) caused by HPV infection. Materials and methods. The study included 210 women with human papillomavirus infection which was identified using real-time polymerase chain reaction (PCR). All women underwent a comprehensive examination which included history taking, general and gynecological examinations, extended colposcopy and a bacterioscopy of Gram-stained vaginal smears. A quantitative determination of vaginal microflora composition by PCR was carried out. Conclusion on either inflammatory response is present or absent was made on the basis of an inflammation index magnitude: with a value of more than 60% indicating a presence of local inflammation signs. Based on cervical cytology data a group consisting of 79 women who had L-SIL was formed. Patients were divided into 2 subgroups: the main one (n=45) who received combined treatment with radio wave ablation + an immunomodulator and a control one (n=34) who received only local monodestruction of L-SIL foci followed etiotropic treatment. Results and discussion. An efficacy of combined treatment which included radio wave ablation + an immunomodulator was higher compared to monodestruction only - 86.7% vs 64,7% respectively. It is important that by 6th month of follow-up a relapse of human papillomavirus infection occurred in 4.5 and 23.5% of patients of main and control groups respectively. Local inflammation was assessed as positive with an inflammation index of more than 60%. So after 6 months of follow-up this indicator decreased by 83.3 and 54.2% in the 1st and 2nd groups respectively. Clinical manifestations of an inflammatory process in the cervix was observed only with CIN recurrence. In addition, combined therapy provides a higher rate of human papillomavirus elimination at 6 months and faster cervix epithelization followed treatment by ablation.
Gynecology. 2019;21(1):28-32
28-32
Combined oral contraceptives with natural estrogen and sexual function: the optimal method of contraception for women of different ages
摘要
Background. Combined oral contraceptives (COCs) are the most common method of prevention of unwanted pregnancies in women from the early reproductive period to perimenopause, therefore their impact on quality of life, sexual function and general well-being remains the subject of active discussion. Some studies revealed various manifestations of sexual dysfunction in patients receiving COCs, therefore such questions, as well as the advantages / disadvantages of individual components (their type and dose) of drugs, are of interest to the clinician. Aim. Assess mechanisms of influence of COCs on female sexual function. Materials and methods. In order to write this review domestic and foreign publications were searched in Russian and international search systems (PubMed, elibrary, etc.) for the last 2-15 years. Relevant articles from the peer-reviewed literature were included. Results. Many studies proved a beneficial effect of estradiol valerate (E2V) which is estrogen identical to natural one in a combination with dienogest (DNG) which is 4th generation progestin in a dynamic dosing regimen on quality of life and sexual function. This beneficial effect is achieved due to combined effects of both components of the drug as well as its reception mode. Conclusion. The combination of estradiol valerate (E2V) which is estrogen identical to natural one with dienogest (DNG) which is 4th generation progestin may be the optimal method of contraception for women of any age, including the young, with decreased libido while taking other COCs.
Gynecology. 2019;21(1):33-37
33-37
Treatment efficacy of infertility due to recurrent external genital endometriosis
摘要
Relevance. Despite lots of studies, issues on a choice of the most effective treatment method for patients with recurrent external genital endometriosis (EGE) as well as a role and features of assisted reproductive technology programs and ways to improve their performance are still unresolved. Aim. To provide a current understanding on etiopathogenesis and management strategy for patients with recurrent EGE and infertility according to Russian and foreign literature date. Materials and methods. In order to write this review, domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2-15 years. The review includes articles from peer-reviewed literature. Results. The article provides risk factors for EGE development, disease pathogenesis and clinical manifestation as well as drug and surgical methods for a treatment of endometriosis. Conclusion. Endometriosis remains still to be a mysterious disease for modern science. An individual approach given an age, ovarian reserve and a history of surgical treatment (numbers of surgical interventions for EGE) will allow you to elaborate a personal approach for each woman with subfertility.
Gynecology. 2019;21(1):38-43
38-43
Vitamin D3 and women's health
摘要
Background. Vitamin D is an essential component that regulates calcium homeostasis and many other cellular functions. Hypovitaminosis D is associated with a risk of osteopenia, obesity, type 1 and type 2 diabetes, malignant neoplasms and immune disorders. Inadequate vitamin D intake during pregnancy increases a risk of pre-eclampsia, preterm birth, low birth weight as well as it has a negative impact on both children’s and adolescents’ health. It is important for the clinician to be known administrating of vitamin D prophylactic and therapeutic regimens according to serum 25(OH)D levels. Aim. To determine causes and effects of vitamin D deficiency and to elaborate ways of their correction. Materials and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-15 years was conducted. The review includes articles from peer-reviewed literature. Results. The article shows that vitamin D has a significant impact on both the cardiovascular, endocrine, digestive, respiratory and other systems functioning and perinatal outcomes that necessitates vitamin D deficiency correction. It provides schemes for effective therapeutic and prophylactic drug doses calculating depending on vitamin D3 blood serum concentration. Conclusion. Preference should be given to cholecalciferol (vitamin D3) due to its better absorption properties and more efficient conversion to active vitamin metabolites (class IIC).
