Вклад хронического эндометрита в нарушения репродуктивной системы у пациенток с повторными неудачами имплантации
Вклад хронического эндометрита в нарушения репродуктивной системы у пациенток с повторными неудачами имплантации
Радзинский В.Е., Оразов М.Р., Токтар Л.Р. и др. Вклад хронического эндометрита в нарушения репродуктивной системы у пациенток с повторными неудачами имплантации. Гинекология. 2021; 23 (1): 102–106. DOI: 10.26442/20795696.2021.1.200671
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Radzinsky V.E., Orazov M.R., Toktar L.R., et al. The contribution of chronic endometritis to reproductive system disorders in patients with repeated implantation failures. Gynecology. 2021; 23 (1): 102–106. DOI: 10.26442/20795696.2021.1.200671
Вклад хронического эндометрита в нарушения репродуктивной системы у пациенток с повторными неудачами имплантации
Радзинский В.Е., Оразов М.Р., Токтар Л.Р. и др. Вклад хронического эндометрита в нарушения репродуктивной системы у пациенток с повторными неудачами имплантации. Гинекология. 2021; 23 (1): 102–106. DOI: 10.26442/20795696.2021.1.200671
________________________________________________
Radzinsky V.E., Orazov M.R., Toktar L.R., et al. The contribution of chronic endometritis to reproductive system disorders in patients with repeated implantation failures. Gynecology. 2021; 23 (1): 102–106. DOI: 10.26442/20795696.2021.1.200671
Хронический эндометрит (ХЭ) – это заболевание непрерывного и незаметного воспаления на фоне инфильтрации стромы эндометрия плазматическими клетками. Многочисленными исследованиями доказано, что ХЭ приводит к повторным неудачам имплантации. Этиологию ХЭ в основном связывают с микроорганизмами, ключевые звенья патогенеза до конца не установлены, хотя контраверсией выступают современные данные о том, что ХЭ вызывает локальные иммунные изменения, приводящие к нарушению децидуализации эндометрия. Учитывая недостаточную эффективность антибиотикотерапии ХЭ, особенно в случаях резистентности возбудителей либо вирусного ХЭ, необходимо разработать схемы с дополнительным применением препаратов, влияющих на другие этиопатогенетические пути развития и поддержания ХЭ. Одним из направлений, действующих на эти звенья патогенеза, является цитокиновая терапия. В настоящем обзоре авторы попытались сделать акценты на этиологии, эпидемиологии, патогенезе, клинических особенностях и лечении ХЭ с позиций нарушений репродуктивной функции женщин, а именно в ассоциации с повторными неудачами имплантации. Завершается обзор описанием клинического случая.
Chronic endometritis (CE) is a disease of continuous and invisible inflammation characterized by infiltration of plasma cells in the stromal region of the endometrium. Numerous studies have proven that CE leads to repeated implantation failures. While it is believed that the etiology of CE is mainly associated with microorganisms, the key links in pathogenesis are yet not fully understood, although there is a modern evidence that CE causes local immune disorders and impaired endometrial decidualization. Considering the insufficient effectiveness of antibiotic therapy for CE, especially in cases of resistant pathogens, or in the case of viral chronic endometritis, regimens with additional treatment that affect other etiopathogenetic pathways of CE development and maintenance are necessary. One of the methods that affects etiopathogenesis of CE is a cytokine therapy. In this review, the authors tried to consider CE with special emphasis on the etiology, epidemiology, clinical features, pathophysiology, and treatment of CE and reproductive disorders in women in association with repeated implantation failures. The review ends with a description of the clinical case.
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1. Kitaya K, Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am J Reprod Immunol 2011; 66: 410–5.
2. Kasius JC, Fatemi HM, Bourgain C, et al. The impact of chronic endometritis on reproductive outcome. Fertil Steril 2011; 96: 1451–6.
3. Moyer DL, Mishell DR Jr, Bell J. Reactions of human endometrium to the intrauterine device. I. Correlation of the endometrial histology with the bacterial environment of the uterus following short-term insertion of the IUD. Am J Obstet Gynecol 1970; 106: 799–809.
4. McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril 2015; 104: 927–31.
5. Beruchashvili M, Gogiashvili L, Datunashvili E, et al. Morphological peculiarities of endometrium in chronic endometritis associated with bacterial vaginosis. Georgian Med News 2010; 181: 59–63.
6. Cicinelli E, Trojano G, Mastromauro M, et al. Higher prevalence of chronic endometritis in women with endometriosis: A possible etiopathogenetic link. Fertil Steril 2017; 108: 289–95.
7. Carvalho FM, Aguiar FN, Tomioka R, et al. Functional endometrial polyps in infertile asymptomatic patients: A possible evolution of vascular changes secondary to endometritis. Eur J Obstet Gynecol Reprod Biol 2013; 170: 152–6.
8. Cicinelli E, Matteo M, Trojano G et al. Chronic endometritis in patients with unexplained infertility: Prevalence and effects of antibiotic treatment on spontaneous conception. Am J Reprod Immunol 2018; 79: e12782.
9. Bouet PE, El Hachem H, Monceau E, et al. Chronic endometritis in women with recurrent pregnancy loss and recurrent implantation failure: Prevalence and role of office hysteroscopy and immunohistochemistry in diagnosis. Fertil Steril 2016; 105: 106–10.
10. 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: 437–41.
11. Liu Y, Chen X, Huang J, et al. Comparison of the prevalence of chronic endometritis as determined by means of different diagnostic methods in women with and without reproductive failure. Fertil Steril 2018; 109: 832–9.
12. Kitaya K. Prevalence of chronic endometritis in recurrent miscarriages. Fertil Steril 2011; 95: 1156–8.
13. Cicinelli E, Matteo M, Tinelli R, et al. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci 2014; 21: 640–7.
14. 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: 677–84.
15. Chen C, Song X, Wei W, et al. The microbiota continuum along the female reproductive tract and its relation to uterine-related diseases. Nat Commun 2017; 8: 875.
16. Hansen LK, Becher N, Bastholm S et al. The cervical mucus plug inhibits, but does not block, the passage of ascending bacteria from the vagina during pregnancy. Acta Obstet Gynecol Scand 2014; 93: 102–8.
17. Zervomanolakis I, Ott HW, Hadziomerovic D, et al. Physiology of upward transport in the human female genital tract. Ann N Y Acad Sci 2007; 1101: 1–20.
18. Cicinelli E, Matteo M, Tinelli R, et al. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod 2015; 30: 323–30.
19. Haggerty CL, Hillier SL, Bass DC, Ness RB; PID Evaluation and Clinical Health Study Investigators. Bacterial vaginosis and anaerobic bacteria are associated with endometritis. Clin Infect Dis 2004; 39: 990–5.
20. Polisseni F, Bambirra EA, Camargos AF. Detection of chronic endometritis by diagnostic hysteroscopy in asymptomatic infertile patients. Gynecol Obstet Invest 2003; 55: 205–10.
21. Kitaya K, Matsubayashi H, Takaya Y, et al. Live birth rate following oral antibiotic treatment for chronic endometritis in infertile women with repeated implantation failure. Am J Reprod Immunol 2017; 78: e12719.
22. Cicinelli E, De Ziegler D, Nicoletti R, et al. Poor reliability of vaginal and endocervical cultures for evaluating microbiology of endometrial cavity in women with chronic endometritis. Gynecol Obstet Invest 2009; 68: 108–15.
23. Campos GB, Marques LM, Rezende IS, et al. Mycoplasma genitalium can modulate the local immune response in patients with endometriosis. Fertil Steril 2018; 109: 549–60.
24. Fang RL, Chen LX, Shu WS, et al. Barcoded sequencing reveals diverse intrauterine microbiomes in patients suffering with endometrial polyps.
Am J Transl Res 2016; 8: 1581–92.
25. Verstraelen H, Vilchez-Vargas R, Desimpel F, et al. Characterisation of the human uterine microbiome in non-pregnant women through deep sequencing of the V1–2 region of the 16S rRNA gene. PeerJ 2016; 4: e1602.
