Endometrial polyps: new strategies for effective treatment

Т. Ф Татарчук, Д. Г. Герман

Abstract


The work is devoted to the issue of effectiveness improvement in treatment of endometrial polyps (EP) in women of reproductive age.

Study objective: to evaluate the clinical efficacy of the Allokin-alpha in combination with dydrogesterone for the treatment of EP in women of reproductive age.

Study design: the study involved 70 patients aged 18–35 years: 34 patients with EP (group I), 30 patients with EP and chronic endometritis (CE) (group II) and 30 patients of the control group (group III). Subgroup Ia (n = 15) received dydrogesterone for the treatment, Ib (n = 19) – dydrogesterone and Allokin-alpha, IIa (n = 17) – dydrogesterone and antibiotic, IIb (n = 19) – dydrogesterone, antibiotic and Allokin-alpha.

Study methods: group I and II were diagnosed by hysteroscopy with histological confirmation, endometrial samples from healthy women were obtained by aspiration biopsy. Bacteriological examination of the endometrium was performed by PCR and by cultivating aerobic and anaerobic microorganisms on special growth media. The endometrial sections were immunostained with monoclonal antibodies against the specific markers of plasmacytes (CD138), NK cells (CD56, CD16), cellular marker for proliferation (Ki-67).

Study results: Endometrial samples of women with EP (isolated or in conjunction with CE) were characterized by significantly higher detection of Candida spp. – 21% (p = 0,012), and Herpes viruses type 1, 2, and 6 – 17% (p = 0,016). Compared with the normal endometrium, isolated EP contained a lower density of CD56 and CD16, EP in conjunction with CE had a higher density of CD138 along with a lower density of CD16.

Dydrogesterone therapy in combination with Allokin-alpha was effective in correcting local immune disorders in the endometrium, normalizing proliferative processes and eliminating infectious agents in the uterine cavity.


Keywords


endometrial polyp; chronic endometritis; infertility; Herpes virus; CD56; CD16; Ki-67; Allokin-alpha

References


Abakushina, E.V., Kuzmina, E.G., Kovalenko, E.I. “Basic properties and functions of human NK cells.” Immunology 4 (2012): 220–4.

Herman, D.G. “Polyps of the endometrium in the reproductive age: strokes to the clinical portrait.” Reproductive endocrinology 3 (2016): 39–43.

Ershov, F.I., Romantsev, M.G. Drugs used in viral diseases: A guide for doctors. Moscow. GEOTAR-Media (2007): 363 p.

Kisilev, V.I., Solodkiy, V.A., Ashrafyan, L.A. “Epigenetic regulation of mammary carcinogenesis and the possibility of its pharmacological correction.” StatusPraesens 4 (2014): 35–43.

Kondrikov, N.I. Pathology of the uterus. Moscow. Practical medicine (2008): 334 p.

Mikhailova, V.A., Selkov, S.A., Sokolov, D.I. “Phenotypic and functional characteristics of NK cells in pregnancy.” Obstetrics and Gynecology 5 (2011): 36–43.

Mikhnina, E.A., Komarov, E.K., Davydova, N.I., et al. “Features of local and systemic immunity and the morphofunctional state of the endometrium in women with anovulatory syndrome.” Medical Immunology 10.4 (2008): 353–60.

Ershov, F.I., Isakov, V.A., Becker, G.P., et al. Application of Allokin-alpha in the treatment of viral infections. Manual for doctors. Moscow – St. Petersburg (2008): 115 p.

Unanyan, A.L., Sidorova, I.S., Kossovich, Y.M., et al. “The role of a combination of HPV infection and chronic endometritis in the pathogenesis of malignant endometrial tumors.” StatusPraesens 3 (2012): 23–6.

Selkov, S.A., Sokolov, D.I. “Immunological mechanisms of placenta development control.” Journal of Obstetrics and Women’s Diseases 1 (2010): P. 6–10.

American Association of Gynecologic Laparoscopists. “AAGL Practice report: practice guidelines for diagnosis and management of endometrial polyps.” Journal of Minimally Invasive Gynecology 19.1 (2012): 3–10.

Harada, T. Endometriosis: Pathogenesis and Treatment. Japan. Springer (2014): 475 p.

Xuebing, P., Tin Chiu, L., Jing, L., et al. “Is endometrial polyp formation associated with increased expression of vascular endothelial growth factor and transforming growth factor-beta1?” European Journal of Obstetrics & Gynecology and Reproductive Biology 159 (2011): 198–203.

Kitaya, K., Yamaguchi, T., Honjo, H. “Central role of Interleukin-15 in postovulatory recruitment of peripheral blood CD16(-) Natural Killer cells into human endometrium.” The Journal of Clinical Endocrinology & Metabolism 90.5 (2005): 2932–40.

Kitaya, K., Nakayama, T., Okubo, T. “Expression of Macrofage Inflammatory Protein-1β in human endometrium: it’s role in endometrial recruitment of Natural Killer cells.” The Journal of Clinical Endocrinology & Metabolism 88.4 (2003): 1809–14.

Tatarchuk, T.F., Herman, D.G. “Endometrial polyps and micropolyps. Microbial landscape of the uterine cavity and its role in their formation.” Reproductive endocrinology 6 (2016): 14–21.

