Хронический эндометрит является клинико-морфологическим синдромом, развивающимся в результате самоподдерживающегося патологического процесса, в основе которого лежит нарушение продукции провоспалительных цитокинов, инициированное инфекционным фактором. В статье представлены клиническая и этиологическая классификации эндометрита, патогенез развития с точки зрения вовлеченности иммунокомпетентных клеток, стандарты диагностики и терапии.
Chronic endometritis is a clinical and morphological syndrome resulting from a self-sustaining pathological process, which is based on alterations in production of pro-inflammatory cytokines initiated by an infectious factor. The article presents the clinical and etiological classification of endometritis, the pathogenesis in terms of an involvement of immunocompetent cells, and standards for diagnosis and therapy.
1. Eckert LO, Hawes SE, Wölner-Hanssen PK et al. Endometritis: the clinical-pathologic syndrome. Am J Obstet Gynecol 2002; 186: 690.
2. Шуршалина А.В. Хронический эндометрит как причина нарушений репродуктивной функции. Гинекология: журн. для практикующих врачей. 2012; 14 (4): 16–8. DOI: 10.1371/journal.pone.0214516
[Shurshalina A.V. Khronicheskii endometrit kak prichina narushenii reproduktivnoi funktsii. Ginekologiia: zhurn. dlia praktikuiushchikh vrachei. 2012; 14 (4): 16–8. DOI: 10.1371/journal.pone.0214516 (in Russian).]
3. Johnston-MacAnanny EB, Hartnett J, Engmann LL et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril 2010; 93: 437.
4. Kreisel K, Torrone E, Bernstein K et al. Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age – United States, 2013–2014. MMWR Morb Mortal Wkly Rep 2017; 66: 80.
5. Reekie J, Donovan B, Guy R et al. Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study. Clin Infect Dis 2018; 66: 437.
6. Westrom L, Mardh PA. Epidemiology, etiology, and prognosis of acute salpingitis: A study of 1,457 laparoscopically verified cases. In: Nongonococcal Urethritis and Related Diseases, Hobson D, Holmes KK (Eds), Am Soc Microbiol, Washington DC 1977; p. 84.
7. Sonnenberg P, Clifton S, Beddows S et al. Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet 2013; 382: 1795.
8. Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet 2000; 356: 1013.
9. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2017. Atlanta, GA: US Department of Health and Human Services; 2018.
10. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1.
11. French CE, Hughes G, Nicholson A et al. Estimation of the rate of pelvic inflammatory disease diagnoses: trends in England, 2000–2008. Sex Transm Dis 2011; 38: 158.
12. Srinivasan S, Hoffman NG, Morgan MT et al. Bacterial communities in women with bacterial vaginosis: high resolution phylogenetic analyses reveal relationships of microbiota to clinical criteria. PLoS One 2012; 7: e37818.
13. Morré SA, Karimi O, Ouburg S. Chlamydia trachomatis: identification of susceptibility markers for ocular and sexually transmitted infection by immunogenetics. FEMS Immunol Med Microbiol 2009; 55: 140.
14. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2015. Atlanta, GA: US Department of Health and Human Services; October 2016.
15. Altunyurt S, Demir N, Posaci C. A randomized controlled trial of coil removal prior to treatment of pelvic inflammatory disease. Eur J Obstet Gynecol Reprod Biol 2003; 107: 81.
16. Cicinelli E, De Ziegler D, Nicoletti R et al. Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril 2008; 89: 677.
17. Pitsos M, Skurnick J, Heller D. Association of pathologic diagnoses with clinical findings in chronic endometritis. J Reprod Med 2009; 54: 373.
18. Yudin MH, Hillier SL, Wiesenfeld HC et al. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188: 318.
19. Kammerer U, Michael von Wolffb, Udo R. Markert Immunology of human endometrium Immunobiology 2004; 209: 569–74.
20. Доброхотова Ю.Э., Ганковская Л.Н., Боровкова Е.И. и др. Модулирование локальной экспрессии факторов врожденного иммунитета у пациенток с хроническим эндометритом и бесплодием. Акушерство и гинекология. 2019; 5: 125–32.
