Хронический эндометрит как исход инфекционного воспалительного заболевания матки
Хронический эндометрит как исход инфекционного воспалительного заболевания матки
Кузнецова И.В., Землина Н.С., Рашидов Т.Н. Хронический эндометрит как исход инфекционного воспалительного заболевания матки. Гинекология. 2016; 18 (2): 44–50.
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Kuznetsova I.V., Zemlina N.S., Rashidov T.N. Chronic endometritis as a result of infectious inflammatory diseases of the uterus. Gynecology. 2016;
18 (№): 44–50.
Хронический эндометрит как исход инфекционного воспалительного заболевания матки
Кузнецова И.В., Землина Н.С., Рашидов Т.Н. Хронический эндометрит как исход инфекционного воспалительного заболевания матки. Гинекология. 2016; 18 (2): 44–50.
________________________________________________
Kuznetsova I.V., Zemlina N.S., Rashidov T.N. Chronic endometritis as a result of infectious inflammatory diseases of the uterus. Gynecology. 2016;
18 (№): 44–50.
Хронический эндометрит – одна из актуальных проблем современной гинекологии. Трудности верификации, отсутствие единства в понимании природы воспалительного поражения эндометрия, малосимптомная картина при множественных негативных исходах для репродукции – все это определяет интерес к патогенезу, диагностике и лечению хронического эндометрита. Лечение эндометрита, как формы воспалительного заболевания органов малого таза, лежит в плоскости применения антибиотикотерапии. Однако формирование хронического воспаления связано не столько с вирулентностью микроорганизма, сколько с особенностями иммунной реакции макроорганизма и локальным иммунитетом эндометрия. Это обосновывает использование в комплексной терапии иммуномодулирующих средств и препаратов, обладающих протеолитическим действием, направленным на предотвращение фиброза и склероза тканей. Одним из таких лекарственных средств является бовгиалуронидаза азоксимер (препарат Лонгидаза®). Ключевые слова: хронический эндометрит, воспалительные заболевания органов малого таза, внутриматочные сращения, воспаление, фиброз, антибиотикотерапия, иммуномодуляция, бовгиалуронидаза азоксимер.
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Chronic endometritis is one of the most urgent problems of modern gynecology. The difficulties of verification, the lack of unity in the understanding of the nature of the inflammatory lesions of the endometrium, a symptomically uneven picture with multiple negative outcomes for reproduction - all this determines the interest in the pathogenesis, diagnosis and treatment of chronic endometritis. The treatment of endometritis, as a form of inflammatory diseases of the pelvic organs, lies in the use of antibiotic therapy. However, the formation of chronic inflammation is associated not so much with the virulence of the organism, but with the features of the immune response of host and the local immunity of the endometrium. This justifies the use in the treatment of immunomodulatory drugs and drugs with proteolytic action, aimed at preventing fibrosis and sclerosis of tissues. One of these drugs is bovhyaluronidase azoximer (Longidaze). Key words: chronic endometritis, inflammatory diseases of the pelvic organs, intrauterine adhesions, inflammation, fibrosis, antibiotic therapy, immunomodulation, bovhyaluronidase azoximer.
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1. Unanian A.L., Kossovich Iu.M. Khronicheskii endometrit: etiopatogenez, diagnostika, klinika i lechenie. Rol' antifibroziruiushchei terapii. Lechashchii vrach. 2012; 11: 35–40. [in Russian]
2. Shurshalina A.V. Optimizatsiia taktiki vedeniia patsientok s vospalitel'nymi zabolevaniiami organov malogo taza. Ginekology. 2012; 14 (2). [in Russian]
3. Motovilova T.M., Kachalina T.S., Anikina T.A. Al'ternativnyi podkhod k lecheniiu bol'nykh s khronicheskim nespetsificheskim endometritom. RMZh. Mat' i ditia. 2013; 14: 751–6. [in Russian]
4. Haggerty CL. Evidence for a role of Mycoplasma genitalium in pelvic inflammatory disease. Cur Opin Infect Dis 2008; 21 (1): 65–9.
5. Kumbak B, Erden HF, Tosun S et al. Outcome of assisted reproduction treatmentin patients with endometrial thickness less then 7 mm. Reprod Biomed Online 2009; 18 (1): 79–84.
6. Glukhova E.V., Shakhovskaia I.N. Mikrobiologicheskaia kharakteristika biotopov reproduktivnogo trakta pri endometrite. Tol'iattinskii med. konsilium. 2011; 1–2: 38–44. [in Russian]
7. Bukharin O.V., Cherkasov S.V., Sgibnev A.V. i dr. Kharakteristika mikroekologicheskikh narushenii pri endometrite. Zhurn. mikrobiologii, epidemiologii i immunobiologii. 2009; 4: 93–6. [in Russian]
8. Shurshalina A.V. Khronicheskii endometrit: sovremennye podkhody k terapii.Consilium Medicum. 2009; 11 (6): 36–8. [in Russian]
9. Aslim B, Kilic E. Some probiotic properties of vaginal lactobacilli isolated from healthy women. Jpn J Infect Dis 2006; 59 (4): 249–53.