26. Mitchell CM, Haick A, Nkwopara E, et al. Colonization of the upper genital tract by vaginal bacterial species in nonpregnant women. Am J Obstet Gynecol 2015; 212: 611.e1–9.
27. Fang RL, Chen LX, Shu WS, et al. Barcoded sequencing reveals diverse intrauterine microbiomes in patients suffering with endometrial polyps.
Am J Transl Res 2016; 8: 1581–92.
28. Moreno I, Cicinelli E, Garcia-Grau I, et al. The diagnosis of chronic endometritis in infertile asymptomatic women: a comparative study of histology, microbial cultures, hysteroscopy, and molecular microbiology. Am J Obstet Gynecol 2018; 218: 602.e1–16.
29. Tortorella C, Piazzolla G, Matteo M, et al. Interleukin-6, interleukin-1β, and tumor necrosis factor a in menstrual effluents as biomarkers of chronic endometritis. Fertil Steril 2014; 101: 242–7.
30. Kitaya K, Yasuo T. Aberrant expression of selectin E, CXCL1, and CXCL13 in chronic endometritis. Mod Pathol 2010; 23: 1136–46.
31. Lee SK, Kim CJ, Kim DJ, Kang JH. Immune cells in the female reproductive tract. Immune Netw 2015; 15: 16–26.
32. King A. Uterine leukocytes and decidualization. Hum Reprod Update 2000; 6: 28–36.
33. Matteo M, Cicinelli E, Greco P, et al. Abnormal pattern of lymphocyte subpopulations in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol 2009; 61: 322–9.
34. Wu D, Kimura F, Zheng L, et al. Chronic endometritis modifies decidualization in human endometrial stromal cells. Reprod Biol Endocrinol 2017; 15: 16.
35. Di Pietro C, Cicinelli E, Guglielmino MR, et al. Altered transcriptional regulation of cytokines, growth factors, and apoptotic proteins in the endometrium of infertile women with chronic endometritis. Am J Reprod Immunol 2013; 69 (5): 509–17.
36. Pinto V, Matteo M, Tinelli R, et al. Altered uterine contractility in women with chronic endometritis. Fertil Steril 2015; 103: 1049–52.
37. Sexually Transmitted Diseases Treatment Guidelines: Pelvic Inflammatory Disease (PID). Centers for Disease Control and Prevention. June 4, 2015.
38. Iudina S.M. Tsitokinoterapiia v klinicheskoi praktike. Chelovek i ego zdorov'e. 2005; 1: 57–61 (in Russian)
39. Diadina K.S., Zemskov A.M., Berezhnova T.A., et al. Perspektivy immunoterapii gnoino-vospalitel'nykh zabolevanii. Vestnik novykh meditsinskikh tekhnologii. 2020; 14 (2): 81–9 (in Russian) DOI: 10.24411/2075-4094-2020-16625
40. Khromova S.S., Akhmedov Kh.B. Kompleksnaia terapiia u patsientov so smeshannymi khlamidiino-mikoplazmennymi infektsiiami. European Research. 2016; 3: 88–90 (in Russian)
41. Khaknazarova M.A. Effektivnost' primeneniia tsitokinov pri lechenii poslerodovogo endometrita u patsientok s infektsiei, peredaiushcheisia polovym putem. Vestnik Avitsenny. 2010; 4: 86–91 (in Russian)
1 ФГАОУ ВО «Российский университет дружбы народов», Москва, Россия;
2 ФГБНУ «Научно-исследовательский институт морфологии человека», Москва, Россия;
3 Клинический госпиталь «Лапино», Лапино, Россия
*radzinsky@mail.ru
________________________________________________
Victor E. Radzinsky*1, Mekan R. Orazov1, Liliia R. Toktar1, Liudmila M. Mikhaleva2, Elena S. Silant'eva3, Roman E. Orekhov1, Pavel A. Semenov1, Elena V. Lagutina1
1 People’s Friendship University of Russia, Moscow, Russia;
2 Research Institute of Human Morphology, Moscow, Russia;
3 Lapino Clinical Hospital, Lapino, Russia
*radzinsky@mail.ru