[Dobrokhotova Iu.E., Gankovskaia L.N., Borovkova E.I. et al. Modulirovanie lokal'noi ekspressii faktorov vrozhdennogo immuniteta u patsientok s khronicheskim endometritom i besplodiem. Akusherstvo i ginekologiia. 2019; 5: 125–32 (in Russian).]
21. Haggerty CL, Ness RB, Amortegui A et al. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188: 141.
22. Propst AM, Liberman RF, Harlow BL, Ginsburg ES. Complications of hysteroscopic surgery: predicting patients at risk. Obstet Gynecol 2000; 96: 517.
23. Nair N, Camacho-Vanegas O, Rykunov D et al. Genomic Analysis of Uterine Lavage Fluid Detects Early Endometrial Cancers and Reveals a Prevalent Landscape of Driver Mutations in Women without Histopathologic Evidence of Cancer: A Prospective Cross-Sectional Study. PLoS Med 2016; 13: e1002206.
24. Maynard SE, Venkatesha S, Thadhani R. Soluble Fms-like Tyrosine Kinase 1 and Endothelial Dysfunction in the Pathogenesis of Preeclampsia. Pediatr Res 2005; 57 (5 Pt 2): 1–7R.
25. Wagaarachchi PT, Sirisena J. Efficiency of Pipelle device in sampling endometrium. Acta Obstet Gynecol Scand 2000; 79: 793.
26. Polena V, Mergui JL, Zerat L, Sananes S. The role of Pipelle Mark II sampling in endometrial disease diagnosis. Eur J Obstet Gynecol Reprod Biol 2007; 134: 233.
27. Williams AR, Brechin S, Porter AJ et al. Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG 2008;
115: 1028.
28. Hirai Y, Sakamoto K, Fujiwara H et al. Liquid-based endometrial cytology using SurePath™ is not inferior to suction endometrial tissue biopsy for detecting endometrial malignancies: Midterm report of a multicentre study advocated by Japan Association of Obstetricians and Gynecologists. Cytopathology 2019; 30: 223.
29. McQueen DB, Bernardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril 2014; 101: 1026.
30. ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstet Gynecol 2018; 131: e172.
31. APGO educational series on women's health issues. Clinical management of abnormal uterine bleeding. Association of Professors of Gynecology and Obstetrics, 2006.
32. ACOG Committee on Practice Bulletins – Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113: 1180. Reaffirmed 2016.
33. Cicinelli E, Resta L, Nicoletti R et al. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol 2005; 12: 514.
34. Cicinelli E, Resta L, Nicoletti R et al. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 2005; 20: 1386.
35. Grimes DA, Schulz KF. Antibiotic prophylaxis for intrauterine contraceptive device insertion. Cochrane Database Syst Rev 2001: CD001327.
36. Eckert LO, Thwin SS, Hillier SL et al. The antimicrobial treatment of subacute endometritis: a proof of concept study. Am J Obstet Gynecol 2004; 190: 305.
37. www.who.int/gtb/publications/globrep/index.html (Accessed 3/7/05)
38. Зароченцева Н.В., Аршакян А.К., Меньшикова Н.С., Титченко Ю.П. Хронический эндометрит: этиология, клиника, диагностика, лечение. Рос. вестн. акушера-гинеколога. 2013; 5: 21–7.
[Zarochentseva N.V., Arshakian A.K., Men'shikova N.S., Titchenko Iu.P. Khronicheskii endometrit: etiologiia, klinika, diagnostika, lechenie. Ros. vestn. akushera-ginekologa. 2013; 5: 21–7 (in Russian).]
39. Сухих Г.Т., Шуршалина А.В. Хронический эндометрит. М.: ГЭОТАР-Медиа, 2010.
[Sukhikh G.T., Shurshalina A.V. Chronic endometritis. Moscow: GEOTAR-Media, 2010 (in Russian).]
40. Сидорова И.С., Макаров И.О., Унанян А.Л. Патогенез и патогенетически обоснованная терапия хронического эндометрита (клиническая лекция). Акушерство, гинекология и репродукция. 2010; 3: 21–4.
[Sidorova I.S., Makarov I.O., Unanian A.L. Patogenez i patogeneticheski obosnovannaia terapiia khronicheskogo endometrita (klinicheskaia lektsiia). Akusherstvo, ginekologiia i reproduktsiia. 2010; 3: 21–4 (in Russian).]