Gynecology. 2019;21(1):44-51
44-51
Modern conceptions of etiology and pathogenesis of benign breast disease: the possibilities of pathogenetic treatment
摘要
Relevance. The review article is devoted to modern conceptions of etiology and pathogenesis of benign breast disease (BBD), a common female pathology, as well as the pathogenetic treatment of BBD. Aim. Substantiation of the new possibilities of the pathogenetic treatment of BBD. Materials and methods. It was conducted the analysis of domestic and world literature in the following areas: etiology, pathogenesis, treatment of BBD, prevention of breast cancer (BC). Results. Dozens of etiological factors of various natures cause BBD: genetic, reproductive, hormonal, gynecological diseases, extragenital pathology, environment and lifestyle, medical interventions. The etiological factors of BBD mostly coincide with the risk factors of BC. The lack of progesterone, the predominance of estradiol and chronic hyperestrogenemia, leading to hyperproliferation of the ductal and lobular epithelium of the mammary glands, underlie the pathogenesis of BBD. The pathogenesis of proliferative forms of BBD and BC have common features. In patients with proliferative and precancerous forms of BBD, the risk of BC increases significantly. Chronic iodine deficiency is one of the common pathogenetic pathways for the development of BBD. The drug mamoclam containing organically bound iodine from laminaria thallus is an effective and safe remedy for the pathogenetic treatment of BBD. Conclusion. Pathogenetic treatment of BBD not only improves the quality of life of patients, but also reduces the risk of BC.
Gynecology. 2019;21(1):52-58
52-58
A strategy of antimicrobial therapy of pelvic inflammatory diseases at antibiotic resistance of microbial pathogens
摘要
Relevance. Antibiotic resistance of microbial pathogens is an interdisciplinary and interstate problem of major medical and socio-economic importance. If multiresistant microbial flora is detected in patients with acute or chronic forms of pelvic inflammatory diseases alternative antimicrobial combined therapy an advisability should be considered. Current trends of an increase in multiresistant gram-negative infections along with limited range of alternative treatment options dictate a need for further research. Study of alternative antibiotics effectiveness in pelvic inflammatory diseases treatment is necessary for a further development of optimal treatment regimens. Aim. To search for adequate combinations of antimicrobial therapy aimed at antibiotic-resistant pathogens. Materials and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 2-12 years was conducted. The review includes articles from peer-reviewed literature. Results. Fosfomycin possesses a broad spectrum of antibacterial effects including gram-positive and gram-negative aerobic bacteria. The drug is highly effective against Pseudomonas aeruginosa and Escherichia coli, anaerobic bacteria (Proteus mirabilis and Klebsiella pneumoniae) as well as against gram- positive bacteria (Staphylococcus spp., including S. aureus, S. epidermidis; Streptococcus spp., including Enterococcus faecalis). Conclusions. When multiresistant microbial flora is detected in patients with acute or chronic forms of pelvic inflammatory diseases an advisability of fosfomycin administration should be considered.
Gynecology. 2019;21(1):60-63
60-63
Hormonal contraception in women of reproductive age: endocrinological aspects
摘要
Relevance. Woman’s late reproductive age is a period of complex hormonal adjustment, a preparation for menopause onset. Despite a decline in a reproductive potential and accumulation of gynecological and extragenital diseases in this population a gynecologist has to deal with their contraception as well as a treatment of menstrual disorders and a prevention of hyperplastic processes in the genitals. A search for safe and reliable drugs to solve these problems is extremely important in women of late reproductive period. Aim. Based on date of modern clinical and scientific research a relevance of combined oral contraceptives (COCs) for a safe and reliable contraception as well as for some gynecological diseases treatment and female genital organs hyperplastic and neoplastic diseases prevention was determined. Materials and methods. To write this review a search for domestic and foreign publications in Russian and international search systems (PubMed, eLibrary, etc.) for the last 10 years was conducted. The review includes articles from peer-reviewed literature, data of domestic and foreign clinical guidelines on contraceptive issues and Cochrane Library reviews. Results. Use administration of microdose COCs in the late reproductive period, when taking into account criteria for their acceptability, provides reliable contraception. Based on Cochrane database systematic reviews (2011-2018) reliable data on COCs non-contraceptive therapeutic and prophylactic properties at menstrual cycle disorders, endometriosis, hyperandrogenemia, premenstrual syndrome and polycystic ovary syndrome are presented. Conclusion. A choice of COC containing ethinyl estradiol 20 µg and gestodene (progestogen III generation) 75 µg, given contraindications and current observation, is a rational, effective and safe. This provides effective family planning and maintenance of reproductive health of women of late and perimenopausal age due to its wide therapeutic and prophylactic properties given woman's body features.
