New directions in the diagnosis and treatment of endometritis
Kagramanova J.A., Malinovskaya V.V., Vyzhlova E.N., Lanshchakova P.E.
1 I.M. Sechenov First Moscow State Medical University of the Ministry of Health of Russia, Moscow.
2 N.F. Gamaleiy CRC of epidemiology and microbiology, Moscow.
Objective: to develop a comprehensive diagnosis and evaluation of the clinical efficacy of pathogenetic therapy of acute and chronic endometritis.
Methods: patients under went complex clinical and instrumental and immunological assessment of the interferon, immune status and cytokines in the serum and in the aspirate of the endometrium before and after complex therapy.
Results: in acute endometritis in the endometrium aspirate marked by high levels of proinflammatory cytokines with a predominance of IL1β and IL6, indicating the severity and predicts the outcome of the disease. The levels of proinflammatory cytokines in the aspirate from the uterine cavity increased 5-8 times compared with the serum (in 3–5 times), which confirms the more pronounced local inflammatory response, and supports local immunocorrection. In chronic endometritis showed a reduction in reserve capacity of the immune cells in the induction of leukocytes in vitro.
Conclusions: Confirmed the need for correction of all parts of the immune system. To determine the spread of the inflammatory process and choice of tactics of local immunotherapy in acute endometritis on the background of spontaneous abortion or non-developing pregnancy, removal of fragments of chorionic or placental tissue effectively under the control of hysteroscopy, assessment of cytokine production (IL-1β, TNF-α, IL-6, IL-8, IL-1RA, IL-4, IL-10) in the endometrium and morphological diagnosis. Tactics immunorehabilitation using a preparation of recombinant interferon-α2b in patients with endometritis.