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1. Eckert LO, Hawes SE, Wölner-Hanssen PK et al. Endometritis: the clinical-pathologic syndrome. Am J Obstet Gynecol 2002; 186: 690.
2. Shurshalina A.V. Khronicheskii endometrit kak prichina narushenii reproduktivnoi funktsii. Ginekologiia: zhurn. dlia praktikuiushchikh vrachei. 2012; 14 (4): 16–8. DOI: 10.1371/journal.pone.0214516 (in Russian).
3. Johnston-MacAnanny EB, Hartnett J, Engmann LL et al. Chronic endometritis is a frequent finding in women with recurrent implantation failure after in vitro fertilization. Fertil Steril 2010; 93: 437.
4. Kreisel K, Torrone E, Bernstein K et al. Prevalence of Pelvic Inflammatory Disease in Sexually Experienced Women of Reproductive Age – United States, 2013–2014. MMWR Morb Mortal Wkly Rep 2017; 66: 80.
5. Reekie J, Donovan B, Guy R et al. Risk of Pelvic Inflammatory Disease in Relation to Chlamydia and Gonorrhea Testing, Repeat Testing, and Positivity: A Population-Based Cohort Study. Clin Infect Dis 2018; 66: 437.
6. Westrom L, Mardh PA. Epidemiology, etiology, and prognosis of acute salpingitis: A study of 1,457 laparoscopically verified cases. In: Nongonococcal Urethritis and Related Diseases, Hobson D, Holmes KK (Eds), Am Soc Microbiol, Washington DC 1977; p. 84.
7. Sonnenberg P, Clifton S, Beddows S et al. Prevalence, risk factors, and uptake of interventions for sexually transmitted infections in Britain: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet 2013; 382: 1795.
8. Grimes DA. Intrauterine device and upper-genital-tract infection. Lancet 2000; 356: 1013.
9. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2017. Atlanta, GA: US Department of Health and Human Services; 2018.
10. Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep 2015; 64: 1.
11. French CE, Hughes G, Nicholson A et al. Estimation of the rate of pelvic inflammatory disease diagnoses: trends in England, 2000–2008. Sex Transm Dis 2011; 38: 158.
12. Srinivasan S, Hoffman NG, Morgan MT et al. Bacterial communities in women with bacterial vaginosis: high resolution phylogenetic analyses reveal relationships of microbiota to clinical criteria. PLoS One 2012; 7: e37818.
13. Morré SA, Karimi O, Ouburg S. Chlamydia trachomatis: identification of susceptibility markers for ocular and sexually transmitted infection by immunogenetics. FEMS Immunol Med Microbiol 2009; 55: 140.
14. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2015. Atlanta, GA: US Department of Health and Human Services; October 2016.
15. Altunyurt S, Demir N, Posaci C. A randomized controlled trial of coil removal prior to treatment of pelvic inflammatory disease. Eur J Obstet Gynecol Reprod Biol 2003; 107: 81.
16. Cicinelli E, De Ziegler D, Nicoletti R et al. Chronic endometritis: correlation among hysteroscopic, histologic, and bacteriologic findings in a prospective trial with 2190 consecutive office hysteroscopies. Fertil Steril 2008; 89: 677.
17. Pitsos M, Skurnick J, Heller D. Association of pathologic diagnoses with clinical findings in chronic endometritis. J Reprod Med 2009; 54: 373.
18. Yudin MH, Hillier SL, Wiesenfeld HC et al. Vaginal polymorphonuclear leukocytes and bacterial vaginosis as markers for histologic endometritis among women without symptoms of pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188: 318.
19. Kammerer U, Michael von Wolffb, Udo R. Markert Immunology of human endometrium Immunobiology 2004; 209: 569–74.
20. Dobrokhotova Iu.E., Gankovskaia L.N., Borovkova E.I. et al. Modulirovanie lokal'noi ekspressii faktorov vrozhdennogo immuniteta u patsientok s khronicheskim endometritom i besplodiem. Akusherstvo i ginekologiia. 2019; 5: 125–32 (in Russian).
21. Haggerty CL, Ness RB, Amortegui A et al. Endometritis does not predict reproductive morbidity after pelvic inflammatory disease. Am J Obstet Gynecol 2003; 188: 141.
