Pharmacological correction of immunometabolic disorders in patients with endometrioma along with chronic inflammatory diseases of the genital tract

Abstract

The objective: to determine the markers of the inflammatory process, development and implementation of methods for pharmacological correction of immunometabolic disorders in patients with endometrioma on the background of chronic inflammatory processes of the pelvic organs. Materials and methods. A complex clinical and laboratory examination of 90 patients with ovarian endometrioma on the background of chronic inflammation was carried out. Of these patients, the comparison group included 45 patients who received basic therapy (antibacterial drugs cefotaxime and metronidazole, vitamin therapy (B vitamins), combined oral contraceptives with dienogest). Patients in the main group (45 women) received basic anti-inflammatory and antibiotic therapy, together with drugs that improve microcirculation and have systemic and local anti-inflammatory and thrombolytic properties (tissue antihypoxant, deproteinized hemoderivative drug from calf blood and local two-component thrombolytic in suppositories) and dienogest and vitamin D3. The control group included 30 gynecologically healthy women.ELISA-method was used to determine tumor necrosis factor-α (TNF-α) level, interleukins (IL) 1β, 4, 10, interferon-γ in blood serum and cervical mucus, immunoglobulins A, M, G in blood serum, and C-reactive protein (CRP), neopterin and 25-hydroxyvitamin-D3. Results. We determined that in patients with endometrioma on the background of chronic pelvic inflammatory disease at the systemic and local levels there are an increased level of proinflammatory cytokines and decreased level of anti-inflammatory cytokines, as well as increased IFN-γ level, increased CRP – in 8.2 times, and neopterin – 2.7 times (p <0.05) relative to healthy women. The use of the proposed treatment program leads to normalize of IgG level and anti-inflammatory cytokine indices within a month. The level of CRP was significantly reduced in the main group, both in blood serum and cervical mucus. There was a decrease neopterin level in patients of the main group by 1.8 times after the treatment.Conclusions. Additional criteria for diagnosis of the inflammatory process in patients with endometrioma are a significant increase level of pro-inflammatory cytokines (TNF-α, IL-1β) and a decrease level of anti-inflammatory (IL-4, IL-10) cytokines, as well as a significant increase of C-reactive protein and neopterin.Studies suggest that the proposed therapy has a corrective effect on altered parameters of metabolic and immune status, which explains the importance of use in this group of patients the antibacterial therapy together with immunomodulatory, antiviral and metabolic drugs.