10. Dimitonova SP, Danova ST, Serkedjieva JP et al. Antimicrobial activity and protective properties of vaginal lactobacilli from healthy Bulgarian women. Anaerobe 2007; 13 (5–6): 178–84.
11. Garg KB, Ganguli I, Das R et al. Spectrum of Lactobacillus species present in healthy vagina of Indian women. Indian J Med Res 2009; 129 (6): 652–7.
12. Martin R, Suarez JE. Biosynthesis and degradation of H2O2 by vaginal lactobacilli. Appl Environ Microbiol 2010; 76 (2): 400–5.
13. Tamrakar R, Yamada T, Furuta I et al. Association between Lactobacillus species and bacterilvaginosis – related bacteri, and bacterial vaginosis scores in pregnant Japanese women. ВМС Infect Dis 2007; 7: 128.
14. Aagaard K, Petrosino J, Keitel W et al. The Human Microbiome Project strategy for comprehensive sampling of the human microbiome and why it matters. J FASEB J 2013; 27 (3): 1012–22.
15. Tapil'skaia N.I., Karpeev S.A., Kuznetsova I.V. Khronicheskii endometrit – subklinicheskoe vospalitel'noe zabolevanie organov malogo taza. Ginekology. 2014; 1: 104–9. [in Russian]
16. Amsler L, Malouli D, De Filippi V. The inflammasome as a target of modulation by DNA viruses. Future Virol Author manuscript; available in PMC Jun 18, 2014.
17. Aflatoonian R, Fazeli A. Toll-like receptors in female reproductive tract and their menstrual cycle dependent expression. J Reprod Immunol 2008; 77: 7–13.
18. Hirata T, Osuga Y, Hamasakia K et al. Expression of toll-like receptors 2, 3, 4, and 9 genes in the human endometrium during the menstrual cycle. J Reprod Immunol 2007; 74 (1–2): 53–60.
19. Horne AW, Stock SJ, King AE. Innate immunity and disorders of the female reproductive tract. Reproduction 2008; 135: 739–49.
20. Le Bouteiller P, Tabiasco J. Killers become builders during pregnancy. Nat Med 2006; 12: 991–2.
21. Quenby S, Farquharson R. Uterine natural killer cells, implantation failure and recurrent miscarriage. Reprod Biomed Online 2006; 13: 24–8.
22. Tuckerman E, Larid SM, Prakash A, Li TC. Prognostic value of the measurement of uterine natural killer cells in the endometrium of women with recurrent miscarriage. Hum Reprod 2007; 8: 2208–13.
23. Serebrennikova S.N., Seminskii I.Zh. Rol' tsitokinov v vospalitel'nom protsesse (soobshchenie 2). Sib. med. zhurn. 2008; 83 (8): 5–9. [in Russian]
24. Smith M, Hagerty KA, Skipper B et al. Chronic endometritis: a combined histopathologic and clinical review of cases from 2002 to 2007. Int J Gynecol Pathol 2010; 29 (1): 44–50.
25. Pitsos M, Skurnick J, Heller D. Association of pathologic diagnoses with clinical findings in chronic endometritis. J Reprod Med 2009; 54 (6): 373–7.
26. Killick SR. Ultrasound and the receptivity of the endometrium. Reprod Biomed Online 2007; 15 (1): 63–7.
27. Caserta L, Labriola D, Torella M et al. The use of transvaginal ultrasound following voluntary interruption f pregnancy to reduce complications due to incomplete curettage. Minerva Ginecol 2008; 60 (1): 7–13.
28. Merce LT, Barco MJ, Bau S et al. Are endometrial parameters by threedimensional ultrasound and power Doppler angiography related to in vitro fertilization/embryo transfer outcome? Fertil Steril 2008; 89 (1): 111–7.
29. Senturk LM, Erel CT. Thin endometrium in assisted reproductive technology. Obstet Gynecol Int 2009; 397079.
30. Ozerskaia I.A., Ageeva M.I., Zaeva V.V. Kompleksnoe ul'trazvukovoe issledovanie matki u zhenshchin posle neudachnykh popytok ekstrakorporal'nogo oplodotvoreniia. Ul'trazvuk. funkts. diagnostika. 2006; 6: 41–50. [in Russian]
31. Kasius A, Smit JG, Torrance HL et al. Endometrial thickness and pregnancy rates after IVF: a systemstic review and metaanalysis. Hum Reprod Update 2014; 20 (4): 530–41.
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Авторы
И.В.Кузнецова*, Н.С.Землина, Т.Н.Рашидов
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2
*ms.smith.ivk@gmail.com
________________________________________________
I.V.Kuznetsova*, N.S.Zemlina, T.N.Rashidov
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2
*ms.smith.ivk@gmail.com