Особливості мікробіоценозу жіночих статевих органів та імунні фактори у пацієнток з аденоміозом

Abstract

Endometriosis is one of the most enigmatic gynecological diseases. An analysis of modern concepts of etiology and mechanisms of endometriosis development, published in PubMed, UpToDate, eLibrary databases over the past 10 years, indicates the theory of bacterial contamination as one of the factors of endometriosis. The purpose of the study. To study the state of microbiocinosis of women's genital organs and immune factors in patients with adenomiosis. Materials and methods. A survey of 65 women of reproductive age was conducted. Based on the clinical course of the disease, the data of genital status are formed by 2 groups: I group amounted to 35 (53.8%) patients with adenomiosis and degree of distribution. Group II (control) amounted to 30 (46.2%) gynecologically healthy women. In order to assess the content of microorganisms in the secrets of the genital organs of women, the material was taken from the cervical channel and the posterior vault of the vagina and subjected to a bacteriological study. In the detection of infections of the urogenital sphere, a polymerase chain reaction (PCR) and ELISA was used. Research results. By studying the microscopic characteristic of the vaginal biocenosis in women with adenomiosis prevailing the ІІ-ІІІ degree of purity of the vagina with the “intermediate” type of biocenosis (43.3%), which is characterized by a reduced content of lactobacillus, the presence of various types of morphotypes of grampositive and gram-negative rods and cocci and “dysbiosis” (50.0%) when mixed bacterial microflora prevails. Microbiological researches of vaginal allocation showed the presence of dysbiosis in all examined women, which was manifested by a significant decrease in the number of lactobacillus or their absence and increasing the content of conditionally pathogenic microbes. In 17 (48.6%) patients, Staphylococcus aureus was isolated at a concentration of 102 ‒ 103 cfu/ml, у 12 (34,3%) ‒ enterococcus: Enterococcus faecalis у 7 (20,0%) in an amount of 102 cfu/ml; Enterococcus faecium in 2 (5,7%) in an amount of 103 cfu/ml; Enterococcus sp in 3 (8,5%) in an amount of 103 cfu/ml; in 9 (25,7%) withdrawn Escherichia coli 103 cfu/ml, in 2 (5,7%) patients ‒ Klebsiella spp 102 cfu/ml, in 4 (11,4%) Proteus spp in the amount of 102 cfu/ml; in 16 (45,7%) ‒ Mobiluncus in the amount of 103 – 104 cfu/ml; in 5 (14,3%) Peptococcus sp. in the amount of 103 cfu/ml; in 13 (37,1%) patients were isolated Candida albicans, 104 ‒ 105 cfu/ml, in 15 (42,8%) ‒ Gardnerella vaginalis (CFUs were not determined, fixed the presence of "key cells" and a change in the pH of discharge). In 9 (25,7%) patients were isolated asporogenic anaerobic bacteria: Bacteroides spp ‒ 6 (17,1%). The PCR diagnosis of the material of the cervical channel revealed: Cytomegalovirus in 4 (11,4%) patients of І group , Virus herpes simplex in 5 (14,3%), Virus papilloma hominis ‒ 5 (14,3%). In women of the control group, the positive definition of Cytomegalovirus and Virus Herpes Simplex amounted to 3.3% of observations. The conducted studies have shown mixed infection in all patients of I group. The obtained data indicate that adenomiosis proceeds against the background of disturbed microbiocenosis of genitalia. Detected microbial associations are able to lead to changes in physico-chemical properties and pH of the secretions of the urogenital sphere, followed by possible penetration into the cavity of the uterus. In peripheral blood, patients with adenomiosis showed a reduced level LL-37 ‒ 21,4±1,3 pg/ml (in the control group LL37 ‒ 23,4±2,5 pg/ml respectively). With grade I adenomyosis, a typical inflammatory reaction occurs with a decrease in the level of antimicrobial peptides in the vaginal and cervical secretions, which indicates their possible role in the pathogenesis of the disease.