INTRODUCTION

The physiological course of pregnancy is accompanied by an immunological restructuring of the woman’s body that promotes adequate invasion by endometrial trophoblasts. The initial immunological disorders encountered in adenomyosis desynchronize the mechanisms of formation of the «implantation window» and adequate processes of blastocyst invasion and can lead to a number of pregnancy complications.

OBJECTIVE

to evaluate the features of cytokine balance at the local level in relation to the course of pregnancy in patients with adenomyosis.

MATERIALS AND METHODS

A prospective cohort study was conducted evaluating the initial cytokine balance and its dynamics during pregnancy in 120 patients of reproductive age with adenomyosis. The scope of the study at the pre-pregnancy stage and the management of pregnancy included standard methods regulated in the relevant clinical protocols. Additional examination included determination of IL-2, IL-6, IL-10 concentrations in the cervical mucus (CS) in the 2nd phase of the cycle and at 5—6, 13—14 and 30—34 weeks of pregnancy, calculation of the proinflammatory index (PVI), as the ratio of IL-6/IL-10, cu, determination of the level of the antimicrobial peptide LL-37 (cathelicidin). In peripheral blood, the content of placental growth factor (PLGF) was evaluated in the corresponding lines. The analysis of the obtained results was carried out in the program Statistica version 10.0, (StatSoft, Inc., USA).

RESULTS

Patients with adenomyosis were stratified into two groups: group 1 — 48 patients whose pregnancy ended in spontaneous miscarriage or very early premature birth; group 2 — 72 patients with pregnancy ended in urgent or premature birth. The control group (group 3) consisted of 50 patients with a physiologically occurring pregnancy that ended with an urgent delivery. In patients with adenomyosis and early reproductive losses (group 1), the maximum degree of cytokine imbalance was observed in the presence of IL2 deficiency. The proinflammatory imbalance was closely correlated with the maximum values of cathelicidin (r=0.94) in the CA and the minimum values of the PLGF content (g= –0.86; p<0.05). Insufficient production of PLGF correlating with hyper-excessive PVI probably leads to disorders of neoangiogenesis during chorion formation in patients with adenomyosis. The presence of an increased concentration of cathelicidin in the cervical mucus of patients with adenomyosis and early reproductive losses indicates the likelihood of a concomitant inflammatory process that exacerbates local immune defects in adenomyosis, and requires verification of chronic endometritis by immunohistochemical and microbiological criteria

CONCLUSIONS

According to the data obtained by us, it can be concluded that the majority of patients with adenomyosis have problems with pregnancy, associated with the development of gestational complications and/or with its untimely termination. Evaluation of the initial cytokine balance and its dynamics during pregnancy in patients with adenomyosis may lead to new therapeutic approaches in preventing reproductive losses in these patients.