Features of systemic immunity in hyperplastic processes of the uterus of infectious origin in women of different ages

Abstract

DOI: 10.52705/2788-6190-2026-03-16
УДК 618.4-007.61-02.7-092-039:612.017.1

Objective. To evaluate the features of systemic immunity in hyperplastic processes of the uterus of infectious origin in women of different ages.
Materials and methods. To achieve this goal, 397 women of different ages were examined. Inclusion criteria: presence of combined uterine hyperplastic processes - two or more diseases (endometrial hyperplasia, uterine fibroids, and adenomyosis), morphologically verified, fertile age (18-45 years), absence of history of immunosuppressive therapy (6 months prior to admission).
Based on the clinical course, genital status data, and pathomorphological conclusion, the following groups were formed: group I consisted of 113 women with an endometrial hyperplastic process and uterine fibroids; group II – 112 women with an endometrial hyperplastic process and adenomyosis; group III - 101 patients with a combination of three diseases - adenomyosis, uterine fibroids, and endometrial hyperplasia. The basis for inclusion in the comparison group was the presence of exclusively endometrial hyperplasia (without combination with uterine fibroids and adenomyosis, group IV) (retrospective study data, n=71). The control group V consisted of 90 gynecologically healthy women. Clinical, laboratory, and statistical methods were included in the complex of studies performed.
Results. To provide a more complete understanding of the ratio of immune parameters in the examined patients, a conventionally named coefficient of immune adaptation was used, which reflects the predominance of humoral factors over the cellular link of immunity. This is most pronounced in patients with uterine fibroids and endometrial hyperplasia compared to the cohort with combined uterine hyperplastic diseases – 1,37 ± 0,05 and 1.22 ± 0,03 (with a ± 95 value for healthy women of 0,46 – 0,65), respectively (p<0,01). For patients with uterine hyperplasia and adenomyosis, the coefficient of immune adaptation was 0,61 ± 0,06, not differing from healthy patients. The ratio of humoral and cellular defense factors, determined by this coefficient taking into account neutrophil phagocytosis activity, demonstrates significant immunodeficiency in patients with adenomyosis, uterine fibroids, and endometrial hyperplasia. Comparative characterization of the immunoreactivity spectrum depending on the variants of combinations of uterine hyperplastic processes and the presence of microbial agents revealed a number of tendencies. A reflection of the involvement of an infectious origin in the development of uterine hyperplastic diseases is a decrease in the coefficient of immune adaptation. When combining endometrial hyperplasia with uterine fibroids and adenomyosis, this indicator turned out to be lower compared to the indicator in the cohort with a negative polymerase chain reaction (PCR test) result (1,35± 0,03 and 1,88± 0,05, respectively), demonstrating the predominance of humoral defense factors over cellular ones (p = 0,0001).
Conclusion. The results of the studies indicate that the isolation of infectious agents in uterine hyperplastic processes is a marker of an immunodeficient state - the cause of persistence of intracellular pathogens. The change in cellular immunity in the combined variant of uterine hyperplastic processes is realized in a decrease in T-lymphocyte subpopulations (CD3+, CD4+, CD8+, CD16+) and the coefficient of immune adaptation. A distinctive feature of the systemic immunity of women with uterine hyperplasia is the balance of immunity links, and in combined uterine hyperplastic processes - the polarization of the immune response towards humoral parameters - an increase in immunoglobulins M, G, A, and circulating immune complexes. Low functional activity of CD3+ lymphocytes synthesizing endoplasmic cytokines, reduced engulfing capacity of neutrophils and monocytes, and the oxidase system of neutrophils reflect the change in the immune status of patients with genital hyperplastic processes associated with infectious pathogens. The obtained data must be taken into account when developing an algorithm for diagnostic and therapeutic-preventive measures.