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Патофизиологические аспекты болевого синдрома при эндометриозе
Сахаутдинова И.В., Хамадьянова А.У., Гимазетдинова Л.Р., Баширова Э.Р., Фаткуллин Б.С., Хамидуллина Р.Р. Патофизиологические аспекты болевого синдрома при эндометриозе. Гинекология. 2022;24(1):18–23. DOI: 10.26442/20795696.2022.1.201361
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Sahautdinova IV, Hamadyanova AU, Gimazetdinova LR, Bashirova ER, Fatkullin BS, Hamidullina RR. Pathophysiological aspects of pain syndrome in endometriosis: A review. Gynecology. 2022;24(1):18–23.
DOI: 10.26442/20795696.2022.1.201361
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Аннотация
Эндометриоз – хроническое заболевание, которое сопровождается хронической тазовой болью и бесплодием. Данная патология поражает 1 из 10 женщин во всем мире. Хроническая тазовая боль – основная жалоба пациенток с эндометриозом, которая доставляет наибольший дискомфорт и оказывает сильное влияние на качество жизни. На сегодняшний день основным общепринятым критерием тяжести болевого синдрома является объем пораженной ткани, но наиболее часто он не соответствует реальным болевым ощущениям пациенток. В данном обзоре литературы мы выделили и сопоставили основные патофизиологические механизмы развития болевого синдрома при эндометриозе, которые помогают ответить на некоторые актуальные вопросы. Мы определили 6 механизмов, которые последовательно активируют и усиливают действие друг друга, приводя к формированию стойкого болевого синдрома. В описанных нами патофизиологических механизмах по-прежнему имеются пробелы, что требует проведения дополнительных клинических исследований. Лучшее понимание патофизиологии боли при эндометриозе поможет улучшить диагностические возможности, а также лечение, которое будет направлено на каждое звено патологического процесса.
Ключевые слова: эндометриоз, болевой синдром, хроническая тазовая боль, патофизиология, механизмы
Ключевые слова: эндометриоз, болевой синдром, хроническая тазовая боль, патофизиология, механизмы
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Endometriosis is a chronic and debilitating disease with chronic pelvic pain and infertility. This pathology affects 1 in 10 women worldwide. Chronic pelvic pain is the main complaint of patients with endometriosis, which causes the most discomfort and has a strong impact on the quality of life. Today, the main generally accepted criterion for the severity of pain is the volume of the affected tissue, but most often it does not correspond to the real pain sensations of the patients. In this review of the literature, we have identified and compared the main pathophysiological mechanisms of the development of pain in endometriosis, which help to answer some urgent questions.
We have identified 6 mechanisms that sequentially activate and reinforce each other's action, leading to the formation of persistent pain syndrome. There are still gaps in the pathophysiological mechanisms described by us, which requires additional clinical studies. A better understanding of the pathophysiology of pain in endometriosis will help improve diagnostic capabilities, as well as treatment that will be directed at each link in the pathological process.
Keywords: endometriosis, pain syndrome, chronic pelvic pain, pathophysiology, mechanisms
Полный текст
Список литературы
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2. Герасимов А.М., Малышкина А.И., Кулигина М.В., и др. Частота встречаемости и структура наружного генитального эндометриоза у госпитализированных больных. Гинекология. 2021;23(2):184-9 [Gerasimov AM, Malyshkina AI, Kuligina MV, et al. Incidence rate and structure of external genital endometriosis in hospital patients. Gynecology. 2021;23(2):184-9 (in Russian)]. DOI:10.26442/20795696.2021.2.200783
3. Ballard KD, Seaman HE, de Vries CS, Wright JT. Can symptomatology help in the diagnosis of endometriosis? Findings from a national case-control study. Part 1. BJOG. 2008;115(11):1382-91. DOI:10.1111/j.1471-0528.2008.01878.x
4. Carranco RC, Zomer MT, Berg CF, et al. Peritoneal retraction pocket defects and their important relationship with pelvic pain and endometriosis. J Minim Invasive Gynecol. 2021;28(2):168-9. DOI:10.1016/j.jmig.2020.05.020
5. Abbott J, Hawe J, Hunter D, et al. Laparoscopic excision of endometriosis: a randomized, placebo-controlled trial. Fertil Steril. 2004;82(4):878-84. DOI:10.1016/j.fertnstert.2004.03.046
6. Shakiba K, Bena JF, McGill KM, et al. Surgical treatment of endometriosis: a 7-year follow-up on the requirement for further surgery. Obstet Gynecol. 2008;111(6):1285-92. DOI:10.1097/AOG.0b013e3181758ec6
7. Surrey ES, Soliman AM, Johnson SJ, et al. Risk of Developing Comorbidities Among Women with Endometriosis: A Retrospective Matched Cohort Study. J Womens Health (Larchmt). 2018;27(9):1114-23. DOI:10.1089/jwh.2017.6432
8. Радзинский В.Е., Оразов М.Р., Михалева Л.М., Бекулова М.А. Грани проблемы инфильтративного эндометриоза: от патогенеза к эффективной терапии. Гинекология. 2021. 23(2):117-24 [Radzinskii VE, Orazov MR, Mihaleva LM, Bekulova MA. Facets of the problem of infiltrative endometriosis: from pathogenesis to effective therapy. Gynecology. 2021.23(2):117-24 (in Russian)]. DOI:10.26442/20795696.2021.2.200741
9. Sampson JA. Metastatic or Embolic Endometriosis, due to the Menstrual Dissemination of Endometrial Tissue into the Venous Circulation. Am J Pathol. 1927;3(2):93-110.