Gynecology. 2019;21(1):65-68
65-68
Immunomodulators use in a treatment of lower urogenital tract infections in women
摘要
Relevance. Women’ immune system indexes are dependent on cyclic hormonal influences. They decrease in the ovulation and in luteal phase of the menstrual cycle forming a “window of vulnerability” when there is an increased risk of infection with pathogenic and opportunistic microorganisms. Infected tissues inflammatory reaction in its turn aggravates these disorders. For these reasons, one should not only use empirical regimens of antimicrobial therapy covering wide spectrum of pathogens, but also to consider the possibility and need of a comprehensive approach with use of adjuvant treatment methods (detoxification, immunomodulatory, supportive therapy). Aim. To determine immunological changes in the body of women with lower genital tract infectious and inflammatory diseases and to justify a role of immunomodulators in increasing of treatment and relapse prevention efficacy. Materials and methods. In order to write this review domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2-22 years. The review included articles from peer-reviewed literature. Results. Due to its immunomodulatory, anti-inflammatory and detoxifying effects azoximer bromide contributes to an increase in treatment efficacy: elimination of pathogenic flora increases by 30%, clinical manifestations resolution occurs 2 times faster, a relapse risk reduces. Conclusion. To activate anti-infective immunity a comprehensive treatment with immunomodulators use is advisable.
Gynecology. 2019;21(1):69-74
69-74
Cancer risks and benefits of hormonal contraception: a literature review and practical issues
摘要
Aim. To provide up-to-date data on cancer risks in women who use oral hormones to protect themselves from unwanted pregnancies, since high onco-alertness is one of the most common reasons for their withdrawal. Materials and methods. To write this review a search for domestic and foreign articles in Russian and international search systems (PubMed, eLibrary, etc.) which were published in the period from 2003 to 2019 was carried out. The review included articles from peer-reviewed literature and guidelines for physicians and periodicals identified by keywords: cancer, cancer risk, hormonal contraception, hormones, non-contraceptive effects of combined oral contraceptives (COCs). Results. Hormonal contraceptives have a large number of beneficial non-contraceptive effects, particularly in relation to diseases associated with a menstrual cycle (premenstrual syndrome and premenstrual dysphoric disorder, menstrual disorders), infertility and a number of other diseases. Oral contraceptive use reduces an incidence of ovarian cancer and colorectal cancer but increases risks for cervix cancer and breast cancer. Based on the analysis of literature data, it was shown that women who have ever used hormonal contraception have a lower risk of death from all causes comparing to those who have never used them. Conclusion. To make a decision on a use of COCs patients should be examined and competently informed about benefits and risks of hormonal contraception.
Gynecology. 2019;21(1):75-79
75-79
Basic principles of management of patients with genital herpes
摘要
Background. Genital herpes is a chronic recurrent sexually transmitted viral disease. Recurrent genital herpes is a serious medical and psychosocial issue which significantly worsens patients’ quality of life. Such a course of the disease is a stressful and psycho-traumatic factor limiting patients’ social life. In addition, in about 10% of cases, relapses of genital herpes cause depression, acute psychosis and suicidal tendencies. Herpesvirus infection occupies a leading position among perinatal TORCH infections. Herpes infection exerts an unfavorable and often fatal effects on pregnancy and childbirth and it is of a relevant issue up today since its role in causing fetal and newborn disorders does not tend to decrease. Current an increase in genital herpes relapse rate dictates need for further research. Study of various etiotropic antiviral therapy regimens effectiveness is necessary for the further elaboration of optimal treatment regimens and preparation for pregnancy. Aim. To search for adequate etiotropic antiviral therapy regimens aimed at reducing genital herpes relapse rate. Materials and methods. To write this review domestic and foreign publications were searched in Russian and international search systems (PubMed, eLIBRARY, etc.) for the last 2-10 years. The review includes articles from peer-reviewed literature. Results. The review describes features of genital herpes clinical course, its diagnosis, differentiated diagnosis and complications. Various treatment regimens are presented. The effectiveness of etiotropic therapy with various drugs was estimated. Conclusions. Episodic use of valaciclovir for recurrent genital herpes allows to reduce significantly a current relapse severity and duration as well as to provide psychological support to patients.
Gynecology. 2019;21(1):80-85
80-85
Menopausal hormone therapy and non-gynecologic cancer (part II)
摘要
Aim. To carry out a systematic analysis of available researches data on a possibility of using menopausal hormone therapy (MHT) in patients who successfully completed a treatment for malignant neoplasms of different localization. Materials and methods. The review includes data of foreign articles published in PubMed and Medline and domestic articles published in Elibrary.ru over the past 20 years. Results. The data obtained allow us to extend indications range for MHT in patients with history of malignant neoplasms in different organs. This study is one of the few attempts of clinicians to justify the use of MHT as one of the tools for the still imperfect rehabilitation of cancer patients. Conclusion. Patients who successfully completed a treatment for malignant tumors of any localization require special conditions of rehabilitation in order to keep their health and quality of life. A reasonable MHT use in these patients will allow to avoid complications caused by estrogen deficiency followed surgery, radiation with or without systemic (cytostatic) treatment methods.
Gynecology. 2019;21(1):86-90
86-90