22. Propst AM, Liberman RF, Harlow BL, Ginsburg ES. Complications of hysteroscopic surgery: predicting patients at risk. Obstet Gynecol 2000; 96: 517.
23. Nair N, Camacho-Vanegas O, Rykunov D et al. Genomic Analysis of Uterine Lavage Fluid Detects Early Endometrial Cancers and Reveals a Prevalent Landscape of Driver Mutations in Women without Histopathologic Evidence of Cancer: A Prospective Cross-Sectional Study. PLoS Med 2016; 13: e1002206.
24. Maynard SE, Venkatesha S, Thadhani R. Soluble Fms-like Tyrosine Kinase 1 and Endothelial Dysfunction in the Pathogenesis of Preeclampsia. Pediatr Res 2005; 57 (5 Pt 2): 1–7R.
25. Wagaarachchi PT, Sirisena J. Efficiency of Pipelle device in sampling endometrium. Acta Obstet Gynecol Scand 2000; 79: 793.
26. Polena V, Mergui JL, Zerat L, Sananes S. The role of Pipelle Mark II sampling in endometrial disease diagnosis. Eur J Obstet Gynecol Reprod Biol 2007; 134: 233.
27. Williams AR, Brechin S, Porter AJ et al. Factors affecting adequacy of Pipelle and Tao Brush endometrial sampling. BJOG 2008;
115: 1028.
28. Hirai Y, Sakamoto K, Fujiwara H et al. Liquid-based endometrial cytology using SurePath™ is not inferior to suction endometrial tissue biopsy for detecting endometrial malignancies: Midterm report of a multicentre study advocated by Japan Association of Obstetricians and Gynecologists. Cytopathology 2019; 30: 223.
29. McQueen DB, Bernardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril 2014; 101: 1026.
30. ACOG Practice Bulletin No. 195: Prevention of Infection After Gynecologic Procedures. Obstet Gynecol 2018; 131: e172.
31. APGO educational series on women's health issues. Clinical management of abnormal uterine bleeding. Association of Professors of Gynecology and Obstetrics, 2006.
32. ACOG Committee on Practice Bulletins – Gynecology. ACOG practice bulletin No. 104: Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol 2009; 113: 1180. Reaffirmed 2016.
33. Cicinelli E, Resta L, Nicoletti R et al. Detection of chronic endometritis at fluid hysteroscopy. J Minim Invasive Gynecol 2005; 12: 514.
34. Cicinelli E, Resta L, Nicoletti R et al. Endometrial micropolyps at fluid hysteroscopy suggest the existence of chronic endometritis. Hum Reprod 2005; 20: 1386.
35. Grimes DA, Schulz KF. Antibiotic prophylaxis for intrauterine contraceptive device insertion. Cochrane Database Syst Rev 2001: CD001327.
36. Eckert LO, Thwin SS, Hillier SL et al. The antimicrobial treatment of subacute endometritis: a proof of concept study. Am J Obstet Gynecol 2004; 190: 305.
37. www.who.int/gtb/publications/globrep/index.html (Accessed 3/7/05)
38. Zarochentseva N.V., Arshakian A.K., Men'shikova N.S., Titchenko Iu.P. Khronicheskii endometrit: etiologiia, klinika, diagnostika, lechenie. Ros. vestn. akushera-ginekologa. 2013; 5: 21–7 (in Russian).
39. Sukhikh G.T., Shurshalina A.V. Chronic endometritis. Moscow:
GEOTAR-Media, 2010 (in Russian).
40. Sidorova I.S., Makarov I.O., Unanian A.L. Patogenez i patogeneticheski obosnovannaia terapiia khronicheskogo endometrita (klinicheskaia lektsiia). Akusherstvo, ginekologiia i reproduktsiia. 2010; 3: 21–4 (in Russian).
1. ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия;
2. ГБУЗ «Городская клиническая больница №40» Департамента здравоохранения г. Москвы, Москва, Россия;
3. ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*katyanikitina@mail.ru
________________________________________________
Iuliia E. Dobrokhotova1, Ekaterina I. Borovkova*1, Viktoriia S. Skal'naia2, Ivan M. Borovkov3
1. Pirogov Russian National Research Medical University, Moscow, Russia;
2. City Clinical Hospital №40, Moscow, Russia;
3. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*katyanikitina@mail.ru