10. Halme J, Hammond MG, Hulka JF, et al. Retrograde menstruation in healthy women and in patients with endometriosis. Obstet Gynecol. 1984;64(2):151-4.
11. Короткова Т.Д., Адамян Л.В., Степанян А.А., и др. Клеточные и молекулярные факторы врожденного иммунитета в патогенезе наружного генитального эндометриоза у женщин (обзор литературы). Проблемы репродукции. 2018;24(6):22-31 [Korоtkova TD, Adamyan LV, Stepanian AA, et al. Cellular and molecular factors of innate immunity in the pathogenesis of external genital endometriosis in women (a review). Problemy Reproduktsii. 2018;24(6):22-31 (in Russian)]. DOI:10.17116/repro20182406122
12. O DF, Roskams T, Van den Eynde K, et al. The presence of endometrial cells in peritoneal fluid of women with and without endometriosis. Reprod Sci. 2017;24(2):242-51. DOI:10.1177/1933719116653677
13. Tal A, Tal R, Pluchino N, Taylor HS. Endometrial cells contribute to preexisting endometriosis lesions in a mouse model of retrograde menstruation. Biol Reprod. 2019;100(6):1453-60. DOI:10.1093/biolre/ioz039
14. Dai Y, Li X, Shi J, Leng J. A review of the risk factors, genetics and treatment of endometriosis in Chinese women: a comparative update. Reprod Health. 2018;15(1):82. DOI:10.1186/s12978-018-0506-7
15. Critchley HOD, Maybin JA, Armstrong GM, Williams ARW. Physiology of the endometrium and regulation of menstruation. Physiol Rev. 2020;100(3):1149-79. DOI:10.1152/physrev.00031.2019
16. Symons LK, Miller JE, Kay VR, et al. The Immunopathophysiology of Endometriosis. Trends Mol Med. 2018;24(9):748-62. DOI:10.1016/j.molmed.2018.07.004
17. Hickey M, Ballard K, Farquhar C. Endometriosis. BMJ. 2014;348:g1752. DOI:10.1136/bmj.g1752
18. Nisenblat V, Prentice L, Bossuyt PM, et al. Combination of the non-invasive tests for the diagnosis of endometriosis. Cochrane Database Syst Rev. 2016;7(7):CD012281. DOI:10.1002/14651858.CD012281
19. Chapron C, Marcellin L, Borghese B, Santulli P. Rethinking mechanisms, diagnosis and management of endometriosis. Nat Rev Endocrinol. 2019;15(11):666-82.
DOI:10.1038/s41574-019-0245-z
20. Балан В.Е., Орлова С.А., Титченко Ю.П., Федоров А.А. Неинвазивные маркеры эндометриоза и динамика их уровня на фоне гормональной терапии. Проблемы репродукции. 2018;24(5):77-81
[Belan VE, Orlova SA, Titchenko YuP, Fedorov AA. Noninvasive markers of endometriosis and their dynamics during hormone therapy. Problemy Reproduktsii. 2018;24(5):77-81 (in Russian)]. DOI:10.17116/repro20182405177
21. Адамян Л.В., Андреева Е.Н., Абсатарова Ю.С. и др. Эндометриоз. Федеральные клинические рекомендации по ведению больных. М., 2020 [Adamyan LV, Andreeva EN, Absatarova YS, et al. Endometriosis. Federal clinical guidelines for the management of patients. Moscow, 2020 (in Russian)].
22. Guerriero S, Saba L, Pascual MA, et al. Transvaginal ultrasound vs magnetic resonance imaging for diagnosing deep infiltrating endometriosis: systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2018;51(5):586-95. DOI:10.1002/uog.18961
23. Dunselman GA, Vermeulen N, Becker C, et al. ESHRE guideline: management of women with endometriosis. Hum Reprod. 2014;29(3):400-12. DOI:10.1093/humrep/det457
24. Classification of endometriosis. The American Fertility Society. Fertil Steril. 1979;32(6):633-4.
25. Hsu AL, Sinaii N, Segars J, et al. Relating pelvic pain location to surgical findings of endometriosis. Obstet Gynecol. 2011;118(2 Pt 1):223-30. DOI:10.1097/AOG.0b013e318223fed0
26. Stegmann BJ, Sinaii N, Liu S, et al. Using location, color, size, and depth to characterize and identify endometriosis lesions in a cohort of 133 women. Fertil Steril. 2008;89(6):1632-6. DOI:10.1016/j.fertnstert.2007.05.042
27. Vercellini P, Fedele L, Aimi G, et al. Association between endometriosis stage, lesion type, patient characteristics and severity of pelvic pain symptoms: a multivariate analysis of over 1000 patients. Hum Reprod. 2007;22(1):266-71. DOI:10.1093/humrep/del339
28. Morotti M, Vincent K, Becker CM. Mechanisms of pain in endometriosis. Eur J Obstet Gynecol Reprod Biol. 2017; 209:8-13. DOI:10.1016/j.ejogrb.2016.07.497
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Авторы
И.В. Сахаутдинова, А.У. Хамадьянова*, Л.Р. Гимазетдинова, Э.Р. Баширова, Б.С. Фаткуллин, Р.Р. Хамидуллина
ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России, Уфа, Россия
*sagidullin12@bk.ru
ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России, Уфа, Россия
*sagidullin12@bk.ru
________________________________________________
Indira V. Sahautdinova, Aida U. Hamadyanova*, Liliana R. Gimazetdinova, Elvina R. Bashirova, Batyrhan S. Fatkullin, Radmila R. Hamidullina
Bashkir State Medical University, Ufa, Russia
*sagidullin12@bk.ru
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