UDK: 618:616-089
M. Ben Salha, N.B. Repina, M.N. Dmitrieva, . . Nikiforov, I.A. Usachev
ФГБОУ ВО «Рязанский государственный медицинский университет имени академика И.П. Павлова» Министерства здравоохранения Российской Федерации
Purpose: to optimize the complex of diagnostic measures in the preoperative period in patients with undifferentiated connective tissue dysplasia on the basis of clinical-anamnestic and molecular genetic predictors to increase the effectiveness of adhesions prevention and its complications. Material and Methods: The study was conducted on the basis of the Regional Clinical Perinatal Center, in which 180 patients with a diagnosis of tuboperitoneal infertility were analyzed. Patients were divided into 2 groups on the basis of a modified point scale T.I. Kadurina. The study of gene phenotypic predictors was carried out by analyzing the severity of undifferentiated connective tissue dysplasia using the modified T.I. Kadurina scale; study of polymorphism of VEGF 634 [rs2010963] and IL6-174 [rs1800795] genes and assessment of adhesion severity according to the classification system of the American Fertility Society, genetic predisposition to adhesions development by the method of genotyping acetylation and pain intensity on a visual-analogue scale. Results: the clinical signs of undifferentiated connective tissue dysplasia are varicose veins of the lower extremities (p = 0,037), mitral valve prolapse (p = 0,044), myopia (p = 0,0007), and chronic pyelonephritis (p = 0,024) and external phenotypic – hyperpigmentation skin above the spinous processes of vertebrae (p ˂ 0,0001), the presence of keloid scars (p ˂ 0,0001) and thin, easily vulnerable skin (p ˂ 0,0001). Diagnosis of genetic predisposition to adhesions by the method of determining the phenotype of acetylation suggests the presence of adhesions in the small pelvis in 77,5 % (p = 0,033), and in the application of ultrasound diagnostics – in 66,66 % (p ˂ 0,0001) in the examined patients operations. The predictive value of ultrasound in the diagnosis of SP on the basis of signs: «Fuzzy contour» is 49,18 % (CI = 0,57–1,55; OR = 0,94; p = 0,158), the presence of liquid formations in the small pelvis is 59,01 % (CI = 1,24–3,45; OR = 2,07; p ˂ 0,0001), Distance – 72,13 % (CI = 3,83–11,73; OR = 6,70 ; p ˂ 0,0001) and fixation of the ovary in abnormal localization – 79,5 % (CI = 8.08–28.03; OR = 15,05; p ˂ 0,0001). The specificity of ultrasound in the diagnosis of adhesions in the pelvis on the basis of indirect criteria («fuzzy contour», «fixation», «distance» and the presence of fluid formations in the pelvis, not related to the egg ik) at 3–4 stages of adhesion process distribution – 97,05 % (100–94,11 %) and at stages 1–2 – 43,48 % (24–62,96 %). Signs of a high probability of the development of adhesions in the GHA are «locality» and the atypical location of the fallopian tube. In the study of chronic pelvic pain, depending on the stage of adhesions, it has been proven and reliably that the more advanced the adhesions, the more intense the nature of chronic pelvic pain (R = 0,695; р ˂ 0,05; criterion c2 = 67,25; the coefficient of mutual conjugacy of K. Pearson (0,518). Molecular genetic predictors of undifferentiated connective tissue dysplasia are the IL6-174 [rs1800795] C/C genotype (p = 0,039) and the C allele (p = 0,035) and the VEGFA 634 [rs2010963] C/G genotype (p = 0,038) and allele G (p = 0,047). The introduction of the developed algorithm for predicting the risk of developing pelvic peritoneal adhesions against the background of undifferentiated connective tissue dysplasia contributes to the preservation of reproductive function. Conclusion: on the basis of a complex of informative, high-precision and economical methods of instrumental and laboratory diagnostics – profiling phenotypic markers on a modified T.I. Kadurina scale, phenotyping of acetylation and molecular genetic research of gene polymorphism (VEGF 634 [rs2010963] and IL6-174 [rs1800795]) – we were able to determine the likelihood of the development of pelvic peritoneal adhesions against the background of undifferentiated connective tissue dysplasia.
pelvic peritoneal adhesions, undifferentiated connective tissue dysplasia, chronic pelvic pain, acetylation, vascular endothelial growth factor, interleukin 6.
Бен Салха Мехди – аспирант кафедры акушерства и гинекологии ФГБОУ ВО РязГМУ им. акад. И.П. Павлова Минздрава РФ, e-mail: mr.bensalha@hotmail.fr