Tatarchuk T.F., Herman, D.G. “Progesteron: a little-known role of the well-known hero.” Reproductive endocrinology 4 (2016): 56–62.

Aplin, J.D., Fazleabas, A.T., Glasser, S.R., Giudice, L.C. The Endometrium. Molecular, Cellular, and Clinical Perspectives. UK. Informa (2008): 922 p.

Workowski, K.A., Bolan, G.A. “Centers for disease control and preventoin. Sexually transmited disease treatment guidelines.” MMWR Recomm Rep (2015).


GOST Style Citations


1. Абакушина, Е.В. Основные свойства и функции NK-клеток человека / Е.В. Абакушина, Е.Г. Кузьмина, Е.И. Коваленко // Иммунология. – 2012. – № 4. – С. 220–224.

2. Герман, Д.Г. Полипы эндометрия в репродуктивном возрасте: штрихи к клиническому портрету / Д.Г. Герман // Репродуктивная эндокринология. – 2016. – № 3. – С. 39–43.

3. Ершов, Ф.И. Лекарственные средства, применяемые при вирусных заболеваниях: Руководство для врачей / Ф.И. Ершов, М.Г. Романцев. – Москва: ГЭОТАР-Медиа, 2007. – 363 с.

4. Кисилев, В.И. Эпигенетическое регулирование маммарного канцерогенеза и возможности его фармакологической коррекции / В.И. Кисилев, В.А. Солодкий, Л.А. Ашрафян // StatusPraesens. – 2014. – № 4. – С. 35–43.

5. Кондриков, Н.И. Патология матки / Н. И. Кондриков. – М.: Практическая медицина, 2008. – 334 с.

6. Михайлова, В.А. Фенотипические и функциональные характеристики NK- клеток при беременности / В.А. Михайлова, С.А. Сельков, Д.И. Соколов // Акушерство и гинекология. – 2011. – № 5. – С. 36–43.

7. Михнина, Е.А. Особенности местного и системного иммунитета и морфофункциональное состояние эндометрия у женщин с ановуляторным синдромом / Е.А. Михнина, Е.К. Комаров, Н.И. Давыдова и др. // Медицинская иммунология. – 2008. – Т. 10, № 4. – С. 353–360.

8. Ершов, Ф.И. Применение Аллокина-альфа в терапии вирусных инфекций. Руководство для врачей / Ф.И. Ершов, В.А. Исаков, Г.П. Беккер и др. – Москва – Санкт-Петербург, 2008. – 115 с.

9. Унанян, А.Л. Роль сочетания ВПЧ-инфекции и хронического эндометрита в патогенезе злокачественных опухолей эндометрия / А.Л. Унанян, И.С. Сидорова, Ю.М. Коссович и др. // StatusPraesens. – 2012. – № 3. – С. 23–26.

10. Сельков, С.А. Иммунологические механизмы контроля развития плаценты / С.А. Сельков, Д.И. Соколов // Журнал акушерства и женских болезней. – 2010. – № 1. – С. 6–10.

11. American Association of Gynecologic Laparoscopists. “AAGL Practice report: practice guidelines for diagnosis and management of endometrial polyps.” Journal of Minimally Invasive Gynecology 19.1 (2012): 3–10.

12. Harada, T. Endometriosis: Pathogenesis and Treatment. Japan. Springer (2014): 475 p.

13. Xuebing, P., Tin Chiu, L., Jing, L., et al. “Is endometrial polyp formation associated with increased expression of vascular endothelial growth factor and transforming growth factor-beta1?” European Journal of Obstetrics & Gynecology and Reproductive Biology 159 (2011): 198–203.

14. Kitaya, K., Yamaguchi, T., Honjo, H. “Central role of Interleukin-15 in postovulatory recruitment of peripheral blood CD16(-) Natural Killer cells into human endometrium.” The Journal of Clinical Endocrinology & Metabolism 90.5 (2005): 2932–40.

15. Kitaya, K., Nakayama, T., Okubo, T. “Expression of Macrofage Inflammatory Protein-1β in human endometrium: it’s role in endometrial recruitment of Natural Killer cells.” The Journal of Clinical Endocrinology & Metabolism 88.4 (2003): 1809–14.

16. Tatarchuk, T.F., Herman, D.G. “Endometrial polyps and micropolyps. Microbial landscape of the uterine cavity and its role in their formation.” Reproductive endocrinology 6 (2016): 14–21.

17. Tatarchuk T.F., Herman, D.G. “Progesteron: a little-known role of the well-known hero.” Reproductive endocrinology 4 (2016): 56–62.

18. Aplin, J.D., Fazleabas, A.T., Glasser, S.R., Giudice, L.C. The Endometrium. Molecular, Cellular, and Clinical Perspectives. UK. Informa (2008): 922 p.

19. Workowski, K.A., Bolan, G.A. “Centers for disease control and preventoin. Sexually transmited disease treatment guidelines.” MMWR Recomm Rep (2015).





DOI: https://doi.org/10.18370/2309-4117.2017.36.14-22

Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

ISSN 2411-1295 (Online), ISSN 2309-4117 (Print)