Current ideas on the pathogenesis of chronic endometritis

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This review summarizes and analyzes the data available in the literature on the pathogenesis of chronic endometritis. The specific features of the pathogenesis of chronic endometritis have not been fully revealed due to their multifactoriness, diagnostic difficulties, and subtle symptoms. Local and systemic immune disorders leading to infertility, in vitro fertilization failures, recurrent pregnancy loss, and obstetric complications (more than 80% of reproductive-aged women with chronic endometritis are infertile and unable to carry a pregnancy to full term) play a considerable role in the maintenance of slowly progressive chronic inflammation in the presence of persistence of opportunistically pathogenic microorganisms. An imbalance between proliferation and apoptosis, subendometrial blood flow disorders, and endometrial sclerotic changes play an important role in the pathogenesis of chronic endometritis. The paper describes the role of cytokines (transforming growth factor-1β, vascular endothelial growth factor, leukemia inhibitory factor, proinflammatory tumor necrosis factor-α and interleukin (IL)-1β, immunoregulatory IL-6, and chemokines, including IL-8) in maintaining the inflammatory manifestations that reduce endometrial receptivity, in impairing microcirculation and regulation of angiogenesis, in enhancing exudation, in forming adhesions, and in depositing fibrin in the endometrial stroma. The expression of Toll-like receptors (TLRs) 2 and 4 is increased in chronic endometritis; the determination of markers for CD138 plasma cells is recommended as an additional method in the diagnosis of chronic endometritis. There is a theory of a self-sustaining autoimmune process induced by infection. A number of assumptions have been made about the role of protein immunomodulators (lactoferrin, alpha-2-macroglobulin) in the pathogenesis of chronic endometritis, as well as that of hormones of the hypothalamic-pituitary-adrenal axis. These findings suggest that there is no consensus of opinion regarding the etiology of chronic endometritis and its pathogenetic aspects, justifying the relevance of further investigations.

Keywords:

chronic endometritis

pathogenesis

infertility

cytokines

angiogenesis

protein immunomodulators

corticosteroids

Authors:

Likhacheva V.V.

Department of Obstetrics and Gynecology Novokuznetsk State Institute for Postgraduate Training of Physicians, Branch, Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia, Novokuznetsk, Russia

Zorina V.N.

NIL immunokhimii Novokuznetskogo gosudarstvennogo instituta usovershenstvovaniia vracheĭ

Tretyakova Ya.N.

«Mother and Child» Perinatal Medical Center, Moscow, Russia

Bazhenova L.G.

Kafedra akusherstva i ginekologii

Tret'iakova T.V.

OOO "Meditsinskiĭ Tsentr" , Novokuznetsk

Renge L.V.

Department of Obstetrics and Gynecology

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